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40 Cards in this Set

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  • Back
Major pain sensitive structures (lots of 'em):
Great venous sinuses
Dura Mater (at base of the skull)
Intracranial portions of the trigeminal, facial, glossopharyngeal, vagus, & the upper cervical nerves
Carotid, vertebral, and basilar arteries as well as dural arteries and the circle of Willis
Proximal portions of the cerebral arteries
Which cranial nerves cause pain that can be localized by a patient?
CNs V, IX, or X

Cervical nerve roots (and external carotid) may not be localizable
Three major primary headache disorders:
Migraine, tension, and cluster headaches
After age 12, which gender has a higher prevalence of migraine headaches?
Females more than males
What is a complicated migraine?
A migraine due to a transient or permanent neurologic deficit. It's uncommon and may be due to the painless constriction of a cerebral artery.
In a classic migraine (migraine + aura) what causes the aura? What causes the actual migraine?
Low blood flow causes the aura. The subsequent increase in blood flow causes the migraine.
Approx what percent of migraines are classic (with aura)?
About 20%
POUND Acronym for diagnosing migraines

(From ICM II small groups)
Pulsatile (throbbing)
One day or longer duration (as opposed to cluster headaches)

If a patient meets at least 3 criteria there is a 90% change they are experiencing a migraine.
Three strategies in managing a migraine
1. Eliminating any triggers of migraines (food, noises, etc)
2. Reduce stress
3. Treat migraine with abortive therapy during aura or soon thereafter.
(T/F) When treating a migraine, avoid ergotamines (cafergot), NSAIDs, and aspirin. Not only are these ineffective, but can cause serious problems.
False. Sometimes these are effective in treating migraines.
Sumatriptan and other triptans are effective at treating which type of headache?
Name four classes of drugs that are often used prophylactically to treat migraines:
Beta blockers;
Tricyclic antidepressants;
Criteria for tension headaches in terms of type of pain, quality of pain, and location.
Tension headaches typically cause a pressing/tightening feeling.

It's a mild or moderate intensity (non-throbbing).

Usually bilateral location.
Are tension headaches typically aggravated by walking stairs or doing routine physical activity?
When diagnosing tension headaches do you expect to see nausea and vomiting?
What about photophobia and phonophobia?
You typically do NOT see these.
In some cases either photophobia or phonophobia may be present but not both.
Do tension headaches typically respond to over the counter analgesics?
Which develops more slowly- tension-type headaches, or migraine headaches?
Tension type headaches tend to develop slower.
Name two classes of drugs used to prophylax tension-type headaches?
SSRI's and TCA's
How common are cluster headaches?
Relatively uncommon (0.07%)
Which gender do you tend to see have more cluster headaches? What age groups?
Men more than woman. Typically they begin between 20 and 40 years old.
Seven warning signs of a headache that must not be overlooked:
Sudden, severe onset
Progressively worsening headache
Stiff neck or fever
Headache on exertion
Onset after 50
Decreased alertness or change in mental status
Abnormal neurologic or physical examination
(T/F) Patients experiencing a subarachnoid hemorrhage typically describe a severe, thunderclap headache. They may be nauseated and have a positive Kernig's sign.
What can happen if you fail to rapidly diagnose and treat arteritis?
Condition may lead to blindness.
If you hear that a patient is over 50 and just had their first headache, and they have have a high ESR, what are you thinking?
Pregnant females or those on OCP's are at risk for which type of secondary headache disorder?
Venous thrombosis

Though notes say that arterial hypertension also carries a risk for eclampsia
Which type of headache disorder is characterized by getting progressively worse, leading to drowsiness, lethargy, and possible coma, as well as fever, focal signs, or papilledema?
Venous thrombosis
What is arterial hypertension?
A sudden, large increase in arterial pressure, whether due to malignant essential hypertension, eclampsia, or pheochromocytoma
Review from POD: What does CSF reveal for a person who has bacterial meningitis?

What about viral meningitis?
For bacterial meningitis, you'll see many granulocytes, increased protein, and reduced glucose

For viral meningitis, you'll see lymphocytes and monocytes in the CSF with mild protein elevation and normal glucose.
What is a key feature for diagnosing a neoplasm as an underlying cause of headaches?
Seizures, focal neurologic dysfunction, or papilledema.
Mrs. X is a lovely 70 year old patient. During a routine visit she complains that for the last few weeks, she's been experiencing headaches when she lies down and in the early morning.

What are you most concerned about at this point?
You are worried that Mrs. X might have a neoplasm which is presumably causing increased intracranial pressure when she lies down.
Ms. X, the slightly obese 20 year grandchild of the lovely Mrs. X has been complaining about a continuous headache that has been lasting for several weeks now. She got a CT scan and and MRI scan a few days ago and both came back normal. What would be another appropriate test for her?
Miss X most likely has benign intracranial hypertension, which often affects obese women ages 16-40. Another good test is the lumbar puncture (patient must be lying flat). You are looking for elevated opening pressure.
In which type of headache do people tend to rock or move around rather than sit and lie still?
Cluster headaches
Which type of headaches are referred to as alarm clock headaches?
Cluster headaches
Which type of headache is often associated with lacrimation, nasal congestion, rhinorrhea, sweating, miosis, ptosis, and eyelid edema?
Cluster headaches

Note: Migraine headaches can produce these symptoms as well.
What is the usual length of time for a cluster headache to last?
15-180 minutes
For all three primary types of headaches, what must you rule out?
Secondary headaches
Four acute treatments for cluster headaches:
Sumatriptan (subcutaneously)
Lidocaine (intranasal)
For a person who has a predictive pattern of cluster headaches, which drug can be taken 30-60 minutes before onset to prevent an attack?
Four preventative medications found useful in the treatment of cluster headaches:
Verapamil, prednisone, lithium, and ergotamine
Do potent analgesics typically help with cluster headaches?
Not really