Headaches & Tumors Flashcards by Elizabeth Sager

Describe the origin points of headaches

extracranially (skin, muscle, vessels, periosteum)
intracranially (vessels, dura, falx cerebri)
brain parenchyma is incapable of producing pain

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Describe the red flags in headache eval

first severe HA or worst HA of life with acute onset
HA progressively worsening over days/weeks
severe HA with fever
nuchal rigidity
decreased LOC or focal neuro signs

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Describe the onset and epidemiology of migraines

onset usually adolescence or young adulthood (childhood too)
female 3:1 male
most commonly without aura

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Describe the 2 types of migraines

Common Migraine (without aura)

Classic Migraine (with aura before or after HA)

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Describe some of the precipitating factors of migraines

menstruation
too much/little sleep
red wine, cheese, chocolate, herring, processed meats, caffeine
meds

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Describe the symptoms of a migraine

+/- aura
- unilateral
- pulsating/throbbing
- nausea/vomiting
- moderate to severe
- worse with activity
- photo/phonophobia

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Describe the types of migraine auras

Visual (scotoma)
Sensory (unilateral paresthesia, numbness)
Motor (unilateral weakness, aphasia)

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What is the diagnostic threshold for migraines

5+ attacks before diagnosis made
photo/phonophobia, impairment, nausea

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What is the potential pathophysiology of a migraine

intense vasoconstriction of cranial vessels
issue with serotonin

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Describe some of the prophylactic treatment for migraines

beta blockers (propranolol)
calcium channel blockers
SSRIs (fluoxetine)
TCAs (amitriptyline)
ASMs (valproic acid)

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Describe some of the abortive therapies for migraine

OTC analgesics
vasoconstrictors (ergots)
antiemetics
serotonin agonists (sumatriptan)
IV/IM NSAID (ketorolac/toradol)

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Describe the characteristics and pathophys of a cluster headache

series/cluster of headaches over 2-3 months with clusters occurring every 1-2 years

dilation of retro orbital blood vessels and inflammation of trigeminal nerve branches

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Describe the clinical presentation of cluster headaches

excruciating penetrating unilateral non-throbbing pain in trigeminal nerve distribution
usually behind an eye

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Describe the treatment of cluster headaches

similar to migraines
- first line sumatriptan
- oxygen inhalation effective in 70%
- beta blockers not used

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What might trigger cluster headaches

alcohol
histamines
nitroglycerine

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Describe the autonomic features associated with cluster headaches

lacrimation
conjunctival injection
rhinorrhea
ptosis/miosis

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What is the most common type of headache

tension headache

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What is the etiology of tension headaches

episodic or chronic
can last 30 mins to 7 days

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Describe the clinical presentation of a tension headache

bilateral occipital, nuchal, frontal, pressure/tightness/band like pain
unaffected by activity
+/- photo/phonophobia
no n/v or throbbing

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Describe the treatment for tension headaches

OTC analgesics (ASA, APAP, NSAIDs)
excedrin
stress reduction
prevention (antidepressants or ASMs)

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Describe sinusitis

acute or chronic infection of sinus cavities

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Describe a sinusitis headache

usually stabbing or aching
worse when bending forward, coughing
better when supine
pain to percussion over sinuses (diagnostic)

Describe acute glaucoma headaches

orbital pain
n/v
cornea is edematous
injected conjunctiva
decreased vision

How is glaucoma diagnosed

measure intraocular pressure via tonometry device

Describe temporal arteritis

vasculitis involving branches of the external carotid arteries, usually the temporal artery (>50, women 4:1 men)

Describe a temporal arteritis headache

jabbing, excruciating pain over temples, usually unilateral, may have vision loss pain with palpation over temple

Describe diagnostics for temporal arteritis

- elevated ESR - temporal artery biopsy

Describe the treatment for temporal arteritis

prompt tx with steroids to decrease chance of visual loss (high dose prednisone)

Describe the etiology of TMJ

usually due to spasms of muscles around the temporomandibular joint, may be due to overbite, previous dental work, grinding teeth

Describe the clinical presentation of TMJ

- unilateral/bilateral pain in TMJ, tender to palpation - may feel clicking in joint

Describe trigeminal neuralgia etiology

Brief severe attacks of pain along the distribution of branches of the trigeminal nerve due in part to compression and demyelination

Describe the pain related to trigeminal neuralgia

- lancinating, stabbing, electric shock

Describe the treatment for trigeminal neuralgia

- analgesics - carbamazepine - phenytoin - possible surgery (refer to ENT)

Describe meningitis presentation

viral or bacterial infection - headache - fever - nuchal rigidity - toxicity/sepsis

What is the diagnostic and treatment course for meningitis

lumbar puncture and gram stain - IV abx and steroids if bacterial - supportive if viral

Describe the presentation of a hypertensive headache

headache usually resulting from a diastolic BP >130

Describe the common types of brain tumors

-astrocytoma (glioma) -meningioma -acoustic neuroma -metastasis

Describe headaches secondary to brain tumor

- worsening over days-weeks - usually worse in the morning with nausea/vomiting - weakness, paralysis, sensory deficits, cranial nerve palsies, visual disturbance, ataxia, AMS, seizure

Describe the etiology of astrocytomas

most common type of tumor (malignant) - from astrocytes in the cerebral hemisphere - 3 histopathological grades

Describe the etiology of meningiomas

2nd most common tumor (benign) - from the meninges

Describe acoustic neuroma etiology

- benign, slow growing tumor, from **Schwann cell sheath** around the **vestibulo-cochlear nerve** (CN8) - occupies the **cerebellopontine angle**

Describe metastatic brain tumors

secondary, more common than primary brain tumors - commonly from the lungs (48%), breasts (15%), and others

Describe the grades of astrocytomas and survivability

- low grade: 6-8 years - anaplastic astrocytoma: 5 yrs with surg/radiation - glioblastoma multiforme: most malignant, <1yr

Describe the symptoms of acoustic neuromas

- unilateral hearing loss, tinnitus - vertigo - headache - facial numbness/weakness

Describe the treatment of meningiomas

observation, surgical (not usually radiation or chemo)

Describe the treatment of acoustic neuromas

surgical excision, gamma knife, or observation

Describe the treatment of metastatic brain tumors

-systemic workup for primary source -brain biopsy -mainly palliative - whole brain radiation therapy - gamma knife - chemo

Astrocytoma

glioblastoma multiforme

meningioma

acoustic neuroma

cerebral metastases

What are the diagnostic tests for brain tumors

- MRI: study of choice - CT with contrast - EEG if seizures present