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(2) MS: Neurological Conditions 🩺 > S1_L3: Headaches & Migraine > Flashcards

S1_L3: Headaches & Migraine Flashcards

1
Q

A term for the occurrence of pain or discomfort over the upper part of the head from the orbits to the suboccipital area

A

Headache

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2
Q

Most common primary headache

A

Tension headache

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3
Q

most popular and described type of headache in clinical practice

A

Migraine headache

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4
Q

A “thunderclap headache” or “worst headache of life” can be suggestive of?

A

Subarachnoid hemorrhage.

Source: Merritt’s Neurology 14th ed

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5
Q

Most common natural method of relieving headache

A

Sleep

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6
Q

Phase where the patient feels bad or good after the disappearance of the headache. Mood changes, muscular weakness, physical tiredness, and reduced apetite may be experienced by the patient during this phase.

A

Postdrome / Postdromal Phase

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7
Q

TRUE OR FALSE: Migraines have a neurovascular etiology

A

True.
The belief that migraine is a primary vascular phenomenon is no longer tenable or widely accepted.

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8
Q

Enumerate the 6 General Mechanisms of Headaches

A
  • Traction on major intracranial vessels
  • Distention, dilation of intracranial arteries
  • Inflammation near pain sensitive structures
  • Direct pressure on cranial or cervical nerves
  • Sustained contraction of scalp or neck muscles
  • Stimulation from disease of eye, ear, nose, and sinuses
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9
Q

Migraine headaches have a duration of:

A

5 attacks lasting 4-72 hours; One-day duration

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10
Q

Tension headaches have a duration of:

A

10 attacks lasting 30 mins - 7 days

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11
Q

TRUE OR FALSE: Migraines occur more often in males than females.

A

False. F > M

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12
Q

Migraines are prevalent at what age?

A

Prevalent at the age of 30-50 y/o.

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13
Q

Enumerate the four environmental migraine triggers

A
  • Bright light
  • Odors
  • Weather changes
  • Cigarette smoke
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14
Q

Migraine trigger/s that is hormonal?

A

Menstruation

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15
Q

Enumerate the five behavioural migraine triggers

A
  • Stress
  • Fasting
  • Emotions
  • Sleep disturbance
  • Too much exercise or physical activity
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16
Q

Internal bodily environment and mechanisms trigger what area of the brain?

A

Activation Site: Hypothalamus

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17
Q

The Cerebral cortex activation site is triggered/activated by?

A

Emotions, stress

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18
Q

What do vasodilators trigger?

A

The carotid vessels

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19
Q

The Thalamus is triggered/activated by?

A

Bright lights, noise, smells

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20
Q

What is osmophobia?

A

sensitivity to smells, gets irritated easily d/t smell

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21
Q

What are the phases of the migraine?

A
  • Premonitory / Prodromal
  • Aura
  • Headache phase
  • Headache termination / resolution
  • Postdrome
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22
Q

Match the medication with the severity of the migraine

  1. Sumatriptan
  2. Ibuprofen (Alaxan)
  3. Chlorpromazine
  4. Ergotamine + antiemetic
  5. Acetylsalicylic Acid (ASA) / Aspirin

Choices:
A. Mild to moderate
B. Moderate to severe
C. Extremely severe
D. None

A
  1. B
  2. A
  3. C
  4. B
  5. A
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23
Q

Enumerate the contraindications for Ergotamine + antiemetic

A
  • Women considering pregnancy & during pregnancy
  • Inadequately controlled hypertension
  • Cerebral, coronary, & peripheral vascular disease (e.g. stroke, previous heart attack, or peripheral anti-occlusive disease of the UE & LE)
  • Hepatic and renal insufficiency / Liver & kidney problems
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24
Q

Match the agent with its classification / group

  1. Propranolol
  2. Amitriptyline
  3. Topiramate
  4. Methysergide
  5. Naproxen sodium

Choices:
A. Beta-adrenergic blocking agents
B. Anticonvulsants / Antiepileptic Drug
C. Calcium channel blockers
D. Tricyclic antidepressants
E. NSAIDs
F. Serotonin antagonists

A
  1. A
  2. D
  3. B
  4. F
  5. E
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25
Q

