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Neuro 2-Unit 3 (Final) > Wednesday, 8-24-Headache-Hon > Flashcards

Wednesday, 8-24-Headache-Hon Flashcards

1
Q

Headaches that are a sign of organic disease

A

Secondary HA

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2
Q

What sorts of triggers are associated with headaches?

A
  • hormones (menstrual cycle, OC’s, HRT)
  • diet
  • stress
  • environmental changes
  • sensory stimuli
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3
Q

List some signs which may indicate HA of pathological origin (secondary HA):

A
  • “Worst” HA
  • Onset of HA after age 50
  • Atypical HA for pt
  • HA w/ fever
  • Abrupt onset (max intensity in seconds to minutes)
  • Subacute HA w/ progressive worsening over time
  • Drowsiness, confusion, memory impairment
  • Weakness, ataxia, loss of coordination
  • Paresthesias/sensory loss/paralysis
  • Abnormal medical or neurological exam
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4
Q

What sort of diagnostic evaluations can be done for headaches?

A
  • Lab testing
  • Neurodiagnostic tests
  • Other: Sedimentation rate, TSH, CBC, glucose
    • CT, MRI/MRA, EEG, LP, arteriogram
    • Dental, ENT, allergy evaluation

-As a general rule, many believe that any person with HA should have a 1-time, thorough neuroimaging study (CT head with and w/o contrast or MRI of head

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5
Q

What is the intensity of the common migraine?

A

Moderate to severe

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6
Q

What is the typical age of onset of common migraines? Gender ratio?

A

Late teens to early 20’s; prevalence peaks between 35-40 years

F:M=3:1

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7
Q

What is the frequency and duration of common migraines? Location?

A

Frequency: 1-4 attacks per month (occurs infrequently)

Duration: 4-72 hrs, usually 12-24 hrs

Location: UNILATERAL or bilateral

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8
Q

How are common migraines described? Prodrome? What types of behavior are displayed?

A

Description: throbbing/sharp/pressure

Prodrome: mood changes, myalgias, food cravings, sluggishness, excessive yawning

Behavior: Retreat to dark, quiet room

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9
Q

Is there typically aura with the common migraine?

A

No: 80-90% of migraine sufferers do not experience an aura

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10
Q

What are the most common associated symptoms with a common migraine?

A
  • Nausea (90%)
  • Vomiting (33%)
  • Photophobia
  • Phonophobia
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11
Q

Describe a classic migraine:

A

-Aura: usually lasts 15-30 minutes, but sometimes longer. Commonly have visual symptoms (i.e., scintillations, scotoma-often hemianopic) but can be anything

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12
Q

Describe the intensity of a tension-type HA and the type of disability:

A

Intensity: mild to moderate

Disability: may inhibit, but DOES NOT PROHIBIT DAILY ACTIVITIES

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13
Q

Describe the disability associated with a common migraine:

A

Inhibits or prohibits daily activities; pain aggravated by activity

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14
Q

What is the general age of onset and gender ratio associated with tension-type HA?

A

Age of onset: variable; generally peak incidence 20-40 yrs

F:M=3:2

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15
Q

What is the frequency for episodic type vs chronic type for tension-type HA?

A

Episodic type: 15 days/month

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16
Q

What is the duration for episodic type vs chronic type of tension-type HA?

A

Episodic type: several hours

Chronic type: all day, waxing and waning

17
Q

What is the location of tension-type HA? Description? Prodrome or Aura?

A

Location: BIFRONTAL, BIOCCIPITAL, neck, shoulders, band-like

Description: DULL, ACHING, SQUEEZING, PRESSURE

NO PRODROME OR AURA

Behavior generally not affected

18
Q

Describe the intensity of a Cluster HA as well as the disability associated with the Cluster HA:

A

Intensity: SEVERE, EXCRUCIATING

Disability: Prohibits daily activities

19
Q

What is the age of onset of cluster HA? Gender ratio? Its recent association?

