(Neuro) Headache

Front 1

Major pain sensitive structures (lots of 'em):

Back 1

Great venous sinuses
Dura Mater (at base of the skull)
Intracranial portions of the trigeminal, facial, glossopharyngeal, vagus, & the upper cervical nerves
Carotid, vertebral, and basilar arteries as well as dural arteries and the circle of Willis
Proximal portions of the cerebral arteries

Front 2

Which cranial nerves cause pain that can be localized by a patient?

Back 2

CNs V, IX, or X

Cervical nerve roots (and external carotid) may not be localizable

Front 3

Three major primary headache disorders:

Back 3

Migraine, tension, and cluster headaches

Front 4

After age 12, which gender has a higher prevalence of migraine headaches?

Back 4

Females more than males

Front 5

What is a complicated migraine?

Back 5

A migraine due to a transient or permanent neurologic deficit. It's uncommon and may be due to the painless constriction of a cerebral artery.

Front 6

In a classic migraine (migraine + aura) what causes the aura? What causes the actual migraine?

Back 6

Low blood flow causes the aura. The subsequent increase in blood flow causes the migraine.

Front 7

Approx what percent of migraines are classic (with aura)?

Back 7

About 20%

Front 8

POUND Acronym for diagnosing migraines

(From ICM II small groups)

Back 8

Pulsatile (throbbing)
One day or longer duration (as opposed to cluster headaches)
Unilateral
Nausea
Disabling

If a patient meets at least 3 criteria there is a 90% change they are experiencing a migraine.

Front 9

Three strategies in managing a migraine

Back 9

1. Eliminating any triggers of migraines (food, noises, etc)
2. Reduce stress
3. Treat migraine with abortive therapy during aura or soon thereafter.

Front 10

(T/F) When treating a migraine, avoid ergotamines (cafergot), NSAIDs, and aspirin. Not only are these ineffective, but can cause serious problems.

Back 10

False. Sometimes these are effective in treating migraines.

Front 11

Sumatriptan and other triptans are effective at treating which type of headache?

Back 11

Migraines

Front 12

Name four classes of drugs that are often used prophylactically to treat migraines:

Back 12

Beta blockers;
Tricyclic antidepressants;
SSRI's;
Anticonvulsants

Front 13

Criteria for tension headaches in terms of type of pain, quality of pain, and location.

Back 13

Tension headaches typically cause a pressing/tightening feeling.

It's a mild or moderate intensity (non-throbbing).

Usually bilateral location.

Front 14

Are tension headaches typically aggravated by walking stairs or doing routine physical activity?

Back 14

No

Front 15

When diagnosing tension headaches do you expect to see nausea and vomiting?
What about photophobia and phonophobia?

Back 15

You typically do NOT see these.
In some cases either photophobia or phonophobia may be present but not both.

Front 16

Do tension headaches typically respond to over the counter analgesics?

Back 16

Yes

Front 17

Which develops more slowly- tension-type headaches, or migraine headaches?

Back 17

Tension type headaches tend to develop slower.

Front 18

Name two classes of drugs used to prophylax tension-type headaches?

Back 18

SSRI's and TCA's

Front 19

How common are cluster headaches?

Back 19

Relatively uncommon (0.07%)

Front 20

Which gender do you tend to see have more cluster headaches? What age groups?

Back 20

Men more than woman. Typically they begin between 20 and 40 years old.

Front 21

Seven warning signs of a headache that must not be overlooked:

Back 21

Sudden, severe onset
Progressively worsening headache
Stiff neck or fever
Headache on exertion
Onset after 50
Decreased alertness or change in mental status
Abnormal neurologic or physical examination

Front 22

(T/F) Patients experiencing a subarachnoid hemorrhage typically describe a severe, thunderclap headache. They may be nauseated and have a positive Kernig's sign.

Back 22

TRUE

Front 23

What can happen if you fail to rapidly diagnose and treat arteritis?

Back 23

Condition may lead to blindness.

Front 24

If you hear that a patient is over 50 and just had their first headache, and they have have a high ESR, what are you thinking?

Back 24

Arteritis

Front 25

Pregnant females or those on OCP's are at risk for which type of secondary headache disorder?

Back 25

Venous thrombosis

Though notes say that arterial hypertension also carries a risk for eclampsia

Front 26

Which type of headache disorder is characterized by getting progressively worse, leading to drowsiness, lethargy, and possible coma, as well as fever, focal signs, or papilledema?

Back 26

Venous thrombosis

Front 27

What is arterial hypertension?

Back 27

A sudden, large increase in arterial pressure, whether due to malignant essential hypertension, eclampsia, or pheochromocytoma

Front 28

Review from POD: What does CSF reveal for a person who has bacterial meningitis?

What about viral meningitis?

Back 28

For bacterial meningitis, you'll see many granulocytes, increased protein, and reduced glucose

For viral meningitis, you'll see lymphocytes and monocytes in the CSF with mild protein elevation and normal glucose.

Front 29

What is a key feature for diagnosing a neoplasm as an underlying cause of headaches?

Back 29

Seizures, focal neurologic dysfunction, or papilledema.

Front 30

Mrs. X is a lovely 70 year old patient. During a routine visit she complains that for the last few weeks, she's been experiencing headaches when she lies down and in the early morning.

What are you most concerned about at this point?

Back 30

You are worried that Mrs. X might have a neoplasm which is presumably causing increased intracranial pressure when she lies down.

Front 31

Ms. X, the slightly obese 20 year grandchild of the lovely Mrs. X has been complaining about a continuous headache that has been lasting for several weeks now. She got a CT scan and and MRI scan a few days ago and both came back normal. What would be another appropriate test for her?

Back 31

Miss X most likely has benign intracranial hypertension, which often affects obese women ages 16-40. Another good test is the lumbar puncture (patient must be lying flat). You are looking for elevated opening pressure.

Front 32

In which type of headache do people tend to rock or move around rather than sit and lie still?

Back 32

Cluster headaches

Front 33

Which type of headaches are referred to as alarm clock headaches?

Back 33

Cluster headaches

Front 34

Which type of headache is often associated with lacrimation, nasal congestion, rhinorrhea, sweating, miosis, ptosis, and eyelid edema?

Back 34

Cluster headaches

Note: Migraine headaches can produce these symptoms as well.

Front 35

What is the usual length of time for a cluster headache to last?

Back 35

15-180 minutes

Front 36

For all three primary types of headaches, what must you rule out?

Back 36

Secondary headaches

Front 37

Four acute treatments for cluster headaches:

Back 37

Oxygen
Sumatriptan (subcutaneously)
Lidocaine (intranasal)
Ergotamine

Front 38

For a person who has a predictive pattern of cluster headaches, which drug can be taken 30-60 minutes before onset to prevent an attack?

Back 38

Cafergot

Front 39

Four preventative medications found useful in the treatment of cluster headaches:

Back 39

Verapamil, prednisone, lithium, and ergotamine

Front 40

Do potent analgesics typically help with cluster headaches?

Back 40

Not really