Match the agent with its classification / group

  1. Ketorolac
  2. Divalproex sodium
  3. Pizotifen
  4. Flunarizine
  5. Imipramine

Choices:
A. Beta-adrenergic blocking agents
B. Anticonvulsants / Antiepileptic Drug
C. Calcium channel blockers
D. Tricyclic antidepressants
E. NSAIDs
F. Serotonin antagonists

A
  1. E
  2. B
  3. F
  4. C
  5. D
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26
Q

Medication for intractable migraine and status migraine

A

Dihydroergotamine IM, IV nasal

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27
Q

Most popular abortive treatment

A

Triptans (Sumatriptan, Zolmitriptan)

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28
Q

Contraindications of Sumatriptan

A
  • inadequately controlled hypertension
  • ischemic heart disease
  • pregnancy
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29
Q

Match the indication to the treatment:

  1. Attacks occurring more than 2-3 times/month
  2. Prevent migraine
  3. Attacks lasting more than 48 hours
  4. Severe attacks of headache
  5. Given during the attack
  6. Psychologically unable to cope with the headache
  7. Attacks occur after prolonged aura

A. Abortive Treatment
B. Prophylactic Treatment
C. Both
D. Neither

A
  1. B
  2. A
  3. B
  4. B
  5. A
  6. B
  7. B
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30
Q

This is present in the classical migraine

A

Aura

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31
Q

Migraine without aura is also known as?

A

Common Migraine

32
Q

TRUE OR FALSE: Abortive treatment is given when the treatment of an acute attack provides inadequate relief or therapy produces serious side effects.

A

False. Prophylactic treatment is indicated for this case.

33
Q

Match the agent with its classification / group

  1. Cyproheptadine
  2. Desipramine
  3. Verapamil
  4. Gabapentin
  5. Atenolol

Choices:
A. Beta-adrenergic blocking agents
B. Anticonvulsants / Antiepileptic Drug
C. Calcium channel blockers
D. Tricyclic antidepressants
E. NSAIDs
F. Serotonin antagonists

A
  1. F
  2. D
  3. C
  4. B
  5. A
34
Q

Match the medication with the severity of the migraine

  1. Dopamine antagonists
  2. Dihydroergotamine
  3. Isometheptene with acetaminophen
  4. Opioids
  5. Dihydroergotamine IV + metoclopramide

Choices:
A. Mild to moderate
B. Moderate to severe
C. Extremely severe
D. None

A
  1. C
  2. B
  3. A
  4. C
  5. C
35
Q

Enumerate the characteristic Red Flags or Headache Alarms

A
  • Sudden / new onset
  • Wakes the patient up from sleep
36
Q

Enumerate the associated features in Red Flags or Headache Alarms

A
  • Vomiting
  • Visual symptoms
  • Weakness / numbness
  • Meningeal irritation - Nuchal rigidity, Brudzinski’s sign, Kernig’s sign
37
Q

Match the clinical feature / symptom to the type of headache

  1. Drop attack
  2. Onset after age 50
  3. Family history of migraine headache
  4. Onset after valsalva maneuver
  5. History of bleeding diathesis

A. Primary Headache
B. Secondary Headache
C. Both
D. Neither

A
  1. A
  2. B
  3. A
  4. B
  5. B
38
Q

What does P.O.U.N.D. stand for in Migraine headaches?

A

Pulsatile quality of headache
One-day duration
Unilateral location
Nausea or vomiting
Disabling intensity

39
Q

Matching Type: Pain Sensitivity

  1. Brain parenchyma
  2. Choroid plexus
  3. Scalp
  4. Cranial venous sinuses
  5. Dural sinuses

Choices:
A. Pain sensitive
B. Pain insensitive
C. Both
D. Neither

A
  1. B
  2. B
  3. A
  4. A
  5. A
40
Q

Matching Type: Pain Sensitivity

  1. Dura near the base of the brain
  2. Arachnoid mater
  3. Skull
  4. Extracranial structures
  5. Dura over convexity of the brain

Choices:
A. Pain sensitive
B. Pain insensitive
C. Both
D. Neither

A
  1. A
  2. B
  3. B
  4. A
  5. B
41
Q

Matching Type: Pain Sensitivity

  1. Skin of head
  2. Pia mater
  3. Dural arteries
  4. Ventricular ependyma
  5. Pial veins

Choices:
A. Pain sensitive
B. Pain insensitive
C. Both
D. Neither

A
  1. A
  2. B
  3. A
  4. B
  5. B
42
Q

Matching Type: Pain Sensitivity

  1. Arteries at base of brain
  2. Anterior cerebral artery
  3. Proximal segments of large pial arteries
  4. Falx cerebri
  5. Middle cerebral artery

Choices:
A. Pain sensitive
B. Pain insensitive
C. Both
D. Neither

A
  1. A
  2. A
  3. A
  4. A
  5. A
43
Q

TRUE OR FALSE: Headaches are commonly orthostatic in nature, occurring in the upright position and resolving or notably improving upon lying supine.

