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26 Cards in this Set

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"Worst HA of life" like being "struck accross head w/ a baseball bat" suggests....

subarachnoid hemorrhage!

T/F


Majority of pts w/ HA have normal physical & neurological exam

TRUE

If an elderly pt w/ a worsening headache, located over left jaw & temporal region & blurry vision, presents w/ palpable, nonpulsatile, tender temporal arteries, what do you suspect?


Tx?

Temporal (Giant Cell) arteritis




Tx: IV prednisone given promptly!




(dx w elevated ESR & confirmed w. temporal artery biopsy)

Headache w/ papilledema suggests....

Increased intracranial pressure

_________ are recurring HAs that involve the blood vessels, nerves (Trigeminal nerve), & brain chemicals.




MC in females, onset usually in young adulthood

Migraines




(spasm of cerebral vessels---> dilation of extracranial arteries--> pain)

______ are episodic UNILATERAL HA's, often associated w/ neurologic (photophobia), GI (anorexia, N/V), &/or autonomic changes & auras




*frontotemporal location, dull (mild) or throbbing pain (severe)


*sx are DISABLING

Migraines

T/F


Migraines occur MC (80%) W/O an aura (common migraine)

TRUE




(migraine w/ aura = classic migraine, less common)

Auras last < 60 mins, what is the Mc type?

Scotoma = visual phenomena that precedes the HA (resembles being too close to a camera flash)

Migraine attack + major neurologic dysfunction (hemiplegia, coma, etc) that last longer than the migraine

Complicated migraine

Migraines do not require CT &/or spinal tap for dx UNLESS....

New symptoms




(rule out emergent condition)

Migraine: treatment




(tx when feel onset, can stop from progressing*)

Drugs: NSAIDs/ tylenol, caffeine - mild


Dihydroergotamines, Tryptans, Anti-emetics, TCAs - moderate


Opioids - severe/resistant


Avoid triggers (glaring, flashing lights)


Regular meals & sleep


Minimize environmental stress (relaxation training, meditation, etc)

T/F


Cluster HAs are common & associated w/ auras

FALSE




Cluster HAs are uncommon & not assoc w/ auras


*One of many Trigeminal Autonomic Cephalgias

____________ sudden onset, extremely intense constant HA assoc w/ Horner's like sxs (ptosis, miosis), nasal congestion, conjunctival injection, & increased sweating on ipsilateral side.




*UNILATERAL Retroorbital location (behind eye)


*Reoccurs frequently over several days/ weeks (interspersed w pain free periods)

Cluster Headache

Cluster HA: tx

preventative- beta blockers


abortive- oxygen, DHE, Ergotamines, triptans




(not relieved by sitting in dark)

MOST common type of headache




(& least severe)

Tension Headache

"Vicelike" (pressure-like) BILATERAL headache w/ pain in the neck & upper shoulders, lasts long periods (days)


Dx?


Tx?

Dx: Tension Headache




Tx: Anxiety/Depression Evaluation, TCAs (prevention), Massage, acupuncture, IM botulin injection, omm

T/F


Stress can cause tension headaches

TRUE




(craniocervical muscle tension can also cause)

HA + Fever + Neck stiffness


+ Brudzinski's


+ Kernigs




what do you suspecT?

Meningitis

Headache & facial pain that is worse w/ movement




What do you suspect?


Tx?

Acute Sinusitis


(chronic sinusitis usually NOT accompanied by HA**)




Tx: nasal decongestant

Obese female of childbearing age, experiences HA's & visual disturbances w/ exertion. PE shows papilledema


Dx?


Tx?

Dx: Idiopathic Intracranial HTN (benign intracranial HTN, "pseudotumor cerebri"




Tx: Weight loss*, Acetazolamide, CSF shunting (for refractory cases)

_________ mc occurs as a result of CSF leakage through the dural sac following a spina tap




*Pt presents w/ HA that is relieved in the recumbent position




tx?

Idiopathic Intracranial HYPOtension




tx: blood patch (stops leakage)

T/F


Cranial Neuralgias are long lasting

FALSE




Neuralgias are very brief (1-2 seconds or less)

________ Neuralgia;


-women, middle age or older


-paroxysmal, excruciation episodes of ipsilateral facial pain (very brief)


-pain exacerbated or triggered by any slight touch to face (touch, movement, drafts, eating)




Tx?

Trigeminal neuralgia -->


(aka Tic Douloureux)


caused by vascular compression of the trigeminal nerve root, usually the unilateral 2nd or 3rd division




tx: carbamazepine, anticonvulsants, antidepressants, surgery (if refractory)

________ Neuralgia;


-follows an outbreak of Herpes Zoster


-Intense burning pain, localized to affected nerve (same place as the zoster)




tx?

Postherpetic Neuralgia




Tx: antidepressants, anticonvulsants, opioids, & topical lidocaine patches

__________is a degenerative disorder of the cervical intervertebral discs


-osteophyte formation


-hypertrophy of adjacent facet joints & ligaments


-Sx: painful, stiff neck, shoulder pain, HA, paresthesias radiating down the arm, + Spurling maneuver




Tx?

Cervical Spondylosis




Tx: NSAIDs, Cervical Immobilization, OMM, Muscle relaxers, Steroid injections, Surgery (if necessary)

_________a burning or aching pain of greater severity & duration (hyperpathia) than expected following trauma to an extremity




PE: muscle wasting, decreased ROM, cool & clammy extremity, temperature intolerance




Tx?

Complex Regional Pain syndrome


(reflex sympathetic dystrophy (RSD))




Tx: Physical therapy (early stages), Gabapentin