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MJ- F2 E4- Neuro > Headaches (secondary HAs)- MJ > Flashcards

Headaches (secondary HAs)- MJ Flashcards

1
Q

The following are possible etiologies of what group of headaches?

  • Trauma/injury to head/neck
  • Cranial or cervical vascular disorder
  • Non-vascular intracranial disorder
  • A substance or its withdrawal
  • Infection
  • Disorder of homeostasis
  • Disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or cervical structure
  • Psychiatric disorder
A

Secondary headaches

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2
Q

Who does pseudotumor cerebri (AKA idiopathic intracranial HTN) primarily affect?

A

women of childbearing age who are overweight

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3
Q

What is the eitiology of pseudotumor cerebri?

A

chronically elevated intracranial pressure (ICP)

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4
Q

What are the 3 possible causative medications of Pseudotumor Cerebri?

A
  1. Growth hormone
  2. Tetracyclines
  3. Hypervitaminosis A
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5
Q

What are the 9 conditions that are possibly related to Pseudotumor Cerebri?

A
  1. Addison Disease
  2. Hypoparathyroidism
  3. Anemia

4. Sleep apnea

  1. SLE (Lupus)
  2. Behcet’s syndrome

7. PCOS

  1. Coagulation disorders
  2. Uremia
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6
Q

What is the MC presentign symptom of a patient with Pseudotumor Cerebri?

A

Headache (sxs vary)

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7
Q

What can cause headache with vision loss?

A

Pseudotumor Cerebri

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8
Q

The following are associated sxs of what condition?

  • Transient visual obscurations
  • Intracranial noises (pulsatile tinnitus)
  • Photopsia
  • Back pain
  • Retrobulbar pain
  • Diplopia
  • Sustained visual loss
A

Pseudotumor Cerebri

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9
Q

What are the 4 physical exam findings of someone w/ Pseudotumor Cerebri?

A
  1. Obesity
  2. Papilledema
  3. Visual field loss
  4. Abducens (CN VI) palsy
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10
Q

How do you diagnose Pseudotumor Cerebri?

A
  • Clinical presentation suggesting increased ICP
  • LP- Opening pressure showing elevated ICP w/ normal CSF
  • MRI w/ MR venography to r/o secondary causes
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11
Q

What are the 6 treament options for a patient w/ Pseudotumor Cerebri?

A
  1. Weight loss for obese patients
  2. Decrease sodium intake
  3. Acetazolamide (Carbonic anhydrase inhibitors)-> reduce rate of CSF production
  4. Furosemide (Loop diuretics)–> adjunct to Acetazolamide
  5. Serial LPs (can be bridge to sx)
  6. Surgery (optic nerve fenestration, CSF shunting)
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12
Q

What medication is no longer recommended for tx of Pseudotumor Cerebri?

A

Corticosteroids

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13
Q

What 2 pharmacologic medications can be used to tx Pseudotumor Cerebri?

A
  • Acetazolamide (carbonic anhydrase inhibitor)–> reduce rate of CSF production
  • Furosemide (adjunct to acetazolamide)
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14
Q

Which 3 acute symptomatic headache medications are most commonly realted to medication overuse headache?

A
  • Opioids
  • Butalbital / analgesic combinations
  • Aspirin / acetaminophen / caffeine combinations
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15
Q

What 3 underlying behavioral disorders should you consider when diagnosing a headache as a medication overuse headache?

A
  1. Addictive personalities
  2. Depression
  3. Anxiety
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16
Q

Medication overuse headache:

Although severity, location and HA pattern varies significantly, what 5 associated sxs may be present?

A
  1. Nausea
  2. Asthenia
  3. Difficulty Concentrating
  4. Memory Problems
  5. Irritability
17
Q
A
18
Q

The following is criteria for diagnosing which type of headache?

  • HA occurring on 15+ days/month in a patient with a pre-existing HA disorder who is:
    • Taking combo meds or prescription meds (triptans, ergotamines, etc) for ≥10 days/month x >3 months OR
    • Regular intake of simple analgesics (ie, acetaminophen, aspirin, or NSAID) ≥15 days/month x >3 months
A

Medication Overuse Headache

19
Q

What are the 5 treatment options for Medication Overuse Headache?

