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Neurology 2 > Headaches > Flashcards

Headaches Flashcards

1
Q

What are the preventative Medications for HA?

A

Beta blocker

Anticonvulsant

Antidepressant

Calcium channel blocker

Serotonin Antagonists

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2
Q

Analgesics:
-2 medications

NSAIDS
-2 medications

Combination Analgesics:
-3 medications

A

Analgesics:
Analgesics:
-Tylenol - 1st choice for PG and breastfeeding

-Aspirin - anti-inflamm and platelet aggregation

NSAIDS: BBW Cardiovascular events

  • Ibuprofen (Motrin)
  • Naproxen (Napersyn)
Combo Analgesics:
Barbituates: 
-Fiorinal; butalbital/caffiene/ASA 
-Fioricet; butalbital/caffeine/Acetaminophen 
BBW: hepatotoxicity

*dont use this class more than 3x/mo, may be habit forming

Midrin: vasoconstriction, sedation, analgesic

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3
Q

Antiemetics

  • drug names
  • BBW
A 
Promethazine (Phenegran) 
-PO, IM, IV, Rectal
Prochlorperazine (Compazine) 
-PO, IM, IV, rectal
Preg C

BBW: resp depression in less than 2yo and tissue necrosis (Phenergan), Dementia related psychosis (Compazine)

Reglan: BBW Tardive dyskinesia
Preg B

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4
Q

Triptans

  • MOA
  • CI
  • SE
A

MOA: agonist effects on serotonin 5-HT1 receptors in cranial blood vessels and inhibition of proinflamm neuropeptide release

CI:

  • CAD
  • PVD
  • Stroke
  • Hemiplegic and basalar migraine

SE:

  • nausea
  • jaw, neck, or chest pressure or tightness
  • fatigue
  • burning sensation of the skin
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5
Q

Sumatriptan (Imitrex)

  • routes of admin
  • how often can it be repeated
  • when do you take?
A

routes: PO, SubQ, Nasal
- can be repeated 2hrs after initial dose
- take at onset of HA, NOT during aura or predrome.

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6
Q

What are the other triptans?

A
  • Naratriptan (Amerge)
  • Rizatriptan (Maxalt) (disinegrating)
  • Zolmitriptan (Zomig) (disinegrating)
  • Almotriptan (Axert)
  • Eletriptan (Relpax)
  • Frovatriptan (Frova)
  • half life = 26hrs, used for menstral migraines
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7
Q

Ergot Alkalods

  • pregnancy
  • BBW
  • 2 medications & SE
A

Pregnancy X

BBW: life threatening peripheral ischemia, effects worse with pt on CYP3A4, protease inhibitors, and macrolide abxs.

Meds:
1.Ergostat; rebound HA and addictive

2.DHE 45 (Dihydroergotamie/Migranal) dry mouth, HA, N/V/D, muscle stiffness, cold clammy skin

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8
Q

What are the narcotic analgesics? WHen are these used?

A
  • Demerol (meperidine)
  • Morphine
  • Oxymorphone
  • hydromorphone (Dilaudid)
  • Hydrocodone + acetaminophen (Norco)
  • Oxycodone + acetaminophen (Percocet)
  • Oxycodone
  • Hydrocodone
  • Fentanyl

-used as rescue medication for severe migraines in the ER when the patients rescue medication has failed them.

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9
Q

Combination Therapy for HA

A

Triptan + OTC Naprosyn with onset of HA

NSAID w/ antiemetic

Moderate narcotic w/ antiemetic

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10
Q

Preventative HA therapy

-medications

A
  • Beta blockers (propranolol/inderal)
  • anticonvulsants (Valproic acid/depakote) (topromax/topiramide)
  • ANtidepressant (TCA, SSRI)
  • Calcium channel blocker (Verapamil)
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11
Q

