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Neuroscience 2 > LE 3: Approach to a Patient with Headache > Flashcards

LE 3: Approach to a Patient with Headache Flashcards

0
Q

ushered in by an evident disturbance of nervous function, most often visual, followed in a few minutes by hemicranial or in about 1/3 of cases by bilateral headache, nausea, and sometimes vomiting, all of w/c last for hrs or as long as day or 2

A

Migraine w/ aura

“classic” or Neurologic migraine

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1
Q

familial d/o, periodic, unilateral, often pulsatile, begin with childhood or early adulthood and diminishing in frequency during advancing years

A

Migraine

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2
Q

unheralded onset over mins or longer of hemicranial headache or less often, by generalized headache w/ or w/o nausea and vomiting, w/c then follows the same temporal pattern as the migrain w/ aura

A

Migraine w/o aura

“common” migraine

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3
Q

1:5

male: 4-6%
female: 13-18%

asians: lower prevalence

A

Migraine

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4
Q

is an instrument often used for verbal assessment of pain

A

The McGill Pain Questionnaire

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5
Q

common clinical complaint w/c rivals backache as a reason to seek medical help

A

Headache

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6
Q

headache:

medical vs neurologic dses

A

medical > neurologic dses

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7
Q

epidemiology: young women w/ family hx of migraine

s/sx: 
    vertigo
    incoordination
    staggering
    incoordination of limbs
    dysarthria

visual phenomena: whole visual field of OU (temp. cortical blindness)

duration: 10-30mins followed by headache

A

Basilar Migraine

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8
Q

s/sx: recurrent unilateral headache assoc w/ weakness of EOM

CN affected w/ manifestion :
transient 3rd nerve palsy w/ ptosis w/ or w/o pupillary involvement
6th nerve rarely affected

duration: paresis often outlast the headache by days or weeks

A

Opthalmoplegic Migraine

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9
Q

most common variety of headache, frontal, temporal or occipitonuchal predominance, pain is dull and aching, sometimes described as fullness, tightness/pressure, does not interfere w/ ADL

middle age w/ anxiety, fatigue, and depression

A

Tension-Type Headache (TTH)

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10
Q

Frequency:

least 10 previous headaches fulfilling crit B-D

A

Frequent TTH

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11
Q

frequency:
ave. > or = to 15d/mo. (180d/yr) for > = 6 mos fulfilling crit. C-D

at least 2 pain char:

  1. Pressuring/tightening (nonpulsating) quality
  2. Mild-moderate intensity
  3. Bilateral location
  4. no aggravation by walking stairs or similar routine, physically activity

both of the ff:

  1. no vomiting
  2. no more than one of the ff:
    a. nausea
    b. photophobia
    c. phonophobia
  3. not attributed to any d/o
A

Chronic TTH

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12
Q

Paroxysmal hemicrania, short-acting unilateral neuralgiform headache attacks w/ conjunctival infection and tearing(SUNCT)

young adult men (20-50yo)
M:F 5:1
occur regularly each day for 6-12 weeks

A

Cluster headache and other trigeminal autonomic cephalgias

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13
Q

severe, chronic, intermittent
days or weeks
r/t injury

A

post-traumatic

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14
Q 
headache w/:
   Drowsiness
   Confusion
   Stupor
   Hemiparesis
A

Post-traumatic:

Acute/Chronic

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15
Q 
Headache is a prominent ft. complex syndrome:
  Giddiness
  Insomnia
  Fatigability
  Irritability
  Nervousness
  Inability to concentrate
  Trembling
  Tearfulness
A

Post-traumatic nervous instability

16
Q

unilateral/bilateral retroauricular or occipital pain d/t stretching or tearing of the ligaments and muscles of occipitonuchal junxn

A

Post-traumatic:

whiplash injury

17
Q

severe, episodic, throbbing, unilateral headache sometimes accompanied by ipsilateral mydriasis and excessive sweating of the face

A

Post-traumatic:

dysautonomic changes

18
Q 
infrequent headache
deep seated
non-throbbing
aching
nocturnal awakening
inc. ICP
dependent on tumor site
A

Brain tumor:

non specific features

19
Q

Increasingly intense throbbing or non-throbbing, unilateral and localized to the affected artery, pain persistent throughout the day and severe at night, ESR >50mmH, elderly pt (60yo) Biopsy of affected vessel is granulomatous or giant cell arteritis, tx w/ steroids improvement in 1-2days. failure to improve will bring dx into question

A

Temporal Arteritis

20
Q

headache assoc w/ greatly reduced pressure of CSF compartment and probably caused by traction of cranial blood vessels

A

Low pressure and spinal puncture headache

21
Q

headache d/t drop in estradiol levels

A

Menstrual migraine

22
Q

Generalized headache may occur in conjunxn w/ flushing of the face and hands and numbness of fingers

A

Erythrocyanotic

23
Q

follows in initiating action within a second or two, last a few seconds to few minutes

A

Cough and exertional headache

24
Q

headache w/ sexual excitement
- TTH

headache w/c occur at time of orgasm
- explosive, severe and throbbing type

A

Headache r/t sexual activity

25
Q

danger signals on Examination

VSP RPM LART

A 
VSP RPM LART
abnormal V/s
altered Sensorium
Pupils unequal and/or poorly reactive
Retinal hemorrhage or Papilledema
signs of Meningeal irritation
Lateralized deficits
Ataxia of gait and/or mov'ts
abnormal Reflexes
Tender and poorly-pulsating cranial arteries
26
Q

danger signals on Hx

SPF O MMS WFC

A

SPF O MMS WFC

Sudden onset of new severe headache
Progressively worsening headache
First headache in an adult
Onset w/ exertion, coughing, straining and sexual activity
Memory loss
Myalgia
Sensorium alteration
Weakness
Fever
Clumsiness
27
Q

pt. w/ serious headache

PACISSCHM

A

PACISSCHM

Pheochromocytoma
Acute glaucoma
Cns infexn, ischemia, hemorrhage
Inc. icp
Sah
Secondary to metabolic disturbance
Cranial arteritis
Head trauma
Malignant hpn
28
Q

pt. w/ benign headache

TOMBC

A

TOMBC

Tth
Orgasmic headache
Migraine
Benign exertional headache
Cluster
29
Q

what modality?

r/o structural d/o
recurring or progressive headache
focal slowing on EEG
comorbid seizures
persistent unilateral headache
assure anxious pt or his relatives
A

Neuroimaging

30
Q

what modality?

Loss of consciousness
Depressed sensorium or alertness
Seizure
Suspected metabolic encephalopathy

A

Electroencephalogram

31
Q

what modality?

Cervical spine
Spine
Parasinuses

A

X-ray

32
Q

what modality?

Vertebral
Intracranial
Carotid
Echogram

A

Ultrasound

33
Q

what modality?

suspected MS, infiltrative or inflammatory process, inc or reduced icp

A

Lumbar Tap (CSF Analysis)

Neuroscience 2 (10 decks)

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