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