Beta Blockers

  • meds
  • SE
A

USED 1ST LINE PROPHYLACTIC THERAPY!!!
-Propranolol and Timolol

SE:
-fatigue, depression, impotence, hypotension

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12
Q

Calcium Channel Blockers

  • meds
  • SE
A

Meds: verapamil
*1st line cluster HA
SE:
-flushing, dizziness, constipation, peripheral edema

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13
Q

Anticonvulsants:

  • meds
  • SE
A 
Valproic Acid (Depakote) 
SE: weight gain*, tremor, nausea, hair loss

need baseline LFT an CBC before starting

Topiramate(Topamax)
-SE: concentration/memory impairment, fatigue, weight loss*, nausea

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14
Q

Antidepressants :

  • meds
  • SE
A

Meds:
TCA: elavil (amitryptiline)
SNRI: effexor
SSRI: prozac, zoloft, paxil

SE:
-sedation, dry mouth, constipation, weight gain*

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15
Q

WHen do you initiate prophylactic migraine medication?

How long may it take to see effects of preventative therapies?

A

when they have less than 14HA, even if they just have 4 per mo that last longer than 12hrs

May take 2-6months

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16
Q

What are the types of HA? Describe age at onset, and common subtypes.

A

Primary: usually begin 20-40yo, MC are migraine and tension-type HA

Secondary: caused by underlying dz. ex: SAH

17
Q

What are the 3 types of primary HA?

Types of secondary HA?

A
  • migraine
  • tension type HA
  • cluster
  • trauma (subdural, epidural)
  • subarachoid
  • meningitis
  • brain tumor
  • temporal arteritis
18
Q

Migraine:

  • MOA
  • common in which gender, age?
  • most common type
  • exacerbating factors
A

Cause: dilation of blood vessels innervated by the trigeminal nerve

  • women in 30-39yr
  • without aura

Exacerbating Factors:

  • emotional stress
  • hormones in women
  • not eating
  • weather
  • sleep disturbances
  • odors
  • alcohol
  • smoke
19
Q

Migraine

-what are 4 phases

A
  • prodrome; sx 24-48hrs before, euphoria, depression, irritability
  • aura: see bright lights, tinnitus, loss of vision, repetative jerking
  • migraine HA: unilateral, throbbing pulsatile, N/V, photophobia, phonophobia
  • migraine postdrome: feel drained or tired
20
Q

Migraine Subtypes;
-migraine w/ brainstem aura: age at onset, aura consists of?

  • hemiplegic migraine: manifestations
  • retinal migraine: describe
  • vestibular migraine: describe
  • mesntrual migraine: describe
A

Brainstem: age 7-20yo, aura consists of:

  • vertigo
  • dysarthria
  • tinnitus
  • diplopia
  • ataxia
  • decreased LOC

Hemiplegic: unilateral motor weakness

  • scintillating scotoma
  • visual field defect
  • fever
  • numbness
  • paresthesias

Retinal: repeated attack of monocular scotomata or blindness lasting less than one hour

Vestibular: episodic vertigo in patients with hx of migraines

Menstraul: occurs before and throughout mestruation

21
Q

Migraine

-dx

A

Dx:

  • no diagnostic test available, do neuroimaging only for
  • -pts with unexplained abnormal finding on neuro exam
  • -atypcial HA features or dont fit definition of migraine
  • -red flag signs
22
Q

Red flag Signs that could indicate something worse than migraine.

A
  • “worst or first HA”
  • significant changes in severity, frequency, or pattern
  • new or unexplained neuro sx
  • HA always on same side
  • new onset HA after 50yo
  • HA not responding to tx
  • new onset in HIV or CA
  • Stiff neck, fever, papilledema, cognitive impairment, personality change.
23
Q

Dx Criteria for Migraine w/o aura

A

At least 5 attacks fulfulling the following:

  1. )HA last 4-72hrs
  2. )HA has at least 2 of the following
    - unilateral location
    - pulsating quality
    - mod-severe pain intensity
    - avoidance of routne physical activity
  3. )During HA at least one of the following:
    - n/v
    - photophobia
    - phonophobia
24
Q

