Neurological Flashcards
Tension headache characteristics
Pressing, NON-PULSATING pain
Mild to moderate intensity
Usually BILATERAL location
0-1 following: nausea, photophobia, photophobia
Female:Male= 5:4
Migraine w/out aura characteristics
Lasts 4-72 hours with >2:
Usually UNILATERAL location, occasionally bilateral
PULSATING quality
Moderate to severe intensity
AGGRAVATED by normal activities
>1: nausea, vomiting, photophobia, phonophobia
Female:Male= 3:1
Migraine with aura characteristics
H/A occurs with or after aura
Feelings of Dread, ANXIETY, unusual fatigue, nervousness or excitement.
Positive family hx in 70-90%
Cluster headache characteristics
Often located BEHIND EYE with a steady, intense “HOT POKER IN THE EYE” intensity. Lasting 15min to 3 hours with most in the range of 30-45 min.
Ipsilateral autonomic signs such as lacramation, conjunctival injection, ptosis, & nasal stuffiness.
Female:Male= ~1:3 or 1:8
Examples of primary headaches
Migraine (with or w/out aura), tension headache, cluster headache
Causes of secondary headaches
Tumor, intracranial bleeding, increased ICP, medications (nitrates), meningitis, accelerated HTN, giant cell arteritis, or viremia.
Red flags with headaches
Systemic symptoms- fever, wt loss, ect.
Neuro sx- confusion, nuchal rigidity, papilledema, cranial nerve dysfunction, or abnormal motor function.
Sudden onset, “thunderclap”, headache with exertion, sexual activity, coughing, sneezing.
Age of onset >50 or
Sx of increased ICP
H/A, nausea/vomiting, increased BP, confusion to time, location, person, double vision, pupils interactive to light.
Medications for migraines
Triptans (selective serotonin receptor agonists), ex- sumatriptan Imitrex
Selected ergot derivatives ex- dihydroergotamine Migranal
Prophylactic medications for migraines
Beta-blockers: metoprolol, propranolol
Tricyclic antidepressants: amitriptyline, nortriptyline
Antiepileptic drugs: divalproex sodium (Depakote), sodium valproate (Depacon), topiramate (Topamax)
Supplements: butterbur, feverfew, coenzyme Q10, mag, riboflavin
Lithium (cluster headaches)
CCB: verapamil
Classic triad for Giant cell arteritis
Fever, normal WBC count, increased sed rate.
Giant cell arteritis etiology
Autoimmune vasculitis that affects medium & large-sized vessels as well as the temporal artery.
Inflammation & swelling of the arteries leads to decreased blood flow & its associated symptoms.
Treatment of giant cell arteritis
Tx aimed to reduce pain & minimize risk of blindness.
High-dose corticosteroids (1-2mg/kg per day prednisone until disease is stabilized). Continue lower dose 6mths-2 years.
ASA to reduce stroke risk.
PPI for GI cytoprotection.
Biphosphonate for bone protection.
Dietary triggers for migraines
Sour cream, pickled, fermented foods, MSG, yeast products, onions, citrus fruits, caffeine, ETOH, aspartame.
Kernigs sign
Flexing pt’s hip 90 degrees, then extending the pts knee-leads to meningeal pain.
Brudzinskis sign
Flex ion of the pts neck causes flexion (involuntary) of pts hips & knees. Meningeal pain.