A

True.
Source: Merritt

44
Q

Enumerate underlying causes of secondary headaches

A
  1. CNS infection
  2. Neoplasm, tumors in brain
  3. Cardiovascular disease (2º to strokes)
  4. Malignant hypertension
45
Q

TRUE OR FALSE: In a primary headache, the headache and associated features constitute the disorder itself and there is no underlying cause.

A

True.
Source: Merritt

46
Q

Migraine vs Tension Headache

  1. Associated sx of nausea, photophobia, phonophobia
  2. Mild to moderate intensity
  3. Moderate to severe intensity
  4. Bilateral
  5. Unilateral

Choices:
A. Migraine headache
B. Tension headache
C. Both
D. Neither

A
  1. A
  2. B
  3. A
  4. B
  5. A
47
Q

Migraine vs Tension Headache

  1. Throbbing
  2. Pain on temples, can radiate to neck or shoulder
  3. Can have one associated sx or neither
  4. Aggravated by physical activity
  5. No effect; may inhibit but not prohibit activities

Choices:
A. Migraine headache
B. Tension headache
C. Both
D. Neither

A
  1. A
  2. B
  3. B
  4. A
  5. B
48
Q

Migraine vs Tension Headache

  1. Has muscle contractions
  2. Sx can move from one side to the other on each attack
  3. Vomiting
  4. May be episodic or chronic
  5. Band-like head discomfort

Choices:
A. Migraine headache
B. Tension headache
C. Both
D. Neither

A
  1. B
  2. A
  3. A
  4. B
  5. B
49
Q

TRUE OR FALSE: In P.O.U.N.D., a criteria of 4/5 must be met to diagnose a migraine headache.

A

True

50
Q

TRUE OR FALSE: Catamenial migraines are attacks of migraine occurring in the premenstrual period.

A

True

Source: Adams

51
Q

Matching Type: Migraine Triggers

  1. Chocolate
  2. Upper respiratory tract infection
  3. Tyramine
  4. Aspartame
  5. Alcoholic beverages

Choices:
A. Infectious
B. Dietary
C. Chemical
D. None

A
  1. B
  2. A
  3. C
  4. C
  5. B
52
Q

A familial disorder characterized by recurrent attacks of headache widely variable in intensity, frequency and duration. Attacks are commonly unilateral and are associated with anorexia, nausea and vomiting. In some cases they are preceded by, or associated with, neurological and mood disturbances.

A

Migraine

53
Q

TRUE OR FALSE: Migraines are not primarily vascular headaches, but are fundamentally a brain disorder.

A

True.
Source: Merritt

54
Q

Selective 5-HT1 receptor agonists

A

Sumatriptan

55
Q

Minimally constricts the peripheral arteries, yet a potent venoconstrictor/vasoconstrictor and it does not result in physical dependence

A

Dihydroergotamine

56
Q

In symptomatic therapy, the dosage should be limited to no more than (1)___ per week and to take no more than (2)____ per week

A

(1) 2 days
(2) 10 mg

57
Q

What is the indication for limiting symptomatic therapy to no more than 2 days per week?

A

To avoid analgesic rebound headache

58
Q

Vascular Theory of Migraine: Headache

(1)—- -> reduced blood flow -> (2)—– -> (3)—-, (4)—-, (5)—– -> Headache

A

(1) vasoconstriction
(2) cerebral hypoxia
(3-5) vasodilation, stimulation of nerve endings for pain, reactive hyperemia

59
Q

Neural Theory of Migraine

—— is produced following the transmission of pain impulses along trigeminal sensory nerve endings supporting the blood vessels of the meninges.

A

Neurogenic inflammation.

