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CDM2 - Final > Jaynstein - HA > Flashcards

Jaynstein - HA Flashcards

1
Q

what do you think of when you see a HA with greatest intensity at the onset or HA that hurts intensely and then gets better

A

SAH

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2
Q

often missed PE exam with HA eval

A

fundoscopic

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3
Q

HA’s account for __% of ER visits

A

15

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4
Q

__% of HA’s occur in women

A

70

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5
Q

__% of HA’s are attributable to primary causes

A

80-90%

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6
Q

t/f: there is a genetic component to HA’s

A

t!

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7
Q

1st step in HA work up

A

differentiate primary cause vs secondary cause

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8
Q

3 types of primary HA

A

tension
migraine
cluster

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9
Q

mc overall primary HA

A

tension

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10
Q

mc type of HA seen in primary care

A

migraine

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11
Q

cluster HA’s account for __% of HA’s

A

0.4

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12
Q

cluster HA’s have __ predominance (gender)

A

male

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13
Q

4 causes of secondary HA

A

infxn
trauma
stroke syndromes
rebound

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14
Q

what type of HA is located on 1 or both sides of head

A

migraine

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15
Q

what type of HA is located on 1 or both sides of head OR neck

A

tension

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16
Q

what type of HA is located on the face, forehead, and between the eyes

A

sinus

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17
Q

what type of HA is located on one side of the head and extends from behind the eyes

A

cluster

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18
Q

duration of migraines

A

4-72 hr

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19
Q

duration of tension HA

A

2 hr - days

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20
Q

duration of sinus HA

A

days if untreated

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21
Q

duration of cluster HA

A

30-90 min

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22
Q

which type of primary HA is limited to mild-mod severity

A

tension

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23
Q

which primary HA is severe intensity

A

cluster

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24
Q

how intense are migraines

A

mild vs mod vs severe

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25
Q

how intense are sinus HA

A

mild to severe

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26
Q

tx for sinus HA

A

decongestants
abx

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27
Q

tx for cluster HA

A

100% O2
triptans

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28
Q

which type of HA requires the most preventive tx

A

migraines

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29
Q

t/f: migraines are overdiagnosed

A

t!

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30
Q

3 causes of HA due to infection

A

sinusitis
meningitis
encephalitis

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31
Q

4 causes of HA due to trauma

A

CVA/TIA
SAH
dissections
temporal arteritis

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32
Q

what 2 types of HA are related to CSF fluid abnormalities

A

spinal HA (30%)
pseudotumor cerebri

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33
Q

pregnancy-related HA

A

preeclampsia

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34
Q

t/f: you can simply dx a HA as “HA”

A

t!

don’t always need to specify type

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35
Q

what type of HA is always bad until proven otherwise

A

new onset HA’s in pt’s > 50 yo

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36
Q

historical/exam findings that indicate secondary cause of HA (10)

A

-systemic dz
-new/different pattern
-new HA in pt > 50 yo
-focal neuro sx
-seizure
-sx provoked by standing, lying down, valsalva, cough, or sex
-hx of neoplasia
-immunosuppression/HIV
-sudden onset
-papilledema

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37
Q

t/f: response to therapy is a good indicator of underlying HA pathology

A

f! -> level C

pt’s w. SAH can feel great after tx and then die

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38
Q

6 indications for further work up for HA

A

-age <5 or > 50 w. no prior HA hx
-progressive in frequency or severity
-HA awakens pt from sleep
-change in HA pattern
-systemic sx
-temporal artery tenderness

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39
Q

what do you think when you see a HA that is progressive in frequency or severity

A

-medication misuse
-subdural hematoma
-mass lesion

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40
Q

4 indications for ER with HA pt

A

-worst HA of life
-thunder clap HA - sudden onset reaching severe max intensity w.in minutes
-rapid onset w. strenuous exercise
-neuro deficits - LOC, AMS

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41
Q

2 underlying pathologies of thunderclap HA

A

ICH
meningitis

42
Q

2 underlying pathologies of HA that has rapid onset w. strenuous exercise

A

SAH
carotid artery dissection

43
Q

6 PE components of HA work up

A

bp -> elevated is bad
fundoscopy
bruits
temporal artery inspection/palpation
meningismus
neuro exam -> motor/sensory/gait

44
Q

t/f: labs are helpful when diagnosing primary HA

A

f!

45
Q

what should you be thinking about if you order labs for a primary HA

A

secondary HA

46
Q

first line imaging for HA

A

CT without contrast

47
Q

4 definite indications for CT w.o contrast for HA

A

focal neuro sx
onset of HA w. exertion or sex
worst HA of life
CHA (concussion HA) w. LOC

48
Q

6 maybe indications for CT w.o contrast for HA

A

CHA w.o LOC
recent significant change in HA pattern
progressive worsening HA despite therapy
onset after 50 yo
cancer hx
unresponsive to tx

49
Q

what is usually more helpful for HA dx than labs or imaging

A

HA diaries/logs

50
Q

what type of HA is responsible for the most disability

A

migraine

51
Q

are migraines mc in men or women

A

women

52
Q

7 characteristics of a migraine

A

4-72 hr
unilateral
throbbing
worse w. exercise/activity
mod-severe pain
n/v
light/sound sensitivity

53
Q

what %age of migraine pt’s have associated aura

A

30

54
Q

mc type of aura/hallucination associated w. migraines

A

visual (lights/flashes/floaters/halos)

less common: sensory, linguistic, motor

55
Q

__ is very uncommon w. migraines and should make you think about a psych disorder

A

auditory hallucination

56
Q

criteria for migraine w. aura

A

at least 5 attacks fulfilling:
-lasts 4-72 hr (treated or untreated)
-has at least 2 of : unilateral, pulsating, mod-severe intensity (inhibits ADLs), aggravated by walking stairs or similar activity
-during HA at least one: n/v, photophobia, phonophobia
-H&P/neuro exam excludes underlying d.o

