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Clin Med, Path, Pharm > Neuro: Headaches > Flashcards

Neuro: Headaches Flashcards

1
Q

The headache and associated symptoms are the disorder itself

A

Primary headaches

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2
Q

Types of primary headaches

A 
Migraine
Tension
Cluster
Paroxysmal Hemicrania
Chronic Daily HA
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3
Q

Types of secondary headaches

A 
Infection
Mass
Hemorrhage
Temporal Arteritis
Glaucoma
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4
Q

What are the four phases of migraine headache?

A

Prodrome
Aura (+/-)
Headache
Postdrome

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5
Q

Two categories of migraines

A

WIth aura and without aura

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6
Q

Euphoria, depression, irritibaility, food cravings, constipation, neck stiffness, and increased yawning are examples of what?

A

Prodromal symptoms

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7
Q

What are the four types of aura?

A

Visual
Sensory (tingling, numbness)
Verbal
Motor disturbances (weakness to hemiparesis)

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8
Q

Common migraine triggers

A 
Glare
Sounds
Hunger
Stress
Physical exertion
Stormy weather
Hormonal changes
Lack of sleep
Alcohol/chemical stimulation
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9
Q

MIgraine pathophysiology

A

Cortical spreading depression (wave of depolarization that spreads across the cerebral cortex)
Neurovascular system becomes hyperexcitable
Activation of trigeminal nerve terminal

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10
Q

What happens as a result of activation of trigeminal nerve terminal in migraine headache?

A

release of CGRP, seratonin, and inflammatory cytokines

also substance P, neurokinin A, glutamate, and prostaglandin

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11
Q

What stage should migraines ideally be treated in?

A

When pain is at first generation neurons in trigeminal nucleus caudalis

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12
Q

What happens if migraines are not treated adequately in first stage?

A

2nd and 3rd generation neurons are activated. Cutaneous allodynia results
Meds are less effective here

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13
Q

What is important in treatment of acute migraines?

A

Activation of serotonin receptors

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14
Q

Vasodilator associated with migraines

A

CGRP

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15
Q

Who should get imaging studies with migraines?

A

Most patients don’t need it.
Recommended in pts atypical features, sudden severe HA (r/o SAH)
First or worst headache
unexplained neuro symptoms
New onset after 50
not responding to tx
sx suggesting meningitis or encephalopathy

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16
Q

Meds taken within first 1-3 hours of onset of migraine

A 
Rescue meds
NSAIDS (Toradol, advil, naproxen, diclofenac)
Triptans
Ergots
Antiemetics
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17
Q

How many migraines warrents the need for prophylactic meds?

A

> 4 migraines/month

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18
Q

What are examples of preventative migraine meds?

A

antiepileptic drugs
Beta blockers
Antidepressants

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19
Q

What combination of meds is often used at migraine onset?

A

NSAID and triptan

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20
Q

MOA of triptan

A

serotonin agonist. Inhibit the release of vasoactive peptides, promote vasoconstriction, and block pain pathways. Inhibit transmission in trigeminal neuclus caudalis

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21
Q

Available triptans

A

SUmatriptan, zolmitriptan, naratriptan, rizatriptan, almotripan, eletriptan, frovatriptan

22
Q

Who should NOT take triptans?

A

pts with stroke, heart disease, uncontrolled HTN, pregnancy, or in someone who used Ergotamine preparations within the last 24 hours

23
Q

SE of triptans

A

paresthesia, dizziness, flushing, chest pain, diaphoresis, N/V, myalgias

24
Q

What antiemetics are used in acute treatment of migraines?

A

Reglan, cholrpromazine, procholrperazine, droperiodl

25
Q

What is sometimes given with antiemetics to prevent akathisia and acute dystonia side effects?

A

Benadryl

26
Q

What should you always give when you are prescribing an Ergot (dihydroergotamine, DHE45)

A

Antiemetic

can cause severe nausea

27
Q

MOA: alpha-adrenergic blocker that directly stimulates vascular smooth muscle to vasoconstrict peripheral and cerebral vessels

A

Dihydroergotamine (DHE45)

28
Q

C/I of Dihydroergotamine

A

Uncontrolled HTN, heart disease, angina, hemiplegic migraine, PVD, sepsis, severe hepatic/renal function.
Cannot use within 24 hours of triptan

29
Q

Used for migraines lasting longer than 72 hours (status migrainosis)

A

Steroids (Dexamethasone and Prednisone)

30
Q

What are preventative treatments for migraines?

A

Antihypertensives (BB, ACEI, CCB, ARBs), Antidepressants, Anticonvulsants

31
Q

You prescribe metoprolol for preventative treatment of migraines. One month later your pt is saying its not working and would like to switch. What do you say?

A

Takes at least 3 months of an effective dose before you can say the med is a failure

32
Q

beta blockers used in preventative treatment of migraines

A

Metoprolol
Propanolol
Timolol

33
Q

What antidepressants are given for migraine preventative treatment?

A

TCAs

34
Q

SE of TCAs

A 
anticholinergic SE
tachy, palpitations
Ortho hypotension
weight gain
blurred vision
35
Q

What anticonvulsants are used to prevent migraines?

A

Valproate (Depakote) Topiramate (Topamax)

36
Q

C/I of Valproate

A

pregnancy

do NOT use in women of child bearing age

37
Q

C/I of Topiramate (Topamax)

A

Hx of kidney stones, GLAUCOOMA

38
Q

Role of butterbur, feverfew, magnesium, and vitamin b12 with migraines

A

MAY be beneficial

39
Q

most prevalent headache in the general population

A

Tension

40
Q

What categorizes someones tension HAs to be infrequent? frequent? chronic?

A

Infrequent: <1 month
Frequent: 1-14 days/month x 3 months
Chronic: 15+ days/month

41
Q

Difference in pathophys of tension HA vs migraine HA

A

Tension: primary d/o of CNS pain modulation alone
Migraine: generalized disturbance of sensory modulation

42
Q

Feature that distinguishes tension from migraine

A

muscle contraction

43
Q

Only proven treatment for tension headaches

A

Amitriptyline (Elavil)

44
Q

Headaches in Trigeminal Autonomic Cephalgias

A

Cluster headaches
Paroxysmal hemicrania
SUNCT

45
Q

Cluster headaches that occur daily (1-8x/day) for several weeks, followed by a period of remission

A

Episodic cluster headache

46
Q

Cluster headaches that occur daily (1-8x/day) without remission

A

Chronic cluster headache

47
Q

Autonomic clinical features of cluster headache

A

Ptosis, miosis, lacrimation
Conjunctival injection
Rhinorrhea
Nasal congestion

48
Q

Theories of pathophys of cluster headache

A
  1. hypothalamic activation (trigeminal atuonomic reflex is then activated)
  2. inflammation of cavernous sinus that injures traversing sympathetic fibers of carotid artery
49
Q

Neuroimaging in Cluster

A

suggested with MRI brain w and w/o contrast or CT to exclude brain and pituitary gland abnormalities

50
Q

Treatment of choice to prevent cluster headaches

A

Verapamil (Calan)

Steroids, topamax, and lithium may also be used

51
Q

First line acute rescue treatment of cluster ha

A

Oxygen inhalation AND

SQ or nasal Sumatriptan or Zolmitriptan

52
Q

Complete line of acute rescue tx for cluster headaches

A

Oxygen inhalation and triptan (first line)
DHE
Lidocaine (IN)
Octreatide

Clin Med, Path, Pharm (12 decks)

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