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PC 617 Neurological problems > Headaches > Flashcards

Headaches Flashcards

1
Q

Tension headaches

A 
Produce little disability
can last 30 minutes to several hours
bilateral
steady and non pulsatile
mild to moderate intensity
may prohibit but do not inhibit activity
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2
Q

tension headaches

A

non N/V should be present
photophobia or phonophobia but not both
No evidence that accounts for underlying HA

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3
Q

Common Migraine

A 
Migraine with no aura
last 4-72 hours
Must have two of the following:
unilateral head pain
throbbing
moderate to severe
pain aggravated by routine activity
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4
Q

common migraine

A 
Must also have 1 of these:
n/v
phtophobia or phonophobia
Aura's are in 15% of migrain attacks
Generally proceded ha by less than 1 hour
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5
Q

Phases of Migraines

A

Prodrome is far more common than aura
involve changes in mood, or energy level, alteration in sensory processing, muscle changes, yawning
Probably redirect the milieu of the CNS

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6
Q

phases of Migraine

A

chocolate was considered a trigger
but now know craving carbohydrates is a prodrome
Prodromes are important markers for timing of treatment
Auras can also be part of the pre-headache phase

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7
Q

phases of migraines

A 
Headache phase:
begins mild ad progresses to severe
unilateral, but can be bilateral
4-72 hours
In children and adolescents duration is less than 4 hours
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8
Q

After migraines

A

symptoms may last 1 to 2 days

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9
Q

4 Diagnostic questions

A

how does it interfere with your life
any change in the pattern
how do you experience the ha’s
how often do you use medications

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10
Q

Cluster HAs

A

Other:
cerebral aneurysm
sub-arachnoid hemorrhage
ICP

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11
Q

Analgesic rebound

A

Suspect with c/o daily ha

Inquire about frequency of use

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12
Q

Traction/inflammation

A

Diseases of the cranium bones

referred pain from sinuses, teeth, tmj, ears and back

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13
Q

Meningeal irritation

A

will have a rise in temperature

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14
Q

Temporal arteritis

A

Differential Dx”
elevated sedation rate
tender to palpation

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15
Q

Manage migraines

A 
Abortive therpay
use at firt indication of headache
Triptans: Imitrex
seperate dosages by 2 hours
May augment with Reglan if n/v is severe
NSAIDS @ higher doses
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16
Q

manage migraines

A 
AVOID triggers
Relaxation techniques
Accupressure- not for pregnant women
regular exercise
adequate sleep
good nutrition
narcotics-last ditch effort
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17
Q

manage migraines

A 
combination analgesics
Ergots-
Corticosteroids
Pregnant women need to avoid triggers, use non pharm measures
may take tylenol
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18
Q

Preventive therapy

A

not for all
If more than 4 per month
if severe
if do not respond to medication

19
Q

Consider other condition

A

HTN

epilepsy

20
Q

Preventative drugs include

A 
beta blockers
Ca channel blockers
anticonvulsants
trycyclic antidepressents
SSRIs
21
Q

Migraine F/U

A

RTC every 2-4 weeks x3 months until responding to medication

22
Q

Red flags for referral

A 
Can't control HAs
new and worsening
effect quality of life
rebound HA
Neuro symptoms
23
Q

Meningitis

A

infection results in inflammation of the meningies
most often caused by a bacterial agent
high fever, HA, photophobia,
nugal rigidity

24
Q

Meningitis

A 
get Hx
travel?
food consumption?
sexual practices?
drug use?
25
Q

Meningitis

A 
physical
temp, pulse, rr all elevated
Brudinskis sign
kernigs sign-can't fully extend legs
(these will not exclude)
26
Q

meningitis

A 
altered level of consciousness
confusion
stupor
assess cranial nerves
diplopia, deafness, facial weakness, pupillary abnormalities
27
Q

meningitis

A

CBC
elevated WBC
serum glucose
LP will be done after referral

28
Q

Bells palsy

A 
unilateral paralysis of face
often precedes by viral infection
acute onset with max paralysis at 48-72 hours
may have altered taste and increased sensitivity to sound
hx of recent infections
chronic diseases?
Insect bites?
Pregnancy?-occurs more frequently
29
Q

Bells palsy -physical exam

A

head and neck
cranial nerve assessment
corneal light reflex may be decreased
eyeball may roll upward when close eyelid

30
Q

bells palsy

A

usually no tests indicated

exclude Lyme disease and infection with CDC diff

31
Q

Manage Bells palsy

A 
Prevent eye injury
lube for nightime sleep-methylcellulose
protective eyewear
eye cup at bedtime
facial massage
Prednisone: 60-80 mg /day for 1 week taper second week
if severe, add valacyclovir-1000 mg 3x/day 
If pregnant, consult OB
32
Q

Dizziness/Vertigo

Vestibular neuronitis-Cranial nerve VIII

A

Acute labyrinthitis-involves cochlea and may cause hearing loss-caused by a virus infection in the labyrinth

33
Q

vestibular neuronitis

A

often occurs after URI followed by vertigo
Symptoms resolve in 3-6 weeks
have client describe dizziness
medical problems
Do they happen with activity or movement?
describe onset and hearing involvement

34
Q

ask?- for Vestibular neuronitis

A

ask about head trauma
Do vision exam
Weber test-lateralization to unaffected with sensorineural hearing loss
See handout

35
Q

Vestibular neuronitis

A 
lie down in darkened room
antibiotics if associated with bacterial infection
Methyprednisone
once daily for 22days
100 mg day 1 to 3
80 mg 4-6
60 mg 7-9
40 mg 10-1220 mg 13-15
10mg 16-18
none on day 19-21 and then 10 mg on day 20 and 22
36
Q

vestibular neuronitis

A

no antiemetics after 3 days

3-6 weeks symptoms resolve spontaneously

37
Q

Menieres

A

bed rest during an attack
refer to otolaryngologist for testing and management
may need to decrease NA, caffeine, alcohol and tobacco
Antivert and antiemetics with sever symptoms
diuretics may reduce severity

38
Q

Menieres

A 
2 episodes
last at least 20 minutes
hearing loss, tinnitus, aural fullness
Vertigo UNRELATED to position change
Hearing loss is reversible initially, then can become permanent.
39
Q

Benign positional paroxysmal vertigo-

Assiociated with movement

A

position changes cause an abrupt onset
NO tinnitus or hearing loss, but may have n/v
Common in the elderly

40
Q

BPPV

A

which moves within the semicircular canal most common type

caused by free floating particle matter with certain head movements

41
Q

BPPV

A

Characteristic is the nystagmus
rolling over
laying down

42
Q

BPPV

A

if the nystagmus is vertical or torsional in nature and lasts 30 seconds, it is consistent with a posterior semicircular canal varant
nystagmus peripheral causes produce 3-10 second delay in onset, lessens with repetition and is ina fixed direction
If it is central, it starts immediately, does not fatique with repitition and may be in any direction

43
Q

BPPV

A

Can use Epleys maneuver

Meds probably wont help

PC 617 Neurological problems (1 decks)

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