A
  1. Discontinue medication
  2. Rescue abortive therapy ≤ 2 days/week with a medication class different than overused med
  3. Prophylactic therapy for the original primary h/a disorder
  4. +/- bridge therapy
  5. Patient education
20
Q
  • What age is it rare to see temporal arteritis?
  • When is the peak incidence?
A
  • Rare < 50y/o
  • Peak incidence= 70-79y/o
21
Q

What are the 4 most common symptoms of Temporal Arteritis (AKA “Giant Cell Arteritis”)

A
  1. Temporal/occipital HA (throbbing/continuous)
  2. Neck, torso, shoulder, and pelvic girdle pain (consistent with polymyalgia rheumatica)
  3. Jaw claudication
  4. Fever

(can also have constitutional sxs- malaise, weight loss, etc)

22
Q

The following is the clinical presentation of what condition?

  • ~1/2 have tenderness over superficial temporal artery
  • Nodularity/thickening of the superficial temporal artery
  • Gentle pressure on scalp may elicit pain
    *
A

Temporal Arteritis

23
Q

If a patient has Temporal Arteritis, what would labs show?

A
  • Elevated ESR and C-reactive protein
  • ESR usually > 50 mm/h (but may be normal)
  • ESR does not correlate well with severity of disease
24
Q

If you suspect a patient has Temporal Arteritis, what diagnostic procedure should be performed?

A
  • Temporal artery biopsy (positive result is 100% specific)
25
Q

If you seriously suspect a patient has temporal arteritis, when should treatment be started?

A

Before temporal artery biopsy is performed

(start tx right away b/c this condition is vision threatening- confirm w/ biopsy)

26
Q

What is treatment for Temporal Arteritis?

A
  • High dose Corticosteroids (Prednisone)
  • Tx continued long enough for sxs to resolve
  • taper initiated when signs of clinical inflammation are suppressed and ESR/CRP remain low
27
Q

In a patient with Temporal Arteritis, when should you see improvement of systemic symptoms after being treated w/ high-dose corticosteroids (Prednisone)?

A

72 hours

(if no improvement at this point then reconsider dx)

28
Q

What is Trigeminal Neuralgia?

A

•Compression of trigeminal nerve root

  • MC aberrant loop of an artery or vein (80 to 90% of all cases)
29
Q
  • What ages is Trigeminal Neuralgia most common in?
  • Before what age is it uncommon?
A
  • Peak incidence= 60-70y/o
  • Uncommon < 40y/o
30
Q

Trigeminal Neuralgia is 20x more prevalent in patients with what disease?

A

Multiple Sclerosis

(this will be on exam)

31
Q

Which branch of the Trigeminal Nerve is most commonly affected in Trigeminal Neuralgia?

A

V3

32
Q

In what condition will the patient complain of severe “sharp” pain with benign tactile stimuli like light touch, shaving, wind blowing?

A

Trigeminal neuralgia

(hyper excitability over select Trigger Zones

33
Q

The following are clinical features of what condition?

  • Sharp electric shock pain lasting few seconds to several minutes (V2 and/or V3, less likely V1)
  • Pain may be triggered by simple actions (chewing, brushing teeth, puffs of air…)
  • Overtime duration of remission periods shortens
  • No clinically evident neurologic deficit
A

Trigeminal Neuralgia

34
Q

How is the diagnosis of Trigeminal Neuralgia made?

A
  • Clinical diagnosis based upon history physical exam
  • MRA with gadolinium visualize neurovascular compression
35
Q

What are the 3 red flags for Trigeminal Neuralgia indicating a worse prognosis/difficulty treating?

A
  1. Trigeminal Sensory loss
  2. Bilateral Sxs
  3. <40y/o
36
Q

The following is criteria for what condition?

A. >3 attacks of unilateral facial pain:

  • Occurring in 1+ divisions of the trigeminal nerve, with no radiation beyond the trigeminal distribution
A

Trigeminal Neuralgia

37
Q

What is first line tx for Trigeminal Neuralgia

A

Carbamazepine (titrate slowly)

38
Q

What type of medications are rarely effective in treating trigeminal Neuralgia?

A

Narcotics

39
Q

Which treatment for Trigeminal Neuralgia has the best long-term outcome? (70% pain free in 10 years)

A

Surgery- Microvascular decompression

MJ- F2 E4- Neuro (19 decks)

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