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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
sumatriptan
serotonin 1b and 1d agonist -effective in stopping migraine - bind these inhibitor serotonin autoreceptors - presynaptic membrane terminate release of serotonin
26
dull, B/L squeezing non-pulsating HA, no vomiting feel like tight hat on
tension headache
27
chronic tension headaches
>15 days/month with average duration >4 hours history of >6 months ensure patient does not take analgesic more than 1/week
28
medication overuse HA
any pain pill more than 1/week - increase frequency of HAs aka rebound HA tx - limit analgesic to 1/week
29
sudden stabbing pain behind eye, with tearing and congestion, come in waves - daily for weeks - then stop for months
cluster headache 2/3 horner syndrome
30
epidemiology of cluster HAs
men
31
autonomic features of cluster headache
lacrimation, congestion, rhinorrhea, swelling, miosis, ptosis, eyelid edema
32
idiopathic intracranial HTN
pseudotumor cerebri
33
progressive diffuse HA with loss of vision one or both eyes - with eye movements
idiopathic intracranial HTN
34
young obese women
get idiopathic intracranial HTN association with E and P supps -also with acutane use
35
HA gone after spinal tap lose CSF
idiopathic intracranial HTN
36
papilledema
seen in idiopathic intracranial HTN also often have extraocular palsy - CN VI, III, IV
37
tx of idiopathic intracranial HTN
weight loss, steroids, CAIs shunt if severe
38
trigeminal neuralgia
tic douloureux brief shooting pain - triggered by facial contact often maxillary division - secondarily mandibular - rarely ophthalmic
39
pain with touching face
trigeminal neuralgia commonly over age 50yo
40
temporal arteritis
giant cell arteritis vasculitis superficial temporal artery - lose pulse
41
loss of pulse in temporal artery
giant cell arteritis
42
risk with giant cell arteritis
complete vision loss
43
diagnosis of giant cell arteritis
elevated ESR and C-reactive protein confirmed - biopsy superficial temporal artery
44
tx of giant cell arteritis
curable - with prednisone - need to take long time

Neuro II Exam 2 (20 decks)

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