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26 Cards in this Set
- Front
- Back
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Migraines often begin when?
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adolescence and are rare after 40
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In women, migraines correlate with what?
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menses
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A migraine subtype has been linked to a mutation in what chromosome in 50% of pts?
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chrom 19
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What are some things that can trigger a migraine?
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red wine, nitrates, monosodium glutamate, sleep deprivation, dehydration, menstruation, certain odors, stress of relief of stress, glairing lights
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Cephalic blood vessels are innervated with what?
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nociceptive afferent nerve fibers
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The nociceptive afferent nerve fibers can be stimulated by a number of factors including what?
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tumor or irritation (infection)
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Migraines often occur with the dilation and distention of what?
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inter-cranial vessels
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Dx/Dx for Migraine
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-tension
-cluster |
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What are some medical conditions that can cause 2nd HA?
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-TMJ
-Medication -sinusitis -refrectory tumore -sleep apnea -influenza -trigemical neuralgia -post coital -hypoglycemia -pseudo tumor cerebri -drug w/drawal |
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What are some more serious medical conditions that can cause 2nd HA?
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-glaucoma
-meningitis -CVA -temoral arteritis -malignant HTN -concussion -CO poisoning -tumor -A V malformation |
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What are some RED FLAGS in HA?
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-new onset or very severe
-focal neurological sx like papilledema -onset <5 or >50 -hx of cancer -change in pattern -w/mental status change -HA which awakes u from sleep -hx of fever w/absence of other illness -pain/stiffness of neck |
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In primary migraines, PE will be what between attacks?
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normal
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What may a PE look like in a magraine attack?
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-fatigue
-pale -vomiting -desire to lay down -want to be in the dark |
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What do you want to do (PE wise) when a person presents with a migraine?
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complete neuro exam
-mental status -fundoscopic -CN -strength -sensations -reflexes -Rhomberg -gait -cerebellar function -speech |
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In the absence of any red flags, what labs do you want to order?
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none
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In the event of reg flags, what labs do you want to order?
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CT
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If a pt presents with HA, fever, and nuchal rigidity what lab would you order?
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LP
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WHat lab would you order to check for glaucoma?
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tonometry
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What lab would you order to check for temporal arteritis?
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sed rate and CRP
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What would you order if you suspect apna?
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sleep study
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What are some non-medication tx for migraine/HA?
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-pt eduction
-self participation -ID triggers -avoid trigger -prevention of medication overuse -CBT including relaxation techniques -tx early in course -rest in quiet, darken room |
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NSAIDS and dose mentioned in ppt for migraine
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-ibuprofen 800 mg q 6hrs
-ketorolac 60 mg IM |
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Tell me about Tylenol for migraines
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-1000mg q 8 hrs (often used in combo with other meds for synergistic effect)
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WHat are some other single medications that can be used for migraine tx?
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-Dihydroergotamine (DHE) 1mg IM or SQ or 0.5 mg NS
-Antiemetic like prochlorperazine 25 mg PO -Triptans like sumatriptan 6mg SQ or 50mg PO or 5mg NS -Narcotics like Butophanol 1mg NS q 4hrs |
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What are some combination products used to abort migraines?
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-ASA/Acetaminophen/caffeine (Excedrin)
-Isometheptene/dichloralphenazone/acetaminophen (Midrin) -ergotamine/caffeine (cafergot) -acetaminophen/ butalbital/caffeine (fioricet) -Acetaminophen/codeine |
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What are some preventative meds for migraines?
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-BB like Propranolol 80mg qd
-Anti-epileptics like VPA 250mg BID -Antidepressants like Amitriptyline 50 mg q hs -CCB like verapamil 240mg qd |
