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Neuro > Headaches > Flashcards

Headaches Flashcards

1
Q

What HA are considered primary HAs?

A
  • Chronic, benign, recurring headache without known cause

ie. Migraines, tension-type headaches, cluster headaches

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2
Q

What HA are considered secondary HAs?

A
  • HA due to underlying pathology

ie. Space-occupying mass, infection, head trauma

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3
Q

What the “red flags” associated with headaches that represent potential emergencies?

A
  • Sudden onset within seconds to minutes.
  • Worst headache of patient’s life.
  • New-onset headache that the patient has never experienced before, especially > 50 years of age.
  • Headache pattern: increase in severity and frequency over time, worse with lying down.
  • Mental status change or any focal neurological signs/symptoms.
  • New headache associated with heavy exertion or head trauma, fever, stiff neck, or rash, HIV infection or cancer.
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4
Q

What are the SNOOP4 red flags?

A
  • Systemic disease or symptoms
  • Neurologic signs or symptoms
  • Onset that is sudden
  • Older than 40 years of age
  • Progressive worsening
  • Postural
  • Precipitated by Valsalva maneuver or exertion
  • Previous headache history with new feature
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5
Q

What are the general characteristics of migraine HAs?

A

A chronic headache syndrome caused by a neurovascular disorder
- neural events lead to intracranial vasodilation (also thought that serotonin is involved somewhere in the pathway)

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6
Q

What are the general types of migraine HAs?

A
  • Migraine with aura
    (15% of cases = “classic migraine”)
  • Migraine without aura:
    (85% of cases = “common migraine”)
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7
Q

What are the clinical features of migraine HAs?

A
  • Severe, throbbing, unilateral headache (not always on the same side)
  • Lasts 4 to 72 hours
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8
Q

What are some sxs of migraine HAs?

A
  • Nausea and vomiting (in as many as 90% of cases)
  • Photophobia
  • Increased sensitivity to smell
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9
Q

What is the tx for an acute attack for migraine HAs?

A
  • NSAIDs
  • Dihydroergotamine (DHE)
  • Sumatriptan and related “triptans”
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10
Q

What is the 1st line prophylaxis tx for migraine HAs?

A
  • Beta-blockers (propranolol and timolol)

- Antidepressants - amitriptyline and venlafaxine

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11
Q

What is the 2nd line prophylaxis tx for migraine HAs?

A
  • Verapamil (calcium channel blocker)
  • Anticonvulsants: valproic acid or topiramate
  • Methylsergide
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12
Q

What are the general characteristics of tension HAs?

A

Most common type of headache overall

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13
Q

What are the clinical features of tension HAs?

A
  • Pain is steady, aching, “vise-like,” and encircle the entire head (tight- band-like pain around the head)
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14
Q

Where is the MC location of pain caused by tensions HAs?

A
  • Most intense around the neck or back of the head
  • Can be accompanied by tender muscles (posterior cervical, temporal, frontal)
  • Tightness in posterior neck muscles
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15
Q

What is the tx for mild to moderate tension HAs?

A
  • Evaluate the patient for depression or anxiety
  • Stress reduction is important
  • NSAIDs, acetaminophen, and aspirin
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16
Q

What is the tx for severe tension HAs?

A
  • Medications that are used for migraines

ie. Dihydroergotamine (DHE), Sumatriptan and related “triptans”

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17
Q

What are the clinical features of cluster HAs?

A
  • Excruciating periorbital pain (“behind the eye”)
  • Almost always unilateral
  • Cluster headache is described as a “deep, burning, searing, or stabbing pain”
  • Pain may be so severe that the patient may even become suicidal
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18
Q

What other sxs are seen in cluster HAs?

A
  • Ipsilateral eye pain and lacrimation
  • Ipsilateral facial flushing/sweating
  • Ipsilateral nasal stuffiness or rhinorrhea
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19
Q

When do cluster HAs usually appear?

A
  • Awakens the patient from sleep
  • Attacks occur nightly for 2 to 3 months and then disappear
  • Remissions may last from several months to several years
  • Worse with alcohol and sleep
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20
Q

What is the abortive 1st line tx for cluster HAs?

A

Inhaled O2

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21
Q

What is the prophylaxis tx for cluster HAs?

A

Verapamil PO daily

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22
Q

What causes a medication overuse HA?

A

Regular overuse for >3 months of acute medications

23
Q

What are the medications that can cause and overuse HA?

A
  • Ergot, triptan, opioid, or butalbital analgesics >10 days per month
  • Nonopioid analgesics > 15 days per month
  • All acute drugs > 15 days per month
24
Q

What is the etiology of secondary morning HAs?

A
  • Primary sleep disturbance
  • Abnormal sleep duration
  • Secondary to another disease (sleep apnea)
25
Q

S/sx of infection-related migraines (meningitis)?

