Mehl. Headaches + drugs Flashcards
M. 11/10 lancinating, knife-like pain that occurs as episodes lasting usually <1 minute. Dx?
Trigeminal neuralgia
M. Classically brought on by minor stimuli, such as brushing one’s hair/teeth, or a gust of wind. Dx?
Trigeminal neuralgia
M. Trigeminal neuralgia, cause?
Thought to be caused by trigeminal nerve irritation or impingement (i.e., at the exit points from the skull).
M. Trigeminal neuralgia.
There is an NBME Q where they ask what part of the brain is fucked up (i.e., they don’t list any nerves), and the answer is pons, since CN V originates from the pons.
M. Trigeminal neuralgia. what part of brain is ,,fucked up”? no peripheral nerves mentioned
Pons, since CN V originates from the pons.
M. Trigeminal neuralgia. prophylaxis?
carbamazepine.
M. Trigeminal neuralgia. Tx?
There is no Tx for acute episodes since pain lasts such short duration.
M. Trigeminal neuralgia. confused with what?
Often confused with cluster headache if occurring in the V1 (ophthalmic branch of trigeminal nerve) distribution.
M. Cluster headache. Duration?
Episodes last minutes to half hour (longer than trigeminal neuralgia), where the Q will say the guy wakes up from sleep + paces around his room until pain eventually goes away.
M. Male 20s-40s who wakes up from sleep with 11/10 lancinating, knife-like headache; often associated with ipsilateral lacrimation, rhinorrhea, and sometimes pupillary changes (I’ve seen NBME say ipsilateral miotic pupil). Dx?
Cluster headache
M. Episodes last minutes to half hour (longer than trigeminal neuralgia), where the Q will say the guy wakes up from sleep + paces around his room until pain eventually goes away. Dx?
Cluster headache
M. Cluster headache. Prophylaxis?
Verapamil
M. Cluster headache. Acute Tx?
Tx for acute episodes is oxygen (bizarre, unless patient has O2 tank lying around).
M. Unilateral throbbing/pounding headache that lasts hours. Dx?
Migraine
M. Migraine. Duration?
- Unilateral throbbing/pounding headache that lasts hours.
M. Migraine. Assoc with what?
Can be associated with prodromal visual aura or sounds.
M. Migraine. prophylaxis?
Prophylaxis is propranolol.
M. Migraine. Tx? first –> followed?
Tx is NSAIDs first, followed by triptans (e.g., sumatriptan).
M. Migraine. Triptans group?
Serotonin (5HT) receptor agonists.
Triptans are not prophylactic meds; they are only used as abortive therapy.
M. Migraine.
USMLE will give 30s female with hypertension who has migraine Hx, and the treatment is “beta blockade” for her HTN management.
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M. Migraine. what is contraindicated if aura present?
Estrogen-containing contraceptives are contraindicated in patients who have migraine with aura.
M. Bilateral, dull, band-like headache. Dx?
Tension headache
M. Tension headache. Tx?
Treated with sleep and acetaminophen.
M. Temporal arteritis. aka giant cell arteritis.
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M. 9/10 Qs will be painful unilateral headache in patient over 50. I’ve seen one Q on NBME where it’s bilateral.
M. Temporal arteritis. aka giant cell arteritis.
M. Temporal arteritis. Flares - what blood findings?
low-grade fever and high ESR.
M. Temporal arteritis. MSK CP?
Patients can get proximal muscle pain and stiffness. This is polymyalgia rheumatica (PMR). The two do not always go together, but the association is HY.
(Do not confuse PMR with polymyositis. The latter will present with incr. CK and/or proximal muscle weakness on physical exam. PMR won’t have either of these findings. I talk about this stuff in detail my MSK notes.)
M. Temporal arteritis. can get pain when doing what?
Patients can get pain with chewing. This is jaw claudication (pain with chewing).
M. Temporal arteritis. Highest yield point?
Highest yield point is we give STEROIDS BEFORE BIOPSY in order to prevent blindness.
M. Temporal arteritis. what complication we’re trying to prevent by giving STEROIDS BEFORE BIOPSY!!
An NBME has “ischemic optic neuropathy” as the answer
M. Temporal arteritis. what steroid?
IV methylprednisolone is typically the steroid given, since it’s faster than oral prednisone.
M. Temporal arteritis.
It’s to my observation many 2CK NBME Qs will give the answer as something like, “Steroids now and then biopsy within 3 days,” or “IV methylprednisolone and biopsy within a week.” Students ask about the time frames, but for whatever reason USMLE will give scattered/varied answers like that.
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M. Temporal arteritis.
Another 2CK Neuro CMS Q gives easy vignette of temporal arteritis and then asks next best step in diagnosis -> answer = biopsy. Steroids aren’t part of the answer. Makes sense, since they’re asking for a diagnostic step.
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M. drugs. Migraine. abortive therapy?
Abortive therapy: NSAIDs first, then sumatriptan (serotonin receptor agonist).
M. drugs. NSAIDs first, then sumatriptan (serotonin receptor agonist). Dx?
Abortive therapy for migraine
M. drugs. Migraine. prevention?
Prevention: propranolol (beta-blockade).
M. propranolol (beta-blockade). Dx?
Migraine. prevention
M. drugs. Cluster. abortive Tx?
Abortive therapy: oxygen.
M. drugs. Cluster. prevention Tx?
Prevention: verapamil (non-dihydropyridine calcium channel blocker).
M. drugs. verapamil (non-dihydropyridine calcium channel blocker). Dx?
Cluster. prevention
M. drugs. oxygen. Dx?
Cluster. abortive
M. drugs. tension Tx?
Rest + acetaminophen.
M. drugs. Rest + acetaminophen. Dx?
tension headache
M. Trigeminal neuralgia. Abortive?
Abortive: goes away on its own because episodes last maximum 30-60 seconds.
M. Trigeminal neuralgia. Prevention?
Prevention: carbamazepine (sodium channel blocker).
M. drugs. goes away on its own because episodes last maximum 30-60 seconds. Dx?
Trigeminal neuralgia. abortive
M. drugs. carbamazepine (sodium channel blocker). Dx?
Trigeminal neuralgia. prevention
