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Clin Med - Neuro > Headache > Flashcards

Flashcards in Headache Deck (30)
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1
Q

What are the 3 types of primary headaches?

A

Migraine, Tension, Cluster

Primary HA is diagnosis of exclusion

2
Q

If patient reports his/her headache to be typical for them and to have come on slowly, is it more likely to be a primary or secondary headache?

A

Primary

Get this hx by asking if pt has had HA like this before and if their HA is the worst they’ve ever had

3
Q

What headache qualities are cause for concern?

A
Non typical HA for pt
Worst HA of life
Altered consciousness
Focal neurologic symptoms
Abrupt onset
Progressively worsening daily HA
Toxic appearing/ abnormal vitals
4
Q

How do Migraine, Tension, Cluster and Brain Tumor HA time courses differ?

A

Migraine - regularly periodic
Tension - consistent with few days of relief
Cluster - bursts of episodes clustered together
Brain tumor - consistently worsening

5
Q

How do tension HA and migraines differ in pattern of pain?

A

Tension - Bilateral forehead and down into neck

Migraine - unilateral, commonly occular and frontal region

6
Q

What are the diagnostic criteria for tension HA?

A
At least 10 previous HA like this
HA lasts for 30 mins - 7 days
At least 2 of:
 - pressure, tightness
 - mild-moderate intensity
 - bilateral distribution
 - not aggravated by physical activity
No nausea or vomiting
\+/- Photophobia or Phonobia - NOT both, commonly neither
7
Q

What are risk factors for tension HA?

A
More common in women
Associated with lower SES
TMJ Dysfuncion
Stress
Analgesic overuse
Depression
8
Q

How can you treat your tension HA while studying for Neuro?

A

NSAIDs/ Acetaminophen
Combination products (Excedrin) that include caffeine
Identification of triggers
Heat, warm bath, muscle relaxants
Physical therapy
Severe - Anti-emetics, Barbiturates, Opiates
Treat depression if it exists (some anti-depressants have mechanism to address tension HA simultaneously)

9
Q

What are possible causes of chronic daily headache?

A

Secondary to overuse of medications (opioids, ASA, tylenol, NSAIDs, ergotamines, barbiturates, triptans)
Depression
PTSD
Hx of sexual abuse
Intracranial pathology (Mass, CSF leak)
COPD, Thyroid condition, HTN, Sleep Apnea

10
Q

How can chronic daily headache be treated?

A
Treat underlying issue
Slowly wean off offending meds
Psychotherapy/ CBT
Regular exercise
Healthy eating
11
Q

Who is most likely to have migraines?

A

Those with family history (90%)
Females 3:1 over males
Onset at adolescence or early adulthood
Lifetime prevalence 18%, Annual prevalence 13%

12
Q

What are the differences between classic migraines and common migraines?

A

Classic (20%) - Aura
- Focal neuro deficits (speech change, vision loss/ field cuts, tingling, weakness, confusion)
Common (80%) - No Aura
- No focal neuro deficits but may feel: “fuzzy in head”, sad, fatigued
Both - Nausea and vomiting

13
Q

Other Migraines (don’t think these will be tested but just in case…)

A

Basilar Artery - diplopia, tinnitus, vertigo, gait disturbance, bilateral paresthesias
Retinal - monocular vision loss
Opthalmoplegic - extra-ocular weakness, typically 3nd nerve and pupil involvement
“Migraine Equivalents” - aura without headache
Abdominal - abdominal pain

14
Q

21 yo otherwise healthy female presents with unilateral right frontal headache with associated nausea, present for 1 hour. Pt took NSAID w/o relief. She states her mother has history of migraines. What treatment are you most likely to employ after ruling out secondary HA?

A

Triptan (Imitrex, Maxalt, Zomig) - 5HT1 agonist, vasoconstrictor (contraindicated in CAD or uncontrolled HTN)
Ergotamines
Anti-emetics (promethazine or metoclopramide)
IVF
Maybe Steriods
Opiates - careful of rebound HA

15
Q

At what point should migraine prophylaxis be considered?

A

4-5 migraine days/mo with normal functioning
2-3 migraine days/mo with some impairment
2 migraine days/mo with severe impairment

16
Q

When should migraine prophylaxis definitely be initiated?

A

6+ migraine days/mo
4+ migraine days/mo with some impairment
3+ migraine days/mo with severe impairment

17
Q

Your patient has migraines associated with her menstrual cycle and is bed ridden for 2-3 days each month. How might you treat her?

A

Beta-blockers (propranolol, metoprolol)
Anti-convulsants (divalproex sodium, valproate, topiramate)
Anti-depressants (amitriptyline, venlafaxine)

18
Q

45 yo male presents with acute, severe right sided headache, right sided rhinorrhea and right sided lacrimation. What is top on your DDx?

A

Cluster Headache

19
Q

What is the likely pathophysiology of cluster headaches?

A

Periodicity of attacks suggest hypothalamic mediation and likely that trigeminal pain pathways are activated and become hypersensitive

20
Q

How will you treat a cluster HA patient?

A

High flow O2
Triptans, Ergotamines
Opiates - careful of rebound
Steroids - high dose followed by taper

21
Q

What is the prevention therapy for cluster HA?

A

Calcium channel blockers (verapamil)
Lithium - substantial side effects
NO beta-blockers

22
Q

What is arteriovenous malformation and why may it cause subarachnoid hemorrhage?

A

Connection of arterial system to venous system w/o capillary bed. Venous side may then rupture d/t lack of intima and no capillary system to diffuse pressure

23
Q

What is a likely cause of aneurysm leading to subarachnoid hemorrhage?

A

Uncontrolled hypertension. Aneurysms are often congenital but HTN can worsen them. HTN can also be primary cause d/t relentless pressure on the wall causing it to pouch out and weaken

24
Q

Where do Berry aneurysms occur?

A

Circle of Willis

25
Q

What are red flags for subarachnoid hemorrhage?

A
Worst HA of life
Altered mental status
Nausea and vomiting
Nuchal rigidity
Photophobia
Hx of recent severe HA which resolved (sentinal bleed)
26
Q

What findings on CT would confirm suspicion of subarachnoid hemorrhage?

A

Fresh blood in subarachnoid space and not in common vascular distribution (not in MCA or PCA distribution as in stroke)
Think blood in sulci, not gyri

27
Q

If CT is normal but still suspect SAH or meningitis what do you do next and what would you expect to find for each?

A

Lumbar puncture
SAH - xanthochromia
Bacterial Meningitis - High protein, Low glucose, Also culture

28
Q

Patient presents with acute stabbing HA, confusion and nuchal rigidity. Upon CT, bright white areas are seen in subarachnoid space. How do you treat this patient?

A
Call neurosurgeon
If large bleed, may need decompression
Help avoid further increase in ICP
Manage HTN to avoid re-bleed
Nimodipine to decrease vasospasm
29
Q

What can the techniques of clipping and coiling be used for?

A

Aneurysm repair

30
Q

Name 3 other potential causes of HA

A
Dehydration
CO poisoning
Sinusitis
Otitis
Acute glaucoma
Influenza
Toxins (hangovers)
Concussion