Headaches (secondary HAs)- MJ Flashcards
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
Secondary headaches
Who does pseudotumor cerebri (AKA idiopathic intracranial HTN) primarily affect?
women of childbearing age who are overweight
What is the eitiology of pseudotumor cerebri?
chronically elevated intracranial pressure (ICP)
What are the 3 possible causative medications of Pseudotumor Cerebri?
- Growth hormone
- Tetracyclines
- Hypervitaminosis A
What are the 9 conditions that are possibly related to Pseudotumor Cerebri?
- Addison Disease
- Hypoparathyroidism
- Anemia
4. Sleep apnea
- SLE (Lupus)
- Behcet’s syndrome
7. PCOS
- Coagulation disorders
- Uremia
What is the MC presentign symptom of a patient with Pseudotumor Cerebri?
Headache (sxs vary)
What can cause headache with vision loss?
Pseudotumor Cerebri
The following are associated sxs of what condition?
- Transient visual obscurations
- Intracranial noises (pulsatile tinnitus)
- Photopsia
- Back pain
- Retrobulbar pain
- Diplopia
- Sustained visual loss
Pseudotumor Cerebri
What are the 4 physical exam findings of someone w/ Pseudotumor Cerebri?
- Obesity
- Papilledema
- Visual field loss
- Abducens (CN VI) palsy
How do you diagnose Pseudotumor Cerebri?
- Clinical presentation suggesting increased ICP
- LP- Opening pressure showing elevated ICP w/ normal CSF
- MRI w/ MR venography to r/o secondary causes
What are the 6 treament options for a patient w/ Pseudotumor Cerebri?
- Weight loss for obese patients
- Decrease sodium intake
- Acetazolamide (Carbonic anhydrase inhibitors)-> reduce rate of CSF production
- Furosemide (Loop diuretics)–> adjunct to Acetazolamide
- Serial LPs (can be bridge to sx)
- Surgery (optic nerve fenestration, CSF shunting)
What medication is no longer recommended for tx of Pseudotumor Cerebri?
Corticosteroids
What 2 pharmacologic medications can be used to tx Pseudotumor Cerebri?
- Acetazolamide (carbonic anhydrase inhibitor)–> reduce rate of CSF production
- Furosemide (adjunct to acetazolamide)
Which 3 acute symptomatic headache medications are most commonly realted to medication overuse headache?
- Opioids
- Butalbital / analgesic combinations
- Aspirin / acetaminophen / caffeine combinations
What 3 underlying behavioral disorders should you consider when diagnosing a headache as a medication overuse headache?
- Addictive personalities
- Depression
- Anxiety
Medication overuse headache:
Although severity, location and HA pattern varies significantly, what 5 associated sxs may be present?
- Nausea
- Asthenia
- Difficulty Concentrating
- Memory Problems
- Irritability
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
Medication Overuse Headache
What are the 5 treatment options for Medication Overuse Headache?
- Discontinue medication
- Rescue abortive therapy ≤ 2 days/week with a medication class different than overused med
- Prophylactic therapy for the original primary h/a disorder
- +/- bridge therapy
- Patient education
- What age is it rare to see temporal arteritis?
- When is the peak incidence?
- Rare < 50y/o
- Peak incidence= 70-79y/o
What are the 4 most common symptoms of Temporal Arteritis (AKA “Giant Cell Arteritis”)
- Temporal/occipital HA (throbbing/continuous)
- Neck, torso, shoulder, and pelvic girdle pain (consistent with polymyalgia rheumatica)
- Jaw claudication
- Fever
(can also have constitutional sxs- malaise, weight loss, etc)
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
*
Temporal Arteritis
If a patient has Temporal Arteritis, what would labs show?
- Elevated ESR and C-reactive protein
- ESR usually > 50 mm/h (but may be normal)
- ESR does not correlate well with severity of disease
If you suspect a patient has Temporal Arteritis, what diagnostic procedure should be performed?
- Temporal artery biopsy (positive result is 100% specific)
If you seriously suspect a patient has temporal arteritis, when should treatment be started?
Before temporal artery biopsy is performed
(start tx right away b/c this condition is vision threatening- confirm w/ biopsy)
What is treatment for Temporal Arteritis?
- 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
In a patient with Temporal Arteritis, when should you see improvement of systemic symptoms after being treated w/ high-dose corticosteroids (Prednisone)?
72 hours
(if no improvement at this point then reconsider dx)
What is Trigeminal Neuralgia?
•Compression of trigeminal nerve root
- MC aberrant loop of an artery or vein (80 to 90% of all cases)
- What ages is Trigeminal Neuralgia most common in?
- Before what age is it uncommon?
- Peak incidence= 60-70y/o
- Uncommon < 40y/o
Trigeminal Neuralgia is 20x more prevalent in patients with what disease?
Multiple Sclerosis
(this will be on exam)
Which branch of the Trigeminal Nerve is most commonly affected in Trigeminal Neuralgia?
V3
In what condition will the patient complain of severe “sharp” pain with benign tactile stimuli like light touch, shaving, wind blowing?
Trigeminal neuralgia
(hyper excitability over select Trigger Zones
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
Trigeminal Neuralgia
How is the diagnosis of Trigeminal Neuralgia made?
- Clinical diagnosis based upon history physical exam
- MRA with gadolinium visualize neurovascular compression
What are the 3 red flags for Trigeminal Neuralgia indicating a worse prognosis/difficulty treating?
- Trigeminal Sensory loss
- Bilateral Sxs
- <40y/o
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
Trigeminal Neuralgia
What is first line tx for Trigeminal Neuralgia
Carbamazepine (titrate slowly)
What type of medications are rarely effective in treating trigeminal Neuralgia?
Narcotics
Which treatment for Trigeminal Neuralgia has the best long-term outcome? (70% pain free in 10 years)
Surgery- Microvascular decompression
