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