A
  • A severe HA that is different from any HA before

- Accompanied by fever, stiff neck, or a focal neurologic abnormality not documented with the pts previous HA.

26
Q

How do you differentiate between meningitis and SAH?

A
  • More abrupt HA onset = SAH> meningitis

- Fever = meningitis > SAH

27
Q

What LP findings would be indicative of a bacterial infection?

A
  • Turbid
  • Protein: > 1g/L
  • Glucose: < 40 mg/dL
28
Q

Viral meningitis most commonly involves what?

A

Enteroviruses

29
Q

Viral encephalitis most commonly involves what?

A

Arboviruses

30
Q

How is Herpes Simplex Virus (HSV) Encephalitis treated?

A

Treat with Acyclovir

31
Q

What is the diagnostic criteria for Temporal Arteritis?

A
  • Must meet 3 of the 5 criteria
  • Age > 50 years
  • New-onset localized headache
  • Temporal artery tenderness or decreased pulse
  • ESR > 50 mm/hr
  • Abnormal arterial biopsy findings
32
Q

What are the clinical features of sinus HAs?

A
  • Usually NOT associated with nausea, vomiting, photophobia, or phonophobia
  • Sinus tenderness d/t congestion, associated with sinusitis.
33
Q

Since spheroids are harder to diagnosis clinically what do you need to be cautious off?

A

Higher risk of meningitis = longer abx (IV)

34
Q

Trigeminal Neuralgia is also known as what?

A
  • Tic douloureux

- “the suicide disease”

35
Q

What are the s/sx of Trigeminal Neuralgia?

A
  • One of the most painful conditions
  • MC in middle-aged women
  • Brief (seconds to minutes) but frequent attacks of severe, lancinating facial pain
36
Q

What part of the face does Trigeminal Neuralgia involve?

A
  • Jaw, lips, gums, and maxillary areas (ophthalmic division is less commonly affected
37
Q

Trigeminal Neuralgia pain worsens with what?

A
  • Chewing, talking, touching face, wind in face.
38
Q

What is the tx for Trigeminal Neuralgia?

A
  • Carbamazepine
39
Q

What are the clinical features of Glossopharyngeal Neuralgia?

A
  • Occurs in the throat (about the tonsillar fossa) and sometimes deep in the ear and at the back of the tongue
  • May be caused by MS
40
Q

What is the tx for Glossopharyngeal Neuralgia?

A

Carbamazepine or Oxcarbazepine

41
Q

What is the Etiology of Subarachnoid Hemorrhage?

A
  • MC: rupture of an intracranial aneurysm

- Second MC: the rupture of an arteriovenous malformation (AVM)

42
Q

What is the clinical features of Subarachnoid Hemorrhage?

A

Thunderclap/”Worst headache of my life!”

43
Q

What are some diagnostic test used to dx Subarachnoid Hemorrhage?

A
  • CT w/o contrast
  • Lumbar puncture: xanthochromia
  • Cerebral angiography
  • ECG
44
Q

Why is a cerebral angiography done in a pt with Subarachnoid Hemorrhage?

A

Shows the localization of the site of aneurysm or rupture prior to neurosurgical intervention

45
Q

What is seen on the ECG in a pt with Subarachnoid Hemorrhage?

A
  • ST segment changes consistent with an ischemic process
  • QRS complex widening
  • QT prolongation
  • Inverted T waves
46
Q

What is Idiopathic Intracranial Hypertension?

A

Increased ICP with no other cause of intracranial hypertension noted via CT or MRI.

47
Q

Idiopathic Intracranial Hypertension is MC’ly seen in who?

A

Obese women of childbearing age

48
Q

What is the tx for Idiopathic Intracranial Hypertension?

A

Acetazolamide

reduces CSF pressure and production

49
Q

What are S/Sx of Post-Concussion Syndrome?

A
  • Grossly observable incoordination (stumbling, inability to walk tandem/straight line)
  • Vacant stare
    (befuddled facial expression)
  • Delayed verbal expression
    (slower to answer questions or follow instructions)
  • Inability to focus attention
    (easily distracted, unable to “follow through”)
  • Disorientation
    (walking in wrong direction, unaware or time or place)
  • Slurred or incoherent speech
    (disjointed or incomprehensible statements)
  • Emotionally out of proportion to circumstances
    (distraught, crying for no apparent reason)
  • Memory deficits
    (repeating questions, impaired recall)
50
Q

What is the tx for SAH?

A

Nimodipine to prevent vasospasm

51
Q

What is the MC space-occupying lesion and what is the sx??

A

Meningioma

- Focal neuro deficits

52
Q

How do you dx a space-occupying lesion?

A

CT w/ contrast

53
Q

What is the sxs of Idiopathic Intracranial Hypertension?

A

Visual changes, papilledema, CN VI palsy

Neuro (14 decks)

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