57
Q

migraine w. aura criteria

A

at least 2 attacks fulfilling 3 out of 4:
-one or more fully reversible aura sx indicating focal, cerebral, cortical, and/or brain stem dysfxn
-at least 1 aura sx develops gradually over > 4 min
-2 or more sx occur in succession
-no aura sx lasts > 60 min
-HA follows aura w. free interval of < 60 min
PLUS:
H&P/neuro exam excludes underlying d.o

58
Q

t/f: you can make the diagnosis of migraine before assessing if pt meets all the criteria

A

f!
pt must meet criteria

59
Q

treating migraines in what time period leads to better outcomes

A

w.in the first 2 hr of attack

60
Q

t/f: HA’s are overtreated

A

f!
they are undertreated -> leads to chronic HA syndromes

61
Q

what is the goal of HA tx (6)

A

treat promptly
limit HA to 2 hr or less
optimize op tx
reduce ER visits
minimize s.e of meds
minimize use of narcotics

62
Q

effective HA tx should reduce # of HA related doc visits to __

A

2/mo

63
Q

4 preventive migraine meds

A

antidepressants
anticonvulsants
bb
ccb

64
Q

ccb are most effective for what type of HA

A

cluster

65
Q

4 abortive meds for HA (this excludes narcotics bc… just don’t)

A

NSAIDs/APAP/ASA
triptans
combos: butalbital/apap/caffeine
DHE

66
Q

t/f: OTC analgesics should not be first line tx for migraines in the hospital setting

A

f!
always start w. first line, even in hospital setting

67
Q

go to first line tx for migraines

A

400 mg IBU

68
Q

there is no clinical benefit to IBU over __ mg

A

400

69
Q

what is the ceiling for toradol:
max age for toradol:

A

15 mg
65 yo

70
Q

black box warning for toradol

A

no more than 5 days dt risk of renal failure

71
Q

admin of toradol must first be __ before you can give it PO

A

IM or IV

72
Q

2nd line abortive tx for migraines if pt does not respond to OTC analgesics

A

sumatriptan (imitrex)

73
Q

t/f: you can’t give a pt imitrex unless you have diagnosed them with a migraine

A

f!
give it early

74
Q

OTC analgesics/caffeine combo are very effective for migraines, but what is the risk of this combo

A

rebound HA

75
Q

benefit of ASA over NSAIDs for migraines

A

ASA is cardioprotective, whereas NSAIDs increase risk for CVA

76
Q

be cautious prescribing ASA for migraine if you suspect

A

SAH

77
Q

migraine w. aura increases risk for (2)

A

stroke
heart attack

78
Q

you should consider preventive migraine tx if (3)

A

> 1 HA/week
miss work
associated complex sx

79
Q

preventive migraine tx takes __ weeks to be effective

A

8-12 weeks

80
Q

3 very effective OTC preventive migraine tx options

A

petadolex (butterbur)
Mg supplement
coenzyme Q10

81
Q

t/f: petalodex is safe for kids

A

t!
good for kids and adults

82
Q

Mg supplements are esp effective for what type of migraine,

and can also help with __

A

migraine w. aura
sleep quality

83
Q

coenzyme Q has an added benefit of

A

lowering bp

84
Q

what class of med can be used for migraine prevention, but is not first line dt s.e profile

A

antiepileptics:
divalproex sodium
gabapentin
topiramate

85
Q

what 3 antidepressants are effective for migraine prevention

A

amitryptiline
nortriptyline
fluoxetine

86
Q

what 3 bb are effective for migraine prevention

A

propranolol
timolol
atenolol

87
Q

what 2 ccb are best for migraine prevention

A

diltiazem
verapamil

88
Q

what type of stroke is associated w. migraines w. aura

A

occipital

89
Q

what increases risk for heart attack and stroke with aura migraines

A

estrogen-based OCP

consider progesterone only OCP

90
Q

recurring HA that is induced by repetitive and chronic use of acute meds

A

rebound HA

91
Q

t/f: tx for rebound HA’s is ineffective until meds have been withdrawn and washout or med withdrawal occurs

A

t!

92
Q

3 other names for rebound HA

A

medication/drug induced/misuse
analgesic rebound
ergotamine rebound

93
Q

what HA meds can lead to rebound HA

A

all of them!

but esp opioids and caffeine

94
Q

5 lifestyle migraine triggers

A

emotional stress
dpn
too little sleep
exercise/overactivity
skipping meals/fasting

95
Q

6 food triggers for migraine

A

chocolate
nuts/nut butters
dairy
red wine/etoh
processed meats
MSG

96
Q

2 physical triggers for migraines

A

menstrual cycle
other hormone changes

97
Q

4 environmental triggers for migraines

A

weather/seasonal changes
time travel :)
odors/pollution
bright light

98
Q

3 common tx pitfalls for HA’s

A

misdiagnosing migraines
overtreating HA and causing rebound
undertreating HA

99
Q

abortive HA cocktail that Jaynstein likes

A

Compazine + Benadryl +/- Toradol

Reglan as alternative to Compazine
caution w. Toradol

100
Q

compazine treats (2)

A

HA
nausea

101
Q

route of admin for HA cocktail

A

PO
IM -> lasts longer, easier admin
IV

102
Q

preventive migraine tx that Jaynstein likes

A

Propranolol + SSRI
PLUS
Excedrin or Triptan for acute episodes

CDM2 - Final (9 decks)

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