Tuesday - pruneski - headaches

Question 1

Three types of primary headaches

Answer 1

Tension-type - bilateral headband - do not get in the way of life

Cluster - painful, behind the eyes, M:F = 4:1, Rare. Hypothalmic activation of trigeminovascular autonomic system & parasympathetics. “Quick onset, lasts 15-180 minutes and its gone.” can happen multiple times/day. Treatment is OXYGEN

Migraine - 3:1 F:M ratio. in 8-10yos they are more common in boys. up to 18% of women have migranes, 6% of men. One sided THROBBING, PULSATING, NAUSIA. Genetic

Question 2

People who have _______ headaches with _____ should avoid estrogen containing birthcontrol because of risk of ______

Answer 2

migrane headaches with aura (aura = you know its coming because of light sensitivity, nausia, etc.)

Question 3

Treatment of migrane

Answer 3

Triptans DHE

Question 4

main migrane headaches prohylactic med

Answer 4

amitriptyline

Question 5

MOH - wat it is

Answer 5

Medication overuse headache

Question 6

What are the most important pharmacological targets for seritonin

Answer 6

synthesis and re-uptake

Question 7

Where do you find the most serotonin in the body

Answer 7

enterochromaffin cells of the gastric mucosa

Question 8

5- ht 1D receptor inhibition treats what

Answer 8

migraines

Question 9

amitriptyline does what

Answer 9

inhibits reuptake of serotonin, prophylactic for migranes.

Question 10

People suseptible to migranes have overall what levels of a certain neurotransmitter

Answer 10

lower levels of serotonin

Question 11

1-HT 1b and 1d receptor agonists. mech of pain relief?

Answer 11

triptans, cause vasoconstriction which relieves some pain of migranes.

Question 12

mech of delivery of sumatriptan

Answer 12

nasal, injectable

Question 13

Ergots

Answer 13

fungal products that cause nausia and vomiting, usually historically associated with contaminated wheats, cause vasoconstriction. mechanistically similar to tryptans

Question 14

Sudden onset, severe “Thunderclap” headache

Answer 14

Subarachnoid hemorrhage

Question 15

Headache onset with exercise

Answer 15

Ruptured aneurysm

Question 16

New HA onset after age 50

Answer 16

Temporal arteritis, intracranial mass

Question 17

HA with fever, stiff neck, photophobia, systemic signs

Answer 17

Meningitis, encephalitis

Question 18

HA onset hours to weeks after trauma

Answer 18

Subdural hematoma

Question 19

HA with focal neurologic signs, symptoms or papilledema

Answer 19

Tumor, subdural hematoma, epidural bleed

Question 20

Multiple people with similar new onset HA, eg family, coworkers

Answer 20

Environmental exposure, carbon monoxide