Migraine Tx

A
  • first line = NSAIDS Aspirin
  • second line = triptans
  • third line = triptans + NSAIDS
  • Opiods/barbituates MC used in ER.
25
Q

Tension Type HA

  • clinical features
  • subtypes
  • common in what age and gender?
A

Features:

  • bilateral non-throbbing HA without other associated features
  • dull
  • band like or vise like
  • tight cap, pressur e
  • pericranial muscle tenderness in head, neck, & shoulders

Subtypes:

  • infrequent less than 1day/mo
  • frequent 1-14 days/mo
  • chronic: 15 or more days/mo

Common in women, 4th decade

26
Q

Tension Type HA

  • precipitating factors
  • dx
  • tx
A

Precipitating factors:

  • stress or mental tension
  • fatigue
  • noise

Dx:
-no dx test based on clinical impression

Tx:

  • massage, hot bath
  • first line: ASA, Tylenol, Ibuprofen, Naproxen
  • 2nd line: 1st line tx with caffeine
  • 3rd line: Butalbital (Fioricet or Fiorinal)
  • parenteral: Ketorolac (toradol)
27
Q

Cluster HA

  • sx
  • common in what age and gender
A

Sx:
-recurrrent severe HA on one side of the head, typically around the eye

  • watering of eye
  • nasal congestion
  • swelling of the eye
  • rhinorrhea
  • lacrimation
  • Horners syndrome:
  • -ptosis of eyelid
  • -constriction of pupil
  • -anhidrosis (inability to sweat)

Common in middle-aged men

28
Q

Cluster HA

  • diagnostics
  • tx
  • prevention
A

Dx:

  • MRI w/ or w/o contrast
  • non contrast CT
  • clinical hx of HA signs an sx

Tx:
-1st line: Sub Q sumatriptan & 100% oxygen (12L Non-rebreather)

Prevention:
-verapamil

29
Q

Secondary HA: SAH

  • most common age?
  • clinical features
  • dx
  • tx
A

40-65yrs

Clinical features:

  • Severe thunderclap HA or worst HA of your life
  • N/V
  • Confusion

Dx:
Noncontrast CT
if CT negative do LP

Tx:

  • ABC’s
  • clip/coil aneurysm
  • nimodipine for vasospasm
  • Nicardipine
30
Q

Secondary cause of HA: Temporal Arteritis

  • what is this?
  • age at onset? gender?
  • most feared complication?
A
  • chronic vasculitis of large and medium size vessels
  • occurs 50-70yrs in women of scandinavian descent.
  • most feared complication is vision loss
31
Q 
Secondary Cause of HA: 
Temporal Arteritis: 
-clinical features 
-Dx 
-Tx
A

Features:

  • Fever, HA, jaw claudication
  • amaurosis fugax
  • polymyalgia rheumatic (morning stiffness of shoulders, hips, neck, & torso)
  • aortic dissection or aneurysm

Dx:

  • temporal artery bx = GOLD STANDARD
  • CBC, CMP, ESR, C-reactive protein

Tx:

  • prednisone
  • low dose aspirin
  • treat first then bx
32
Q

Secondary Cause of HA:
Intracranial Pressure

  • what is this?
  • causes
  • clinical features
  • dx
  • tx
A

What: increase rise in pressure of the CSF (greater than 70-180), ICP should be less than 15.

Cause:

  • subdural, epidural
  • ruptured aneurysm
  • CNS infection
  • ischemic stroke
  • neoplasm
  • hydrocephalus

Features:

  • HA; worse with cough/sneeze
  • N/V
  • ocular palsies
  • altered LOC
  • back pain
  • papilledema

Dx:

  • CT of head
  • MRI
  • LP
Tx: 
ICP monitoring
-Intraventricular (GOLD STANDARD) 
-intraparenchymal 
-subarachnoid 
-epidural

Neurology 2 (8 decks)

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