A

Age of onset: 20’s-50’s

F:M=1:6

Recent association with obstructive sleep apnea –> can put on a CPAP to relieve the HAs

20
Q

Describe the monthly frequency of cluster HAs in episodic type vs chronic type:

A

Episodic type: 1 or more attacks/day for 6-8 weeks (MOST COMMON)

Chronic type: several attacks per week without remission (LESS COMMON)

21
Q

What is the duration of a cluster HA? Location? Description?

A

Duration: 30 mins-2 hrs

Location: 100% UNILATERAL; GENERALLY ORBITOTEMPORAL

Description: Nonthrobbing, excruciating, sharp, boring, penetrating

22
Q

Describe prodrome of cluster HA, if there is aura, and behavior associated with the type of HA:

A

Prodrome: may include brief mild burning in ipsilateral inner canthus or internal nares

No aura

Behavior: FRENETIC, PACING, ROCKING

23
Q

What are some associated symptoms of a cluster HA?

A

Ipsilateral ptosis, miosis, conjunctival injection, lacrimation, stuffed or runny nose

24
Q

What are some hormonally-related HA triggers?

A

Menses, ovulation, HRT, OC’s

25
Q

What are some diet-related HA triggers?

A

Alcohol (esp beer and red wine), chocolate, aged cheeses, MSG, aspartame, caffeine, nuts, nitrates/nitrites, citrus fruits, others

26
Q

What are some environmental changes associated with HA triggers?

A

Weather, seasons, travel, altitude, sleep pattern, diet, skipping meals

27
Q

What are some stress-related HA triggers?

A

Let down periods, times of intense activity, major life change/stress

28
Q

What are some sensory stimuli related to HA triggers?

A

Bright or flickering lights, odors

29
Q

What are contraindications to triptan usage?

A

Documented or strong risk factors for ischemic heart disease
Cerebrovascular, cardiovascular, or peripheral vascular diseases
Raynauds syndrome
Uncontrolled HTN
Hemiplegic or basilar migraine
Severe renal or hepatic impairments
Use within 24 hrs of tx with ergotamines, MAOI’s, or other 5-HT1 agonists

30
Q

A migraine (with or without aura), tension type, cluster HA, post-traumatic HA, drug rebound HA are classified as these types of headache?

A

Primary HA (benign HA disorders)

31
Q

What are some preventative measures for migraines?

A
  • Antidepressants (TCAs, SSRIs, MAOIs)
  • Beta-blockers (propanolol)
  • Ca channel blockers (verapamil)
  • anticonvulsants (valproate, gabapentin, topiramate, tigabine)
  • ergot alkaloids (ergotomine + phenobarbital)
  • NSAIDs(ASA, naproxen)
  • Muscle relaxants (Zanaflex)
  • Methysergide (sansert)
32
Q

What are some nonprescription tx suggestions for migraines?

A
  • exercise
  • quit smoking
  • HA education
  • Riboflavin (400 mg daily)
  • Mg (325 mg daily for menstrual migraine)
  • Biofeedback/relaxation/stress management
33
Q

What can you use for acute tx of Tension HA?

A
  • OTC analgesics
  • NSAIDs (ibuprofen, naproxen)
  • Opioids (codeine, hydrocodone)
  • Midrin
34
Q

What can you use as preventative tx for Tension HA?

A
  • antidepressants (TCAs, SSRIs, MAOIs)
  • Muscle relaxants (tizanidine)
  • anticonvulsants (valproate and gabapentin)
  • BOTOX
  • Ergot alkaloids (DHE sometimes used to break cycle of chronic daily HA
35
Q

What can you use for the acute tx of a Cluster HA?

A
  • DHE 1 mg IM or Ergotamine 2 mg SL
  • Lidocaine 4%-1 ml intranasal
  • Narcotics (meperidine, morphine)
  • Oxygen 100% 8L/min by mask
  • Sumatriptan 6 mg SQ
  • Zolmitriptan nasal spray
36
Q

What is preventative tx for Cluster HA?

A
  • Ca channel blocker (Verapamil)
  • Anticonvulsant (valproate)
  • Lithium
  • Indomethacin
  • Prednisone x 10-14 days
  • Capsaicin 0.025% intranasal tid x 1 wk
  • Ergotamine tartrate

Neuro 2-Unit 3 (Final) (15 decks)

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