These triggers activate the trigeminal nerve causing the release of inflammatory mediators from nerve endings

60
Q

Neural Theory of Migraine

Innervation of the (1)— to the cranial blood vessels can cause (2)— and (3)— via (4)— release

A

(1) trigeminal nerve
(2-3) vasodilation, local edema
(4) neuropeptide

61
Q

Trigeminal nerves initiate and promote tissue inflammation via release of vasoactive peptides

A

Neural Theory of Migraine

62
Q

In this type of HA, M > F

A

Cluster headache

63
Q

Match general mechanisms of headache

  1. otitis media
  2. papilledema
  3. vertebral bruits
  4. Horner’s syndrome
  5. Hypoxia
    Choices:
    A. vital signs
    B. head/face
    C. eyes
    D. ears
    E. mouth
    F. neck
    G. skin
    H. neurologic
A
  1. D
  2. C
  3. F
  4. H
  5. A
64
Q

triad of manifestations in Horner’s syndrome

A

ptosis, anhidrosis, miosis

65
Q

HA where pain behind the brow bone and/or cheekbones

A

Sinus HA.

Pain in frontal and maxillary sinuses

66
Q

TRUE OR FALSE: Sinusitis inflammation can trigger HA

A

True

67
Q

HA with pain that is deep, usually retro-orbital, often excruciating in intensity, nonfluctuating, and explosive in quality

A

Cluster HA

68
Q

TRUE OR FALSE: Cluster HA is bilateral and a disorder involving central pacemaker neurons in the posterior hypothalamic region

A

True

69
Q

Match the clinical feature / symptom to the type of headache

  1. Recurrent, non progressive
  2. Immediately severe
  3. Steady, shocklike, tightness sensation
  4. Family history of subarachnoid hemorrhage
  5. Exacerbated by changes in head positions

A. Primary Headache
B. Secondary Headache
C. Both
D. Neither

A
  1. A
  2. B
  3. A
  4. A
  5. B
70
Q

Match the clinical feature / symptom to the type of headache

  1. Flushing
  2. Lacrimation
  3. Onset after head trauma
  4. Dizziness, vertigo
  5. (+) signs of IICP

A. Primary Headache
B. Secondary Headache
C. Both
D. Neither

A
  1. A
  2. A
  3. B
  4. A
  5. B
71
Q

Matching Type: Occurring in aura or not?

  1. Develops in >4 mins, lasts less than 1 hour
  2. Pulsating quality, moderate to severe intensity, worsened physical activity
  3. Digito-lingual or cheiro-oral paresthesia
  4. Headache follows
  5. Teichopsia

Choices:
A. Aura
B. Not

A
  1. A
  2. B
  3. A
  4. A
  5. A
72
Q

Matching Type: Occurring in aura or not?

  1. Scintillating scotoma
  2. Photophobia
  3. Brainstem dysfunctions
  4. Language dysfunctions
  5. Phonophobia

Choices:
A. Aura
B. Not

A
  1. A
  2. B
  3. A
  4. A
  5. B
73
Q

Matching Type: Premonitory/Prodromal

  1. Diarrhea
  2. Irritability
  3. Drowsiness
  4. Cold feeling
  5. Euphoria

Choices:
A. Psychological
B. Neurological
C. Autonomic

A
  1. C
  2. A
  3. B
  4. C
  5. A
74
Q

Neurovascular Theory (Combined Neural and Vascular Theory)

Headache arises from the loss of inhibition of the anti-nociceptive system as a result of the depletion of (1)—-

A

(1) 5-HT / Serotonin

75
Q

Neurovascular Theory (Combined Neural and Vascular Theory)

Turn-over of 5-HT is increased with (1)— activation

A

(1) brainstem

76
Q

Neurovascular Theory (Combined Neural and Vascular Theory)

Brainstem activation also causes (1)—- causing stimulation of the (2)— and transmission of pain impulses to the brain. (3)—- ensues; this then causes pain due to build-up of fluids in the tissues of the meninges

A

(1) vasodilation
(2) trigeminal nerve
(3) neurogenic inflammation

77
Q

Neurovascular Theory (Combined Neural and Vascular Theory)

Activation of certain parts of the brainstem (LC, DR) can induce (1)— causing localized lack of (2)—, abnormal neural function, and (3)— symptoms.

A

(1) vasoconstriction
(2) oxygen
(3) aura

(2) MS: Neurological Conditions 🩺 (12 decks)

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