PDF - HA Flashcards
How does brain feel pain?
It does not, it is the effect of stretching and changes in nerves and vessels
- Tension of muscles and inflammation of adjacent mucosal structures also can cause this
What happens to arteries in migraine?
They dilate
- This is a result of the disease, not a cause of it
- Cause is neuronal dysfunction
Who at most risk for migraine?
Women with family history
- Often arise at puberty with menstruation being a trigger
What causes and aura?
Wave a depolarization over certain parts of the cortex
- Visual is form depolarization of visual occipital cortex
What is a scotoma?
Patch of blindness often seen in migraine aura
Laterality migraine?
Starts unilateral, can generalize but often does not
- Described as throbbing or pounding
Duration migraine?
Hours - 2 days
- Malaise and hangover can continue after
How does migraine start?
Spreading wave of cerebral depolarization, which is often, but does not have to have a trigger
What happens when depolarization hits trigeminal?
Nausea, vomiting, and photophobia.
What to do if there is first migraine without an aura?
MRI
When to image MRI?
- If appears later in life
- If first and no aura
- If neuro deficit
- Cognitive change
- Seizure
Med or aborting migraine?
Triptans which come in nasal, oral, IM
What is Dihydroergotamine?
Drug helpful in aborting severe migraine, delivered by
injection or nasal spray
Prophylactic migraine meds?
- Propranolol
- Verapamil
- Amitriptyline,
- Valproate / gabapentin / topiramate
How are tension HAs described?
Pressure or band like feeling around head w/o warning signs or aura
Med never to use for HA?
Butalbital
What is traction HA? Rx?
Post LP from leaking of CSF
- Positional and relieved with lying flat
Rx: injection of patient’s blood into epidural space produces “epidural blood patch” sealing dural leak
Rx Pseudotumor Cerebri?
- Weight loss
- Acetazolamide - medication to inhibit CSF production
- Shunt
- Repeated LPs
Presentation pseudotumor?
- Obese
- Similar to migraine
- Papilledema bilateral
- Brain scan with no lesion
- LP - normal CSF with high pressure giving relief
What causes papilledema in pseudotumor?
Increased ICP from impaired CSF reabsorption and can lead to blindness if not diagnosed and treated
Lab in temporal arteritis?
Very high ESR
Rx temporal arteritis?
Prompt corticosteroids to prevent blindness from
involvement of ophthalmic arteries
