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Neurology > Headaches > Flashcards

Headaches Flashcards

1
Q

What is the mnemonic for concerning symptoms with HAs?

A
  • Systemic symptoms
  • Neurological signs
  • Onset sudden
  • Old (more than 50)
  • Prior h/o
  • Secondary illnesses
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2
Q

New onset HAs in patient over how old is concerning for more severe disease?

A

50 years

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3
Q

What should the neuro exam always include with HA complaints?

A

Fundoscopy

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4
Q

What are the characteristics of the pain with HAs 2/2 a space occupying lesion in the brain?

A

Steady, non-throbbing HA that occurs in the morning or awakens patients

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5
Q

What usually worsens HAs 2/2 a space occupying lesion in the head?

A

Valsalva-disruption of CSF flow

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6
Q

What is the natural h/o space occupying HAs?

A

Slowly increases in frequency and duration

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7
Q

What is the leading cause of subarachnoid hemorrhage?

A

Rupture of cerebral arterial aneurysm

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8
Q

True or false: Regardless of the CT outcome, CSF fluids is needed if suspected subarachnoid hemorrhage

A

True–5% false negative rate

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9
Q

True or false: Giant cell arteritis, meningitis, and acute sinusitis can all cause a thunderclap HA

A

True

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10
Q

Which gender is usually more affected with reversible vasoconstrictive syndrome?

A

Females

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11
Q

What is the mean age of onset for reversible vasoconstrictive syndrome?

A

45

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12
Q

What are the characteristics of the HAs with reversible vasoconstrictive syndrome? How frequent are they?

A

Thunderclap HA that peaks within one minute, and is very intense. Followed by n/v.

Usually have multiple over a 1-4 week period

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13
Q

True or false: multiple “thunderclap” HAs over a week period is usually pathognomonic for reversible vasoconstrictive syndrome

A

True

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14
Q

What are the complications from reversible vasoconstrictive syndrome?

A
  • Localized cortical SAH

- Ischemic/hemorrhagic stroke

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15
Q

What is the pathophysiology of reversible vasoconstrictive syndrome?

A

Transient disturbance of cerebral arterial vascular tone in segmental and multifocal fashion

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16
Q

What are the characteristics of the HA with meningitis?

A

Severe and global

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17
Q

What are the four major etiologies of low pressure HAs?

A
  • Post LP
  • CSF rhinorrhea
  • Inappropriate shunt
  • Primary intracranial hypotension
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18
Q

What is the characteristic features of low pressure HAs?

A

HA that is present when standing, but resolves upon lying down

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19
Q

What usually causes acute hydrocephalus?

A

Ventricular obstruction or shunt malfunction

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20
Q

What is pseudotumor cerebri?

A

Idiopathic intracranial HTN that often causes HAs

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21
Q

What is the sound that is heard with pseudotumor cerebri?

A

Pulsatile “swishing” tinnitus

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22
Q

What are the exam findings of pseudotumor cerebri (LP, fundoscopic)?

A
  • High opening pressure with an LP

- Papilledema

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23
Q

What is the major sequelae of high pressure HAs?

A

Permanent visual loss

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24
Q

How do you diagnose high pressure HAs?

A

Normal imaging with appropriate history

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25
Q

What is the treatment for pseudotumor cerebri?

A

Weight loss and diuretics

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26
Q

What age does cranial arteritis occur?

A

50+

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27
Q

What are the labs that should be obtained if suspected cranial arteritis? (3)

A

ESR
CRP
Platelets

28
Q

What are the associated s/sx of cranial arteritis? (3)

A
  • Polymyalgia rheumatica
  • Jaw claudication
  • TTP over the temporal artery
29
Q

What is the treatment for cranial arteritis?

A

Steroids treatment to prevent blindness

30
Q

What is the cause of trigeminal neuralgia?

A

Crossing of a blood vessel over CN V frays the myelin sheath, and causes a “short circuit”

31
Q

What systemic disease can cause bilateral trigeminal neuralgia?

