Headaches

Question 1

What are two important questions in neurology?

Answer 1

How long have you had this? Sudden or gradual?

Question 2

Acute

Answer 2

now (1-2 days)

Question 3

Subacute

Answer 3

Recent (2 days-3 weeks)

Question 4

Chronic

Answer 4

Months to years

Question 5

Remote

Answer 5

A long time ago

Question 6

How to characterize a migraine and the timeline?

Answer 6

Most common HA.
Prodrome> Aura> HA> Postdrome.
“Miserable”.

Question 7

Sxs of migraines

Answer 7

Typically lateralized, bounding, lasts all day. +N/V.

+/- Aura

Question 8

What is an atypical migraine?

Answer 8

Migraine with different characteristics. Typically without aura. “Weird”

Question 9

What gene is thought to be exaggerated in people with migraines?

Answer 9

CGRP (people with migraines have increased CGRP)

Question 10

Calcitonin gene

Answer 10

Related to protein signalling- thought to be exaggeratedin migraines. Calcitonin is a neuropeptide that signals pain in the trigeminal nerve (CN V= sensory nerve of face)…Calcitonin peptide is increased during migraine and decreases when migraines stop.

Question 11

What is a recent new tx for migraine?

Answer 11

Block calcitonin gene related to peptide receptors&raquo_space; meds block calcitoin GRP receptors

Question 12

What are abortive meds for migraine?

Answer 12

=stops HA’s.

OTC= ibuprofen (hard on kidnesy and stomach), Tylenol (tough on liver).

Serotonin R ant’s: Triptans= Vasoconstictors (avoid in MI/Stroke. Causes paresthesia). Ergot (vasoconstrictor, some nausea, often given with antiemetics).

Butalbitals: Pain killer (ex.Fioricet)= works like ETOH/addictive, sedation (great for ppl with bleeding issues)

Question 13

What is good for treating migraines in ER situations?

Answer 13

1) Ketorolac/Toradol = ibuprofen type (hard on kidneys and stomach).
2) Benadryl= antihistamine (puts ppl to sleep).
3) Compazine= nausea medications, dopamine receptor antagonist (like haldol, can cause tardive diskinesias)

Question 14

Why should you not give migraine meds (triptans/ergots) to patients with a hx of stroke or MI?

Answer 14

They are vasoconstrictors and cause blood clots

Question 15

Medication overuse headaches

Answer 15

Using too many migraine meds can cause migraines! If you use any meds more than twice per week, it can trigger HA’s (tylenol, ibuprofen). Opiates give you rebound HA’s (esp. Morphine)!

Tx: try medrol dosepack and taper off medication.

Question 16

When patients call the office with a headache, what do you give them?

Answer 16

Toradol/ketorolac and medrol dosepack are great for pts that call into the office the HA’s. Troadol IM 30mg to 60mg (bad on kidnesy and stomach), Medrol dosepak oral = several days of oral steroids (can cause anxiety or insomnia).

Question 17

Treatment approach to migraines

Answer 17

Neck pain? Yes!&raquo_space; Muscles relaxers (tizanidine, flexeril), acupuncture, chiropractic manipulations.

Trouble sleeping?&raquo_space;Amitriptyline/nortriptyline (TCA, antidepressant),

DRY MOUTH. Weight loss?&raquo_space; Topiramate/topamax (anit-seizure med) KIDNEY STONES, WORD FINDING (dopamaz)

Question 18

Natural supplements

Answer 18

Can help treat young pts or pt’s who don’t like medications.

Magnesium (oxide=pill, citrate = solution) = helps with aura and preventing migraines.

Coenzyme q10= good for migraine prevention, especially helpful for statin- induced HA’s.

Riboflavin (B2) or B-complex= good for ppl who may have an unbalanced diet.

Vitamin D= Inverse relation between Vit D and migraines. Vit D can help with reducing migraines.

Question 19

What is a tension headache?

Answer 19

Band like, mild, short and triggered by stress

Question 20

What is a cluster HA?

Answer 20

Severe, unilatral pain, lacimation, nasal congestion, sharp, behind the eye, restless, short duration ~4mins-2hrs, o2 helps. Most common in men.

*very RARE

Question 21

Does HTN cause anterior of posterior HAs?

Answer 21

posterior

Question 22

What is idiopathic intracranial HTN (pseudotumor cerebri)?

Answer 22

Basically an increase in pressure around the brain causing HA, blurred VA and tinnitus.

Can lead to papilledema

Generally in obese pts.

Pulsatile tinnitus (can hear own heartbeat, HA’s, blurred vision. Dx: if acute get LP (if opening prssure is over 250mm H2O (25cm). Tx: draining fluid until pressrue is back to normal. *LP can cause HA’s. Also, treat chronicly with diet (need 5% weight loss) and acetazolamide (diamox..s/e= numbness in extremities, or kidney stones).

Question 23

How do you treat idiopathic intracranial HTN

Answer 23

LP- drain fluid until pressure is back to normal

**Can cause HA though

Question 24

Concussion

Answer 24

Sx: HA’s , dizziness, insomnia, mood swings.

Tx: medrol dosepak and amitryptline (go low, start slow)

Question 25

Sleep apnea

Answer 25

causes HA’s. Also generally in obse pts.

tx: CPAP

Question 26

Occipital neuralgia

Answer 26

Inflamed neck nerves. Bad posture, car accidents (whiplash), s/p neck surgeries.

Like a pinched nerve

Question 27

Sinus HA

Answer 27

Often Migraines in disguise.

Tx: Nasal corticosteroids, Abx (augmentin), allergy testing.

Question 28

TMJ

Answer 28

Inflammation of the joint

Tx: Steroids or ibuprofen or dental guard.