Uiuc M2 2010 Fcp Headaches

Front 1

Scotoma

Back 1

an area of depressed vision in the visual field, surrounded by an area of less depressed or of normal vision.

Front 2

Teichopsia

Back 2

the sensation of a luminous appearance before the eyes, with a zigzag, wall-like outline. It may be a migraine aura

Front 3

Types of headaches:
primary: (3)
secondary: (...)

Back 3

1) Tension
2) Cluster
3) Migraine

2nd: tumor, infection, bleeding, concussion, temporal arteritis, glaucoma

Front 4

Scenario: Sudden onset of left-sided headachs, with tearing of the left eye, and left-sided runny nose. Intense immediately. lasted only about an hour.
3x/day each day this week.

Back 4

Cluster Headache

Front 5

Cluster Headache

frequency:
demographic:
symptoms:
precipitating:
timing/duration:

Back 5

<1% of Headaches
Males>Females, Ages 25-50

1) unilateral
2) Begins quickly
3) Maximum intensity in minutes
4) Deep, excruciating, continuous
5) Begins around eyes or temple usually
6) Patient restless, may pace around
7) associated: lacrimation, rhinorrhea, sweating, Horner's.

alcohol can precipitate

Lasts 15min – 3 hrs
Each Cluster lasts 6-12w
Remission lasts approximately 6 months
Usually @night (9pm-9am)

Front 6

Claster Headache

pathophysiology:

Back 6

-Unclear-
• Trigeminal pain distribution
• Ipsilateral cranial autonomic features
• Episodic/circadian pattern

Likely: extra cranial vasodilatation secondary to neuronal dysfunction

Hypothalamus:
anterior: circadian rhythm.
posterior: autonomic function.

Front 7

Tension Type Headache

symptoms: (3)
affected by: (3)

Back 7

1) pressure/tightness around head
2) mild to moderate pain
3) no nausea, vomiting, phonophobia, photophobia, and aura

Psychological factors, diet, and sleep

Front 8

Tension Type Headache

pathophysiology: (2)

Back 8

-Controversial-

1) (older) Head and neck muscle contraction causing vasoconstriction and ischemia

2) Headache continuum TTH<->Migraine
• Trigeminal neurovascular system and serotonin

Front 9

stabbing unilateral frontal headache. Nauseated, and light and sound sensitive

Back 9

Migraine

Front 10

Migraine:

types:

Back 10

Migraine with aura
Migraine w/o aura (80%)
Variants:
1) retinal
2) opthalmoplegic
3) familiar hemiplegic

Front 11

Migraine

frequency/demographic:

Back 11

17% of ♀ and 6% of ♂ each year
-Most common between 30-39 y.o.
-often familial

Front 12

Migraine

pathophysiology theories:

Back 12

1) Trigeminovascular system
• imbalance: brainstem nuclei regulating antinociception and vascular control.
• substance P, calcitonin gene-related peptide(CGRP): pain and vasodilation

2) Cortical Spreading Depression (CSD): aura
• Self propagating wave of neuronal and glial depolarization
• Activates trigeminal nerve afferents causing inflammation in meninges

3) Serotonin: ↓ →cranial vessel dilation and sensitization of meningeal afferents of trigeminal nerve.

4) CGRP: Expressed in trigeminal ganglia nerves, potent vasodilator

Front 13

Stages of Migraine (4)

Back 13

1) premonitory symptoms: precede migraine by several hours to 2 days. Fatigue, neck stuff, light/sound sensitive, nausea, blurred vision, yawning, pallor

2) Aura: progressive neurolgic deficit or disturbance with subsequent complete recovery.
-caused by CSD
-usually occur before headache.

-visual disturbance (99%)
-sensory disturbance (31%)
-motor weakness (18%)
-speech disturbance (6%)
-autonomic, sinus, cutaneous allodynia.

3) Headache: usually AM, rarely awaken, one-sided usually, dull, deep, steady or throbbing/pulsitile.
worse with head movement, sneeze,...
photophobia, phonophobia

4) postdrome- tired and sluggish

Front 14

Cutaneous allodynia

Back 14

-Innocuous stimulation of skin produces pain
-Brushing hair, shaving, tight clothes

Front 15

Prolonged neurological migraine symptoms can be associated with:

Back 15

migraine infarction or seizures

Front 16

Menstrual Migraine

timing:
pathophysiology:
aura?

Back 16

2 d before to 3 days after menstration

Due to ↓ estrogen levels

No aura

Front 17

Hemiplegic migraine

features:
timing/prognosis:
genetic form pathophysiology:

Back 17

Motor and sensory lost unilateral

Can last weeks, and if recur often, can lead to permanent loss

Familial hemiplegic migraine: dominant. mutation in transmembrane ion channels.

