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Neuro II Exam 2 > Headaches - Cohen > Flashcards

Headaches - Cohen Flashcards

1
Q

primary vs. secondary HA

A

primary - no cause

secondary - pathologic cause

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2
Q

primary HAs

A

migraine
tension
cluster

90% HAs primary

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3
Q

secondary HAs

A

tumor
meningitis
stroke
SA hemorrhage

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4
Q

worst headache of my life

A

SA hemorrhage

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5
Q

thunderclap headache

A

all of a sudden

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6
Q

CT vs. MRI

A

MRI - more likely to show cause of HA

CT sensitive for SA hemorrhage and faster than MRI

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7
Q

SA bleed imaging

A

CT best

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8
Q

high opening pressure on LP

A

pseudotumor cerebri

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9
Q

MC headache

A

tension

-but don’t go to doc

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10
Q

sick HA, with light and sound sensitivity, worse with activity, grow in intensity, last 24 hours

A

migraine

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11
Q

aura

A

visual/sensory deficit - before migraine

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12
Q

criteria for migraine

A

> 5 attacks lasting 4-72 hours

> 2 of following

  • unilateral
  • pulsating
  • moderate/severe intensity
  • aggravated by activity

> 1 of following

  • nausea/vomiting
  • photophobia/phonophobia
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13
Q

migraine epidemiology

A

white adult women

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14
Q

mutation Na and Ca channels in neurons

A

familial hemiplegic migraine
-migrain with one sided weakness for days with HA

suggest genetic component

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15
Q

hormones and migraines

A

75% patients women - start just after puberty

-end at menopause

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16
Q

triggers

A

environmental factors that cause migraine

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17
Q

aura

A

20 minutes before migraine

  • visual change
  • sensory/motor change
  • speech or language change
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18
Q

HA pain

A

from arteries
meninges
periosteum
CN - V and IX

19
Q

migraine pathology

A

not vascular - more important is electrical signaling

neurogenic theory of pathology

20
Q

cortical spreading depression

A

prolonged reduction in depolarization and synpatic transmission

believed this is what happens in migraines

21
Q

pain pathology in migraines

A

pons very active 30 minutes before increase blood to brain

pons - sends increased frequency of depolarization - to cranial nerve V - increased trigeminal nerve

results in vasodilation and inflammation of dura

22
Q

trigeminovascular activation

A

thought to be cause of pain in migraine

-pons > trigeminal > vasodilation and inflammation of dura

23
Q

serotonin release

A

occurs in migraine

pons and trigeminal nerve

also GCRP, substance P, and NO are released

24
Q

excessive serotonin release

A

inhibitory autoreceptors on presynpatic membrane are stimulated

neurons stop releasing more serotonin

migraine attack eventually ends

25
Q

sumatriptan

A

serotonin 1b and 1d agonist
-effective in stopping migraine - bind these inhibitor serotonin autoreceptors - presynaptic membrane

terminate release of serotonin

26
Q

dull, B/L squeezing non-pulsating HA, no vomiting

feel like tight hat on

A

tension headache

27
Q

chronic tension headaches

A

> 15 days/month with average duration >4 hours

history of >6 months

ensure patient does not take analgesic more than 1/week

28
Q

medication overuse HA

A

any pain pill

more than 1/week - increase frequency of HAs

aka rebound HA

tx - limit analgesic to 1/week

29
Q

sudden stabbing pain behind eye, with tearing and congestion, come in waves - daily for weeks - then stop for months

A

cluster headache

2/3 horner syndrome

30
Q

epidemiology of cluster HAs

31
Q

autonomic features of cluster headache

A

lacrimation, congestion, rhinorrhea, swelling, miosis, ptosis, eyelid edema

32
Q

idiopathic intracranial HTN

A

pseudotumor cerebri

33
Q

progressive diffuse HA with loss of vision one or both eyes - with eye movements

A

idiopathic intracranial HTN

34
Q

young obese women

A

get idiopathic intracranial HTN

association with E and P supps
-also with acutane use

35
Q

HA gone after spinal tap lose CSF

A

idiopathic intracranial HTN

36
Q

papilledema

A

seen in idiopathic intracranial HTN

also often have extraocular palsy - CN VI, III, IV

37
Q

tx of idiopathic intracranial HTN

A

weight loss, steroids, CAIs

shunt if severe

38
Q

trigeminal neuralgia

A

tic douloureux

brief shooting pain - triggered by facial contact

often maxillary division

  • secondarily mandibular
  • rarely ophthalmic
39
Q

pain with touching face

A

trigeminal neuralgia

commonly over age 50yo

40
Q

temporal arteritis

A

giant cell arteritis

vasculitis

superficial temporal artery - lose pulse

41
Q

loss of pulse in temporal artery

A

giant cell arteritis

42
Q

risk with giant cell arteritis

A

complete vision loss

43
Q

diagnosis of giant cell arteritis

A

elevated ESR and C-reactive protein

confirmed - biopsy superficial temporal artery

44
Q

tx of giant cell arteritis

A

curable - with prednisone - need to take long time

Neuro II Exam 2 (20 decks)

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