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24 Cards in this Set

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