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48 Cards in this Set

  • Front
  • Back
Name some characteristics of a primary headache syndrome
recurrent, associated with prodrome/postdrome, exacerbated by stress and lack of sleep
Name some symptoms worrisome for secondary headache
new onset, increasing severity and frequency, worse when supine/awakening/night, worse with valsalva, associated with abnormal neuro exam
Photophobia and nausea are commonly associated with what type of headache?
migraine; but can also be secondary to meningitis or subarachnoid hemorrhage
Recurrent unilateral severe headaches that alternate sides, radiate over the head, and improve in recumbent position are most likely due to?
migraine
Difficulty concentrated localizes to?
bicerebral hemispheres
Photophobia localizes to?
meninges
Migrating sensory symptoms can be due to what two things?
migraines or partial seizures
What differentiates sensory symptoms of migraines vs. those of seizures?
symptoms travel over seconds in seizures, over minutes in migraines
What specific lesions can cause visual phenomena other than migraines?
optic radiations or occipital lobe (visual cortex) lesions
What does right face tingling localize to?
left parietal lobe
Where does right hemianopsia localize to?
left cerebral hemisphere, posterior to the optic chiasm (through temporal, parietal, and occipital lobes)
New onset headache over age 50 with fever, weight loss, monocular visual loss, temporal tenderness, jaw claudication, polymyalgia rheumatica, increased ESR and CRP?
temporal arteritis (giant cell arteritis)
What is the management of temporal arteritis?
ESR, CRP (to help with dx, I guess), long term steroids, temporal artery biopsy
What blood vessels are affected in temporal arteritis?
medium and large sized arterities
Why is newly diagnosed giant-cell arteritis an emergency?
because up to 60% of patients have permanent visual loss
What is polymyalgia rheumatica?
aching pain and stiffness in the neck, shoulders, and hips
Does normal ESR exclude the diagnosis of temporal arteritis?
no
What do you treat temporal arteritis with if there are no visual symptoms?
prednisone 60-80 mg/day
What do you treat temporal arteritis with if there are visual symptoms?
consider IV methylprednisolone
What is another name for idiopathic intracranial hypertension?
pseudotumor cerebri
What are the signs and symptoms of idiopathic intracranial hypertension?
headache, diplopia, transient visual obscurations, bilateral papilledema, enlarged blind spots, vision loss if untreated
What type of patient gets idiopathic intracranial hypertension?
young obese female, 15-45 years
Diagnosis of idiopathic intracranial hypertension?
MRI to rule out mass, lumbar puncture demonstrates elevated opening pressures
What is the treatment for idiopathic intracranial hypertension?
acetazolamide 125 mg po daily, shunt or optic nerve sheath fenestration if not responsive to acetazolamide
What is the most common cause of daily chronic headache?
medication overuse headache
When does medication overuse headache occur?
If you use abortive agents more than 2-3 days per week
In which patient population is medication overuse headache more common?
migraineurs
What is the treatment for medication overuse headache?
stop all analgesics, begin migraine prophylaxis, sedate (vistaril) for 3-10 days; patient will get a severe rebound headache for 1-2 weeks but will then feel much better
What is the likely inheritance of migraine?
autosomal dominant
What is the origin of migraine?
neurologic. Focal decrease in serotonergic activity with dysfunction of brainstem serotonergic/noradrenergic brain pathways + vasoactive neuropeptide release by TG nerve --> secondary arterial dilatation and constriction
What are the four phases of migraine?
prodrome, aura, headache, postdrome
What do you do to evaluate persistent/worsening headache despite treatment or abnormal neuro exam + headache?
Brain MRI with and without gad, lumbar puncture, ESR/CRP in pt. >50, EEG if partial seizures are suspected
What is it called when pt. has recurrent unexplained neurologic or GI signs/sx without associated headache?
migraine equivalent; diagnosis of exclusion
What type of migraines requires prophylaxis?
If they are more than twice weekly, or less than that but prevent activities of daily living
What classes of meds are used for migraine prophylaxis?
antihypertensives, TCAs, NSAID (naproxen), Anticonvulsants, + random other meds. on another card
What are the "other" medications used to treat migraine?
cyproheptadine, Mg gluconate or oxide, feverfew, botulinum toxin
What are the side effects of TCAs you want to keep in mind when prescribing for migraine?
sedation, weight gain
What are the side effects of valproic acid that you want to keep in mind when prescribing for migraine?
weight gain, hair loss
What are the side effects of topiramate to keep in mind when prescribing for migraine?
weight loss, abnormal cognition
What side effect of magnesium should you keep in mind for pts. with migraine?
loose stools
What side effects of beta blockers do you need to keep in mind when prescribing for migraine?
depression,sedation
What side effects of naproxen do you need to keep in mind when prescribing for migraine?
ulcers, renal disease
What are abortive agents used for migraines?
tylenol, NSAIDs, narcotics, excedrin migraine/BC powder, Goody's headache powder, fiorinal, fioricet
What is the mechanism of action of triptans?
selective serotonin receptor agonists --> vasoconstriction of meningeal blood vessels
In whom are triptans contraindicated?
patients who are pregnant, 60 or older, vascular disease/risk factors, migraine associated with aphasia, hemiplegia, vertigo
Name other abortive agents that can be used for migraines
cafergot, DHE, IV chlorpromazine, IV prochlorperazine, IV valproic acid, IV droperidol, Hydrozyzine (vistaril), Promethazine (phenergan)
What can you do to reduce migraine frequency (lifestyle wise)
Avoid triggers, reduce caffeine intake, maintain regular sleep schedule, avoid medication overuse headache by limiting abortive agent use
What should you do before adding a second prophylactic medication?
maximize the dose of the first med.