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57 Cards in this Set

  • Front
  • Back
What is the most common pain complaint to a primary care physician?
Headache
What are the most common type of recurring headaches?
Migraines
What is the most common type of primary headache?
Tension
True/False: Tension headaches are more common in women than in men.
True.
To be classified as chronic, tension headaches must occur more than how many days in a month?
15
List the criteria by IHS to diagnose tension headache.
1. bilateral
2. pressure headache, non-throbbing
3. Mild to moderate intensity
4. No functional impairment
5. No nausea/vomiting, sensitivity to light/noise, or focal neurologic symptoms
True/False: Stress can cause a tension headache.
False
What is the best treatment for acute tension headaches?
NSAIDs
What is the danger in using narcotics and butalbitols to treat tension headaches?
headaches are prone to worsen with these meds, can also cause habituation and addiction
What are some preventative meds for tension headaches?
TCAs, anticonvulsants such as valproate
What is the most common headache presented to a doctor and why?
Migraine b/c of severity
Women are ___ time more likely to suffer from a migraine than men.
three
What is the most common misdiagnosis for migraine and why?
Sinus headache b/c
1. Pain is found over sinuses.
2. Migraine can cause congestion.
3. Weather changes can trigger migraines.
4. Sinus meds can help migraines.
5. Steriods will make it better.
List the IHS criteria for diagnosing migraines w/o aura.
1. Two of the following characteristics: unilateral, pulsating, moderate/severe intensity, worsened by activity.
2. One of the following symptoms: nausea/vomiting, photophobia, phonophobia
3. Have to have at least 5
What distinguishes a migraine w/ aura?
reversible neurological deficit lasting less than an hour preceding the headache
What is scintillating scotomata? What is it pathogneumonic for?
zig-zag, C-shaped "thing/graying out of vision" that moves across visual field. Pathogneumonic for migraine w/ aura.
True/False: Migraines can be associated with menstration.
True.
True/False: Most people w/ migraines do not have a family history of migraines.
False. 90% have a family history.
What are some common comorbidities associated w/ migraines?
affective disorders, IBS, fibromyalgia, chronic fatigue syndrome, mitral valve prolapse, epilepsy
What neurotransmitter is thought to be involved with migraines and causes many of the comorbidities?
Serotonin
What are five common triggers of migraines?
odors, food, alcohol, weather changes, routine changes
What genes (on which chromosomes) have been related to Familiarl Hemiplegic Migraine?
2 calcium channels and a Na/K channel on chromosomes 1 and 19
Which cranial nerve is a migriane mediated by?
Trigeminal (V)
What is a spreading cortical depression?
wave of intense cortical excitation followed by a wave of cortical suppression beginning in the occipital poles and moving anteriorly.... thought to be a possible cause of migraine
True/False: Migraine is a vascular problem.
False, neurogenic process
Trigeminal afferents along the perimeningeal vessels synapse in which nucleus?
Trigeminal nucleus caudalis
The superior salivatory nucleus sends a signal to teh perimeningeal vessels through which ganglion?
sphenopalatine ganglion
Which nuclei are involved with the central processin of pain and are thought to be involved in a migraine?
raphe nuclei
The nucleus caudalis is located near which structure that is triggers an important symptom of migraines?
emesis center --- nausea and vomiting
The superior salivatory nucleus is located near the ______ causing congestion.
glandular structures of the sinus cavities
Which two receptors mediate activation of the trigeminal neurons?
5HT1b and 5HT1d
What are three serotonin receptor agonists used in treatment of migraines?
triptans, ergotamines, dihydroergotamine
Which are more eficacious: triptans or ergotamines?
triptans
What are some preventative treatments for migraines?
Beta blockers, calcium channel blockers, TCAs, anticonvulsants such as valproatea and topimarate
Cluster headaches are more common in men or women?
men (8 times more common)
How often do cluster headaches occur?
once a day
What are cluster headaches commonly called?
suicide headaches --- very severe pain
How long do cluster headaches last?
30 minutes to 3 hours (distinguishing feature b/c migraines last many hours)
Are cluster headaches unilateral or bilateral?
unilateral
What symptoms are cluster headaches associated w/?
autonomic signs such as lacrimation, rhinnorrhea, ptosis, scleral injection (redness of eye), ipsilateral to headache
What are some treatments for cluster headaches?
oxygen, indomethacin, ergotamines, triptans, steroids
What are some preventative treatments for cluster headaches?
Ca channel blockers (1st line)
lithium
Patients with analgesic rebound headache are usually taking meds for primary headaches greater than ___ days a week
two
True/False: Patients with analgesic rebound headaches typically respond well to preventatives.
False
What is treatment for analgesic rebound headache?
Slowly withdraw off of analgesic
How long should you wait for preventative meds to be effective?
2 months
When should you work up a a headache?
atypical history, elderly, change in previous headache pattern, focal neurological signs, positional headaches
What is involved in a headache workup?
CT (r/o bleed), MRI (structure), LP (SAH or increase CSF pressure)
What causes pseudotumor cerebri?
decreased absorption of CSF
Who is pseudotumor cerebri generally seen in?
obese young women
What is the triad of symptoms of pseudotumor cerebri?
normal CT, headache, papilladema
Headache in pseudotumor cerebri is increased in the ____ position.
supine
What is treatment for pseudotumor cerebri?
acetazolamid, serial LPs, shunting, weight loss, optic nerve fenestration
Low pressure headaches usually follow after a _____.
lumbar puncture
Low pressure headaches are generally worse when in the ____ position.
standing
What is treatmen for low pressure headache?
bed rest, anti-inflammatories, epidural blood patch, or surgical repair
What should you always think with a thunderclap headache?
subarachnoid hemorrhage