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74 Cards in this Set
- Front
- Back
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Headache Intracranial causes include:
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lesions(tumor, hydroceph, bleed, inflammation), psych(depression,psychosomatic), tension(migraine)
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Headach Cranial causes includes:
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head injury, hematoma, wound
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headache Pathology:
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blood flow distubance or neurotransmitter: serotonin
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Extracranial causes of headache includes:
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sense organs: eye,ear,teeth, noseHTN sinusitis,musculoskeletal dz, cerv spondylosis, TMJ etc
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Recommend r/o mass if headache is:
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new onset, worse w exertion, occur in sleep, neuro ss/focal deficit
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Pain that is neurogenic -
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nerve irritation causes vascular permeability to increase, dilation, platelets activated, muscular contraction
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pain due to Vascular causes - reduced flow =
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migraine/aura
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vascular pain due to increased flow =
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throbbing pulsating pain of migraine or tension headaches
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pain Quality: tightness or pressure =
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tension HA
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pain that is lancinating =
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neuritis
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pain that feels like an eye struck by an icepick =
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migraine or cluster
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pain that feels dull or steady=
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intracranial mass
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headache eye pain means that
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eye likely involved
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headache that feels like a headband =
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tension headache
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headache that feels lateral =
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migraine or cluster HA
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headache with tender cheek forehead =
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sinus HA
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headache that is focal or general =
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mass
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headache that includes face pain =
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trigeminal neuralgia
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pharynx/ear pain =
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CN IX glossopharyngeal neuritis
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pain with chewing =
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TMJ, TN, GPN
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headache that is worse on waking =
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sinusitis or mass
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headache that occurs at same time daily =
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cluster headache
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headache at the end of day =
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tension headache
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MigrainePrecip:
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stress fatigue nitrites tyramine menses
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migraine Aura can be :
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sensory, motor or visual
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classic migraine occurs
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with an aura
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common migraine occurs
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without an aura
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SS of migraine:
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confusion, speech impairment, focal neuro def, photophobia, N/V dizzy,yawning, food cravings, mood changes, thirst/polyuria, constip/dia
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migraine Characteristics:
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throbbing, pulsating, starts unilateral,lasts 4-72 hrs
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Migraine Food Triggers:
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choc, tomatoes, onions, oranges,cheese, msg, aspartame, red wine;
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Migraine Tx:
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nsaids, cafergot, sumatriptan zolmitriptan;
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migraine prophylaxis:
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ASA, amitriptyline,propanolol,imipramine, sertraline
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other migraine triggers:
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hormones, exercise, fatigue; meds - antihtn, ntg,zantac, histamine, estrogen; stress
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migraines occuring when there is positive FMH:
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over 70%, 4x more likely if pos fmh of migraine w aura; usually maternal
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Cluster headache Precip:
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alcohol
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cluster headache m:f =
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6:1
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when does cluster headache usually occur?
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wakes at night,
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cluster headache usually last
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2 hr
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unilateral periorbital pain, tearing and nose running, ptosis eyelid
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cluster headache ss |
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Tension headache occurs more frequently in
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F > M
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usually non throbbing, but tight, worse w stress tension noise or glare, muscle spasms too are ss of
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tension headache |
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tension headache tx:
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nsaids, anti migraine meds, alt
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what does amitriptyline do?
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inhibits reup of serotonin and norepi
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what is sertraline?
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is an SSRI
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Temporal Arteritis
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r/o with new onset HA any pt > 50 yo
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visual impairment/loss 50%
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temporal arteritis |
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20-50% of sufferers with no tx go blind
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temporal arteritis |
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F>m
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temporal arteritis incidence |
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other ss of temporal arteritis
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anorexia wt loss fatiguemalaise fever sweats tender to palpate
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lab test for temporal arteritis |
ESR > 50mm/h
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trigeminal neuralgia most often caused by-
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superior cerebellar artery presses on trigeminal nerve root in most-
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trigeminal neuralgia ss
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sudden lancinating pain shooting from corner of mouth to nose,eye or ear-
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trigeminal neuralgia is triggered by
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touch eating drafts-
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trigeminal neuralgia tx: |
anticonvulsants, surgery w teflon felt pad between art/nerve
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Atypical face pain-
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burning aching dull or crushing -not in location ot TN but occipital or lateral face-
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differentiate Atypical face pain from
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TN, migraine, cluster or TMJ-
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atypical face pain results when trauma or basal skull fx injures
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the Trigeminal Nerve
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trigeminal neuralgia-
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superior cerebellar artery presses on trigeminal nerve root in most
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-sudden lancinating pain shooting from corner of mouth to nose,eye or ear -
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TN characteristic ss |
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triggered by touch eating drafts -
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TN triggers |
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tx =anticonvulsants, surgery w teflon felt pad between art/nerve
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TN treatment |
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bells palsy-
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LMN inflammation of facial nerve near stylomastoid foramen-
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causes of Bells palsy |
vasc, infect or immune causes-herpes simplex, influenza, varicella.EBV, HBV,mumps TB or lymes-HSV most common-
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bells palsy ss |
paresis,, pain drooping and loss of sense of taste
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-60% recover s tx from what ?
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bells palsy |
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western med tx for bells palsy
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corticosteroids +acyclovir
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in headache from trauma prompt tx may
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lessen chronicity -
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in headache from trauma there are
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altered levels Amino Acids, catecholamines, serotonin,endogenous opioids, glucose -
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concussive ss like disequilibrium, imp memory, imp concentration, emotional lability -
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headache from trauma ss |
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amitryptyline, propanolol ergot
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tx for headache from trauma |
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-4 stages CVA
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TIA transient ischemic attack
RIND reversible ischemic neuro deficit SIE stroke in evolution CS completed stroke |
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-HTN, smoking, BC post menopause-
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risk factors for CVA |
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CVA from thrombosis ss:
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dizzy, memory loss, no pain-
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CVA from bleed ss:
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dizzy, tinnitus, HA
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