Front 18

Basilar-type migraine

demographic:
symptoms:

Back 18

Young women and children

Dysarthria, vertigo, diplopia, tinnitus, decreased hearing, ataxia, bilatral paresthesias and altered consciousness

Front 19

Ophthalmoplegic migraine

frequency:
demographic:
features:

Back 19

Rare
Children and young adults
CN III, IV or VI impaired

Front 20

Retinal (ocular) migraine (rare)

frequency:
features:

Back 20

Rare

monocular scotoma or blindness for < 1 hr with headache

Front 21

Medication Overuse Headache

frequency:
demographic:
drugs:
pathophysiology:

Back 21

1% of population
Women > Men, with previous hx of episodic migraines.
Tylenol, aspirin, butalbital, or any Rx

Continuous analgesic exposure causes antinociceptive tolerance, ↓effectiveness. ”mini-withdrawals” from fluctuating serum drug levels.

Front 22

facial pain, pressure, fever, anosmia
Pressure-like dull sensation, bilateral and periorbital

Back 22

Sinus Headache

Acute sinus headache with sinusitis, fever, and purulent discharge
-Frequently misdiagnosed, lasts for days at a time.

+congestion,
-nausea, photophobia,

Front 23

clinical case:
dull preauricular headaches that radiate to his temples. jaw is stiff and sore, take force to move lower jaw into place.

Pain is deep, dull, continuous, and worse in am

Back 23

TMJ Dysfunction Syndrome

Can present as just headache, or
unilateral ear or preauricular pain that can radiate to the jaw, temple, or neck.

Front 24

Giant Cell (Temporal) Arteritis

pathophysiology:
demographic:
symptoms: (3)
labs:
dx:
tx:

Back 24

Chronic vasculitis of large and medium sized blood vessels.
Women:men = 3:1, usually ~70y/o, 1:500 people >50y.o

1) 2/3 of patients have headaches, may be temporal, frontal or occipital.
2) fever, jaw claudication, blurred vision, or transient loss of vision in one eye
3) 1/3 have tender temporal or occipital arteries

80% have very elevated sedimentation rate >50
dx:biopsy
tx: steroids

Front 25

Brain tumor

symptoms:

Back 25

1) Headaches occur in 50% of patients, bifrontal but worse ipsilaterally, Worse with bending (32%), cough, sneeze, valsalva
2) Nausea and vomiting in 40%
3) change from baseline headache pattern + abnormal neurologic findings

Front 26

• Severe headache of sudden onset
• worse with bending over, sneezing...
• may have ↓ level of consciousness
• Stiff neck
“sentinal headache” that lasts for only few minutes

Back 26

Ruptured Aneurysm
"Worst headache of life"

Front 27

Cerebral Venous Thrombosis

symptoms: (6)

Back 27

1) 90% have headache
2) papilledema
3) visual loss
4) seizures,
5) neuro deficits,
6) altered consciousness and coma

Front 28

Clinical Scenario:
Sudden severe eye pain, nausea, vomiting, headache
Unilateral blurred vision, halos, profuse tearing

Back 28

Acute Angle- Closure Glaucoma

Front 29

Acute Angle- Closure Glaucoma

pathophysiology:
demographic:

Back 29

iris pushing against trabecular meshwork (drainage channels)

farsighted people, elderly, Asians, Eskimos

Front 30

Bacterial Meningitis

symptoms: (9)
bugs: (3)

Back 30

1) Very ill within 24 hours
2) High fever (95%),
3) nuchal rigidity (88%),
4) altered consciousness (78%);
5) headache, photophobia,
6) petechia,
7) seizures,
8) focal neuro deficit, arthritis
9) Kernig and Brudzinski

Strep Pneumonia, Neisseria Meningiditis, Listeria monocytongenes

Front 31

Concussion

definition:
causes:
pathophyz:
symptoms: (minutes, vs. hours to days)

Back 31

Mild traumatic brain injury (TBI) with trauma-induced alteration in consciousness ± loss of consciousness.

Vehicle accidents (45%), Falls (30%), occupational (10%), recreational (10%), assault (5%)

Cortical contusion with axonal disruption

Immediate:
headache, dizziness, vertigo or imbalance, lack of awareness of surroundings, and nausea and vomiting
Hours-days:
mood and cognitive disturbances, sensitivity to light and noise, and sleep disturbances

Front 32

Postconcussion syndrome

symptoms: (4)
timing:

Back 32

1) headache, 2) dizziness, 3) neuropsychiatric symptoms, and 4) cognitive impairment

first days after mild TBI and generally resolve few weeks - months

Front 33

Post-traumatic headaches

frequency:
timing:

Back 33

occur in 25 to 78% of patients after mild TBI

onset within 7 days after injury

Front 34

Normal Pressure Hydrocephalus

demographic:
pathophysiology:
symptoms: (6)

Back 34

Patients older than 60
-Drainage of CSF impaired

1) demential (memory loss, speech, mood, etc)
2) difficulty focusing eyes
3) Walking problems (freezing, shuffling, etc)
4) Urinary symptoms (incontinenece, polyuria/urgency)
5) nausea
6) Headache