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24 Cards in this Set
- Front
- Back
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Headache can be caused by irritation of what?
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• dural sinuses
• intracranial portions of trigeminal, glossopharyngeal, vagus, and upper cervical nerves • large arteries • pain-sensitive intracranial structures • venous sinuses |
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What percentage of acute headaches with a normal neurological exam will have significant abnormalities of CT or MRI? with an abnormal neurological exam?
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• with normal neuro exam: < 1%
• with abnormal neuro exam: 10%-15% |
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True/False: Onset of migrane headaches is typically later in life (after 50 y/o)
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• Peak ages at onset are adolescence and early adulthood
• The correct answer is: False |
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What are the different classifications of migrane headaches?
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• classic migrane (w/ aura)
• common migrane (w/o aura) • complicated migrane |
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What are different types of complicated migranes?
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• basilar artery migrane
• confusional migrane • hemiplegic migrane • ophthalmoplegic migrane |
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What are clinical characteristics of a migrane headache?
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• focal neurologic symptoms
• pain (often pulsating, unilateral, and frontotemporal) • associated w/ anorexia, nausea, vomiting (GI compliants) |
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What are examples of focal neurologic symptoms seen with migraines?
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• aphasia
• clumsiness • field defects • luminous visual hallucinations (ex. stars, sparks, light flashes) • numbness • scintillating scotomas • tingling • weakness |
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What are characteristics of a complicated headache?
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has major neurologic dysfunction separate from visual aura (ex. hemiplegia, coma)
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How do you definitively diagnose giant cell arteritis (temporal arteritis)?
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biopsy (will see giant cells)
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What is the treatment for giant cell arteritis?
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prednisone (60 mg/d)
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What is thought to be the cause of neurologic phenomena and pain in migraine headaches?
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• neurologic phenomena thought to be caused by cerebral spasm
• pain thought to be caused by dilation of extracranial arteries |
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What are some medications that can be used to treat a migraine with mild to moderate pain?
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• acetominophen
• aspirin • caffeine adjuvant compounds • NSAIDs |
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What are examples of extracrnial vasoconstrictors that can be used for treatment of severe migraines?
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• ergotamine
• sumatriptan • neuroleptics (ex. droperidol) • narocotics: used in rare instances (ex. butorphanol NS) |
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What are examples of drugs that can be used for prophylactic treatment of migraines?
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• anticonvulsants (divalproex sodium)
• beta blockers (ex. propanol, nadolol) • calcium channel blocker (ex. verapamil) • serotonin antagonists (methysergide) • SSRIs (ex. paroxetine, sertraline) • tricyclic antidepressants (ex. amitriptyline) |
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Which type of headache is less often associated with a family history, migraine?
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• Cluster often has NO family history
• Migraine has a positive family history in 65%-90% of patients |
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What are physical manifestations associated with cluster headaches?
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• injection of conjuctiva
• increased sweating • nasal congestions • ocular signs of Horner's syndrome |
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Describe the pain of cluster headaches
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• steady, non-throbbing
• localized retro-orbitally • occurs at night (often awaking patients) • have headache-free periods in between episodes |
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What can precipitate a cluster headache?
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alcohol
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What are treatment options for acute cluster headaches?
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• oxygen
• sumatriptan • dihydroergotamine |
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What are prophylactic options for cluster headaches?
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• corticosteroids
• divalproex sodium • lithium • methysergide • verapamil |
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What are characteristics of tension headaches?
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• steady "pressure feeling" or "vise-like"
• may be frontal, occipital, or generalized • frequently pain in neck area • not associated with focal neurologic symptoms |
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Why do people with cough headache need an MRI?
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> 50% of people have underlying structural lesion
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Which sinus most often causes headaches associated with sinusitis?
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maxillary sinus
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What is the medical treatment for post-traumatic headaches?
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• amitriptyline
• anxiolytics • muscle relaxants • NSAIDs |