A

MS

32
Q

What are the drugs to treat trigeminal neuralgia? (2)

A
  • Carbamazepine
  • Lamotrigine

(antiepileptics)

33
Q

What is the ultimate treatment for trigeminal neuralgia?

A

Gamma knife therapy or suboccipital craniotomy

34
Q

What is CADASIL?

A

Cerebral AD arteriopathy with subcortical infarcts and leukoencephalopathy

35
Q

What is the treatment for CADASIL? Prognosis?

A

ASA and usual HA treatment

Progresses to subcortical dementia

36
Q

What are the symptoms like with CADASIL?

A

Recurrent HAs with neurological deficits and numerous TIAs beginning at a young age

37
Q

How do you diagnose CADASIL?

A

CSF will show lymphocytosis, and MRI will show subcortical infarcts at a young age

38
Q

What is HaNDL?

A

HA with neurological deficit and CSF lymphocytosis

39
Q

What is the diagnostic imaging choice for secondary HAs?

A

MRI wwo contrast unless acute hemorrhage–then CT

40
Q

What is the most common type of primary HAs?

A

Tension HA

41
Q

What are the characteristics of tension HAs?

A

Non-pulsatile, pressing, squeezing pain that is without n/v or photo/phonophobia

42
Q

How common are n/v and photophobia with tension HAs?

A

Rare

43
Q

What is the treatment for tension HAs?

A

OTC analgesics

44
Q

True or false: tension HAs are usually non-disabling

A

True

45
Q

What is the diagnosis criteria for daily persistent HA?

A

Abrupt onset of less than 3 days of HA that does not remit

46
Q

What is the treatment for persistent daily HA?

A

OCT analgesics

Gabapentin

47
Q

What are the four major diagnostic criteria for migraines? Two minor? How many are needed?

A

Major:

  • Unilateral
  • Throbbing
  • Worsened by movement
  • Moderate or severe

Minor:

  • n/v
  • Photo/phonophobia

2 + 1 = migraine

48
Q

Are migraines usually unilateral or bilateral?

A

Unilateral

49
Q

Are migraines worsened by movement?

A

Usually

50
Q

What percent of people have auras with migraines?

A

20%

51
Q

What is the cause of the premonitory s/sx of migraine HAs?

A

Excess rush of dopamine

52
Q

What is the postdrome s/sx of migraines?

A

Flu-like s/sx

53
Q

What is the classic visual disturbance with migraines?

A

Scintillating scotoma

54
Q

What is the cortical spreading depression theory of migraines?

A

-Wave of intense cortical neuron activity that is followed by neuronal suppression

55
Q

What is the dysmodulated brain theory of migraines?

A

Activation of the dorsal pons leads to release of proinflammatory components, leading to meningeal blood vessel dilation, and subsequent CN V irritation

56
Q

What are the 3 vasodilatory cytokines in migraines?

A

CGRP
NO
Substance P

57
Q

What are the mast cell degranulation cytokines in migraines?

A

CGRP

Substance P

58
Q

How long do migraines last?

A

4-72 hours

59
Q

What is the most frequently reported trigger of migraines?

A

Stress

60
Q

True or false: neck pain is uncommon with migraines

A

False–common

61
Q

What usually causes primary intracranial hypotension HAs?

A

Nick in the dura from cervical problems (e.g. spondylosis etc), causes a slow loss of CSF

62
Q

What are the MRI findings of primary intracranial hypotension?

A

Empty sella + meningeal enhancement + sagging into foramen magnum

63
Q

What is the usual presentation of high pressure HAs?

A
  • Transient visual loss (that becomes permanent)
  • Papilledema
  • Pulsatile tinnitus
64
Q

True or false: patients with pseudotumor cerebri have normal imaging

A

True–have to have normal imaging

65
Q

What is pseudobulbar palsy?

A

a medical condition characterised by the inability to control facial movements, as a result of damage of motor fibers traveling from the cerebral cortex to the lower brain stem

66
Q

What are lacunar strokes?

A

a type of stroke that results from occlusion of one of the penetrating arteries that provides blood to the brain’s deep structures

Neurology (23 decks)

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