Hon: Headache Flashcards by Kaitlynn Loper

Secondary headaches are a sign of?

Organic disease

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What are the 10 worrisome signs which may indicate headache of pathologic origin (secondary HA)?

“Worst HA”
Onset of HA after age 50
Atypical HA for patient
HA w/ fever
Abrupt onset (max. intensity in sec. to min.)
Subacute HA w/ progressive worsening over time
Drowsiness, confusion, memory impairment
Weakness, ataxia, loss of coordination
Paresthesias/Sensory loss/ Paralysis
Abnormal medical or neurological exam

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Any patient presenting with a headache who has a “worrisome history” or abnormal examination needs what?

Urgent imaging study
Perhaps even a L.P. and possibly arteriogram

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Differentiate a common migraine from a classic migraine.

Common migrarine = without aura
Classic migraine = with aura

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What is the intensity, age of peak prevalence, and gender ratio for common migraines?

Intensity: moderate to severe
Prevalence peaks between 35-40 years
Gender ratio: F:M = 3:1

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What is the location, patient description of pain, and patient behavior with a common migraine?

Location: unilateral or bilateral
Description: throbbing/sharp/pressure
Behavior: retreat to dark, quiet room

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What are the 4 most common associated symptoms with a common migraine?

Nausea
Vomiting
Photophobia
Phonophobia

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What are the common visual symptoms associated with Classic Migraines?

Scintillations: flashes of light
Scotoma: an interruption or break in the visual field (blind spots)

*Often hemianopic

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The most widely discussed theory about the cause of migraines says that they are caused by?

Neurogenic inflammation

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To be defined as a chronic migraine which criteria must be met?

Headache for 15 or more days/month, lasting 4 hours or longer, for a period of at least 3 months

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What is the intensity and disability caused by Tension-Type HA’s?

Intensity: Mild to Moderate
Disability: May inhibit, but does NOT prohibit daily activities

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What is the common location, patient description of pain, and is there an associated aura/prodrome with a Tension-Type HA?

Location: bifrontal, bioccipital
Description: dull, aching, squeezing, pressure
No prodrome or aura

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Which type of headache has an association with sleep apnea as a comorbidity?

Cluster HA

*This will be on the exam!

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What is the intensity and gender ratio for Cluster HA?

Intensity: severe, excruciating
Gender ratio: F:M = 1:6

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In regards to monthly frequency what constitutes an episodic type vs. chronic type of Cluster HA?

Episodic type: 1 or more attacks/day for 6-8 weeks
Chronic type: several attacks per week without remission

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What is the most common location/distribution of Cluster HA’s?

100% unilateral
Generally orbitotemporal

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Frenetic, pacing, and rocking behaviors are most often associated with what type of headache?

Cluster HA

What are some of the associated symptoms of Cluster HA’s?

Ipsilateral ptosis
Miosis
Conjunctival injection
Lacrimation
Stuffed or runny nose

What is the normal duration for a Cluster HA?

30 minutes to 2 hours
Classic is 45 min

What are the 5 primary types of HA?

Classic migraine
Common migraine
Chronic migraine
Tension type HA
Cluster HA

What is the only FDA approved treatment for chronic migraines?

BOTOX injections

What are some underlying conditions which are contraindications for the use of Triptans in the acute treatment of migraines?

Ischemic heart disease
Cardiovascular, cerebrovascular, or peripheral vascular disease
Raynaud’s syndrome
Uncontrolled HTN
Hemiplegic or basilar migraine
Severe renal or hepatic impairment

Which agent/therapy can be used to break the cycle of a prolonged migraine or several weeks of frequent migraines?

Also, a good treatment for people who get in frequent cluster HA’s?

A prednisone taper

What’s Trigeminal Neuralgia?

Treatment?

Excruciating sharp, shooting, electrical quality pain occuring in paroxysms in one or more distributions of the trigeminal nerve, often freqent through the day
Treatment is usually carbamazepine or oxcarbamazepine

A group of headache disorders characterized by unilateral trigeminal distribution pain that occurs in association with prominent ipsilateral cranial autonomic features, describes what?

Trigeminal autonomic cephalgia (TAC's)

What 5 types of headache disorders are classified as Trigeminal Autonomic Cephalgias (TAC's)?

1. Cluster HA 2. Paroxysmal hemicrania 3. Hemicrania continua 4. SUNCT syndrome 5. SUNA syndrome (similar to SUNCT, but with autonomic sx's)

What are the characteristics of SUNCT syndrome? Location? Onset and which sex is most commonly affected?

- Shortlasting, **unilateral**, neuralgiform headache attacks w/ conjunctival injection and tearing - Excruciating, burning, stabbing electrical HA in **periorbital** area lasting **seconds to a few mins**, occuring **frequently** throughout the day - Onset typically **over 50** in **men**

What is the treatment for SUNCT syndrome?

- Usually anticonvulsants - Particularly **lamotrigine**

Which HA type is **very similar to cluster HA**, but **shorter duration** (often only a few mins) and **increased frequency** (usually \>5 times per day)?

Paroxysmal Hemicrania

Paroxysmal Hemicrania (HA) is exquisitely reponsive to which drug?

Indomethacin

As a general rule, many physicians (including neurologists) believe that any person with HA should have what type of evaluation?

A **one-time**, thorough neuroimaging study (**CT head with AND w/o contrast** or **MRI** of head)

What's a good oral tx for someone experiencing multiple cluster HA's in a year?

Verapamil (Ca²⁺ channel blocker)

What is the most likely organism to cause meningitis in adults?

Strep pneumo

What are some s/s of meningitis in newborns?

Contstant crying Excessive sleepiness Inactive Poor feeding **Bulging fontanelle** Stiff neck

What should you use to treat meningitis if an LP and imaging are not **immediately** available?

**ALL IV MEDS** _Steroid_ - dexa 3rd gen _cephalosporin_ - cephtriaxone _Vancomycin_

What are some common causes of infectious encephalitis in healthy adults?

**HSV1/2** HIV West nile Varicella Syphyllis

How does HSV1 encephalitis present? Where does it like to infect? What is a common complication? What's the Rx?

- S/s: fever, HA, unconcious, seizures, focal neuro sx - Will see **temporal lobe** abnml on MRI/EEG - Can cause secondary **autoimmune encephalitis** - Rx: acyclovir

When should you consider autoimmune encephalitis as a dx?

Rapidly **progressive** encephalopathy or **psych** disturbances, especially if **seizure** is present

What are the **s/s** of NMDA encephalitis? What are 2 findings? What is an assc? Prognosis?

- S/s: behavior change, seizures, movement disorder, unconscious, hypoventilating - Findings: extreme delta brush on EEG, oligoclonal bands on LP - Assc: teratoma - Prognosis: good with aggressive treatment

Which autoimmune encephalitis' are assc with each gender?

Male = LGl1 encephalitis Female = NMDA encephalitis

What are the s/s of LGl1 encephalitis? Location? Prognosis?

- S/s: **faciobrachial dystonic seizures** that are very brief and occur on one side of the body, sleep disturbances - Acutely abnml temporal lobe - Prognosis: failure to ID causes permanent brain injury