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Geriatrics > Headaches & Tumors > Flashcards

Headaches & Tumors Flashcards

1
Q

Describe the origin points of headaches

A
  • extracranially (skin, muscle, vessels, periosteum)
  • intracranially (vessels, dura, falx cerebri)
  • brain parenchyma is incapable of producing pain
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2
Q

Describe the red flags in headache eval

A
  • 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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3
Q

Describe the onset and epidemiology of migraines

A
  • onset usually adolescence or young adulthood (childhood too)
  • female 3:1 male
  • most commonly without aura
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4
Q

Describe the 2 types of migraines

A

Common Migraine (without aura)

Classic Migraine (with aura before or after HA)

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5
Q

Describe some of the precipitating factors of migraines

A
  • menstruation
  • too much/little sleep
  • red wine, cheese, chocolate, herring, processed meats, caffeine
  • meds
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6
Q

Describe the symptoms of a migraine

A

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

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7
Q

Describe the types of migraine auras

A
  • Visual (scotoma)
  • Sensory (unilateral paresthesia, numbness)
  • Motor (unilateral weakness, aphasia)
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8
Q

What is the diagnostic threshold for migraines

A
  • 5+ attacks before diagnosis made
  • photo/phonophobia, impairment, nausea
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9
Q

What is the potential pathophysiology of a migraine

A
  • intense vasoconstriction of cranial vessels
  • issue with serotonin
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10
Q

Describe some of the prophylactic treatment for migraines

A
  • beta blockers (propranolol)
  • calcium channel blockers
  • SSRIs (fluoxetine)
  • TCAs (amitriptyline)
  • ASMs (valproic acid)
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11
Q

Describe some of the abortive therapies for migraine

A
  • OTC analgesics
  • vasoconstrictors (ergots)
  • antiemetics
  • serotonin agonists (sumatriptan)
  • IV/IM NSAID (ketorolac/toradol)
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12
Q

Describe the characteristics and pathophys of a cluster headache

A

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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13
Q

Describe the clinical presentation of cluster headaches

A
  • excruciating penetrating unilateral non-throbbing pain in trigeminal nerve distribution
  • usually behind an eye
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14
Q

Describe the treatment of cluster headaches

A

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

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15
Q

What might trigger cluster headaches

A
  • alcohol
  • histamines
  • nitroglycerine
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16
Q

Describe the autonomic features associated with cluster headaches

A
  • lacrimation
  • conjunctival injection
  • rhinorrhea
  • ptosis/miosis
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17
Q

What is the most common type of headache

A

tension headache

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18
Q

What is the etiology of tension headaches

A
  • episodic or chronic
  • can last 30 mins to 7 days
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19
Q

Describe the clinical presentation of a tension headache

A
  • bilateral occipital, nuchal, frontal, pressure/tightness/band like pain
  • unaffected by activity
    +/- photo/phonophobia
  • no n/v or throbbing
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20
Q

Describe the treatment for tension headaches

A
  • OTC analgesics (ASA, APAP, NSAIDs)
  • excedrin
  • stress reduction
  • prevention (antidepressants or ASMs)
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21
Q

Describe sinusitis

A

acute or chronic infection of sinus cavities

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22
Q

Describe a sinusitis headache

A
  • usually stabbing or aching
  • worse when bending forward, coughing
  • better when supine
  • pain to percussion over sinuses (diagnostic)
23
Q

Describe acute glaucoma headaches

A
  • orbital pain
  • n/v
  • cornea is edematous
  • injected conjunctiva
  • decreased vision
24
Q

How is glaucoma diagnosed

A

measure intraocular pressure via tonometry device

25
Q

Describe temporal arteritis

A

vasculitis involving branches of the external carotid arteries, usually the temporal artery

(>50, women 4:1 men)

26
Q

Describe a temporal arteritis headache

A

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

pain with palpation over temple

27
Q

Describe diagnostics for temporal arteritis

A
  • elevated ESR
  • temporal artery biopsy
28
Q

Describe the treatment for temporal arteritis

A

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

29
Q

Describe the etiology of TMJ

A

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

30
Q

Describe the clinical presentation of TMJ

A
  • unilateral/bilateral pain in TMJ, tender to palpation
  • may feel clicking in joint
31
Q

Describe trigeminal neuralgia etiology

A

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

32
Q

Describe the pain related to trigeminal neuralgia

A
  • lancinating, stabbing, electric shock
33
Q

Describe the treatment for trigeminal neuralgia

A
  • analgesics
  • carbamazepine
  • phenytoin
  • possible surgery (refer to ENT)
34
Q

Describe meningitis presentation

A

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

35
Q

What is the diagnostic and treatment course for meningitis

A

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

36
Q

Describe the presentation of a hypertensive headache

A

headache usually resulting from a diastolic BP >130

37
Q

Describe the common types of brain tumors

A

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

38
Q

Describe headaches secondary to brain tumor

A
  • worsening over days-weeks
  • usually worse in the morning with nausea/vomiting
  • weakness, paralysis, sensory deficits, cranial nerve palsies, visual disturbance, ataxia, AMS, seizure
39
Q

Describe the etiology of astrocytomas

A

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

40
Q

Describe the etiology of meningiomas

A

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

41
Q

Describe acoustic neuroma etiology

A
  • benign, slow growing tumor, from Schwann cell sheath around the vestibulo-cochlear nerve (CN8)
  • occupies the cerebellopontine angle
42
Q

Describe metastatic brain tumors

A

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

43
Q

Describe the grades of astrocytomas and survivability

A
  • low grade: 6-8 years
  • anaplastic astrocytoma: 5 yrs with surg/radiation
  • glioblastoma multiforme: most malignant, <1yr
44
Q

Describe the symptoms of acoustic neuromas

A
  • unilateral hearing loss, tinnitus
  • vertigo
  • headache
  • facial numbness/weakness
45
Q

Describe the treatment of meningiomas

A

observation, surgical (not usually radiation or chemo)

46
Q

Describe the treatment of acoustic neuromas

A

surgical excision, gamma knife, or observation

47
Q

Describe the treatment of metastatic brain tumors

A

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

48
Q
A

Astrocytoma

49
Q
A

glioblastoma multiforme

50
Q
A

meningioma

51
Q
A

acoustic neuroma

52
Q
A

cerebral metastases

53
Q

What are the diagnostic tests for brain tumors

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

Geriatrics (34 decks)

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