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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
What is the treatment for pseudotumor cerebri?
Weight loss and diuretics
26
What age does cranial arteritis occur?
50+
27
What are the labs that should be obtained if suspected cranial arteritis? (3)
ESR CRP Platelets
28
What are the associated s/sx of cranial arteritis? (3)
- Polymyalgia rheumatica - Jaw claudication - TTP over the temporal artery
29
What is the treatment for cranial arteritis?
Steroids treatment to prevent blindness
30
What is the cause of trigeminal neuralgia?
Crossing of a blood vessel over CN V frays the myelin sheath, and causes a "short circuit"
31
What systemic disease can cause bilateral trigeminal neuralgia?
MS
32
What are the drugs to treat trigeminal neuralgia? (2)
- Carbamazepine - Lamotrigine (antiepileptics)
33
What is the ultimate treatment for trigeminal neuralgia?
Gamma knife therapy or suboccipital craniotomy
34
What is CADASIL?
Cerebral AD arteriopathy with subcortical infarcts and leukoencephalopathy
35
What is the treatment for CADASIL? Prognosis?
ASA and usual HA treatment Progresses to subcortical dementia
36
What are the symptoms like with CADASIL?
Recurrent HAs with neurological deficits and numerous TIAs beginning at a young age
37
How do you diagnose CADASIL?
CSF will show lymphocytosis, and MRI will show subcortical infarcts at a young age
38
What is HaNDL?
HA with neurological deficit and CSF lymphocytosis
39
What is the diagnostic imaging choice for secondary HAs?
MRI wwo contrast unless acute hemorrhage--then CT
40
What is the most common type of primary HAs?
Tension HA
41
What are the characteristics of tension HAs?
Non-pulsatile, pressing, squeezing pain that is without n/v or photo/phonophobia
42
How common are n/v and photophobia with tension HAs?
Rare
43
What is the treatment for tension HAs?
OTC analgesics
44
True or false: tension HAs are usually non-disabling
True
45
What is the diagnosis criteria for daily persistent HA?
Abrupt onset of less than 3 days of HA that does not remit
46
What is the treatment for persistent daily HA?
OCT analgesics | Gabapentin
47
What are the four major diagnostic criteria for migraines? Two minor? How many are needed?
Major: - Unilateral - Throbbing - Worsened by movement - Moderate or severe Minor: - n/v - Photo/phonophobia 2 + 1 = migraine
48
Are migraines usually unilateral or bilateral?
Unilateral
49
Are migraines worsened by movement?
Usually
50
What percent of people have auras with migraines?
20%
51
What is the cause of the premonitory s/sx of migraine HAs?
Excess rush of dopamine
52
What is the postdrome s/sx of migraines?
Flu-like s/sx
53
What is the classic visual disturbance with migraines?
Scintillating scotoma
54
What is the cortical spreading depression theory of migraines?
-Wave of intense cortical neuron activity that is followed by neuronal suppression
55
What is the dysmodulated brain theory of migraines?
Activation of the dorsal pons leads to release of proinflammatory components, leading to meningeal blood vessel dilation, and subsequent CN V irritation
56
What are the 3 vasodilatory cytokines in migraines?
CGRP NO Substance P
57
What are the mast cell degranulation cytokines in migraines?
CGRP | Substance P
58
How long do migraines last?
4-72 hours
59
What is the most frequently reported trigger of migraines?
Stress
60
True or false: neck pain is uncommon with migraines
False--common
61
What usually causes primary intracranial hypotension HAs?
Nick in the dura from cervical problems (e.g. spondylosis etc), causes a slow loss of CSF
62
What are the MRI findings of primary intracranial hypotension?
Empty sella + meningeal enhancement + sagging into foramen magnum
63
What is the usual presentation of high pressure HAs?
- Transient visual loss (that becomes permanent) - Papilledema - Pulsatile tinnitus
64
True or false: patients with pseudotumor cerebri have normal imaging
True--have to have normal imaging
65
What is pseudobulbar palsy?
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
What are lacunar strokes?
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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