Trans 016 Neuro optha Flashcards
Condition consisting of repetitive bouts of headachexF>Mx(+) familial tendencyx(+) history of motion sickness in childhoodxOnset-puberty or young adulthoodxDecrease after menopause xCharacteristics:oUnilaterality, pulsating, N/V1, photophobia, aggravated by physical activities.xExacerbated by:oMenstruation, pregnancy, hunger, stress, certain foods and sleep deprivation
migraine
xClassic migrainex30%“among the migraine headachesxVisual aura: begins with a small scotoma near fixation that gradually expands then breaks upSSometimes patients seek consult because of the visual auras.x<45 minutesSUsually,visual auras lasts for 45 mins
MIGRAINE WITH AURA
xCommon migrainex65%
xNo preceding neurologic symptoms
xGlobal can last hours to days
MIGRAINE WITHOUT AURA
xAcephalgic migrainex5%xVisual Aura:oScintillating scotoma, transient homonymous hemianopia, peripheral VF2constriction, transient monocular visual loss, episodic diplopia (vertical).SVery hard to diagnose because you have to think of all the possible causes of the visual aura.SUsually this is called a wastebasket diagnosis, when everything that can could cause the symptomshasbeen ruled out then the patient is diagnosed with migraine aura.
MIGRAINE AURA WITHOUT HEADACHE
xChronicxAchingSThe description is more of ‘heaviness’ of ‘Soreness’ in the head.xWorse at the end of dayxPrecipitated by stressxAssociated with depression
TENSION-TYPE HEADACHE
MIGRAINE AND TENSION-TYPE HEADACHE -TREATMENT
xReassurance
xAvoid precipitating factors:oChocolates, nitrates, MSG3, cheese, caffeine, red wine, alcohol, nuts, shellfishoOCPsoStress, change in sleep patterns, strong scents such as perfume, cigarette smoke and exercise
xAcute relief:oDihydroergotamine, serotonergicagents, NSAIDS4
xProphylactic treatment:
oDisrupted functions of daily life
oBeta blockers, Ca channel blockers, TCA5, SSRIs6, sodium valproate, NSAIDS
xCommon in men x30’s to 40’sxCigarette smokers xPain localized behind 1 eye xTearing, conjunctival injection, rhinorrheax<2 hrs xDifficult to treat xInhaled oxygen, methysergide, subcutaneous sumatriptan or dihydroergotamine. xPrednisone tapered for 10-14 days xVerapamil-prophylaxis
Cluster headache
Neuroimaging is very important ASAP in these cases, these are warning signs:
Sudden onset of severe headache
oUnexplained change in headache pattern
oUnresponsive to medical therapies
oHeadaches related to physical exertion or change in body position
oNew onset of headache after the age of 50 years
oNew headaches in immunosuppressed patients
o(+) focal neurologic signso(+) fever, neck stiffness, change in mental status, behavioral changes.
ORBITAL AND OCULAR CAUSES OF HEADACHE
xRefractive errors and strabismus xKS7, Keratitis, AACG8, Intraocular inflammation xRecurrent erosion syndrome xScleritis xOptic neuritis
Usually if the headache is accompanied by photophobia you have to think of an
inflammatory condition of the eye
xKeratitisxUveitisxChorioretinitisxMeningeal irritationxMigraine
xTic douloureuxSSometimes associatedxCause by vascular compression of CN VxDemyelinating disease, posterior fossa mass lesionSUsually caused by thesexUnilateralxExacerbated by chewing, toothbrushing, cold windxNormal sensory functionxMRISTo rule out any other causes.
TRIGEMINAL NEURALGIA
treatment of trigeminal neuralgia
oGabapentin, carbamazepine, phenytoin, bacifen, clonazepam, valproic acid.oRhizotomy, decompression of CN V.
OTHER CAUSES OF FACIAL PAIN
xGlossopharyngeal neuralgiaxCarotidyniaoNeckpain that radiates to ipsilateral faceand ear.xCarotid dissectiono(+) sympathetic dysfunctionxTemporomandibular disease
oPain before vesicle eruptionSWil last even after the skin lesions have resolvedSThe prodrome of HZO9meaning before the skin lesions happen the patient will tell you that there was pain in that area before the vesicles occurred.
Herpes Zoster Ophthalmicus
