Foundations II (Cholley) > HA > Flashcards

HA Flashcards

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1
Q

What is the 6th most disabling disorder in the world?

A

Migranes

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2
Q

How are HAs classified?

A
  • Primary (90%)
  • Secondary
  • Neuropathies & facial pains
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3
Q

What are primary HAs composed of?

A
  • Migraines
  • Tension HAs
  • Cluster HAs
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4
Q

What are red flags?

A
  • Abrupt onset of severe HA (“thunderclap”
  • Trauma associated HA w/ neurological deficit/ worsening sx
  • Focal neurological sx
  • Change in HA presentation
  • Systemic sx/illness
  • New onset in pt w/ CA or HIV
  • New onset after 50 yo
  • Wakes from sleep
  • Jaw claudication/temporal tenderness
  • Posture, exercise, valsalva provoked
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5
Q

What is the MC type of HA leading to pts seeking medical attention?

A

Migraines

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6
Q

Migraines are most common in what population?

A
  • White females
  • Low SES
  • Genetically predisposed (1st degree relatives)
  • Obese
  • Depression/anxiety
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7
Q

What triggers can cause a migraine?

A
  • Emotional stress
  • Hormones (women)
  • Not eating
  • Weather
  • Sleep disturbances
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8
Q

When do migraine prodrome sx typically appear?

A

24-48 hours prior to HA

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9
Q

What are prodrome sx of a migraine?

A
  • Yawning
  • Depression
  • Irritability
  • Cravings
  • Constipation
  • Neck stiffness
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10
Q

What are characteristics of a migraine aura?

A
  • Gradual, over 5 mins
  • Duration of 5-60 mins
  • Visual: shimmering or scintillating shapes/lines
  • Sensory: tingling on 1 side of face or limb
  • Language: dysphagia, difficulty w/ wording
  • Motor: weakness of face & limbs on 1 side
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11
Q

What are characteristics of migraine HA?

A
  • Duration 4-72 hrs
  • Unilateral
  • Throbbing, pulsating
  • Mod-severe pain
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12
Q

What sx are associated w/ a migraine HA?

A
  • N/V
  • Photophobia
  • Phonophobia
  • Osmophobia
  • Cutaneous allodynia
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13
Q

What is 1st line tx for migraine mild-mod attack?

A

NSAIDs (ibuprofen, naproxen, indomethacin, diclofenac, ketorolac)
- More effective if given early

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14
Q

What is 2nd line tx for migraine mild-mod attack?

A

Acetaminophen (Tylenol)

- Use if NSAID contraindication or previously unsuccessful

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15
Q

What is 3rd line tx for migraine mild-mod attack?

A

ASA/Acetaminophen/Caffeine (Excedrin)

  • For intermittent use
  • Common cause of med-overuse HA
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16
Q

What is 1st line tx for migraine SEVERE attack?

A

Serotonin agonists “Triptans”

  • Sumatriptan
  • Zolmitriptan
  • Eletriptan
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17
Q

What can happen if you use a “triptan” for > 2-3 times/wk?

A

Can lead to daily dull HA or migraine-like overuse HA

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18
Q

What is 2nd line tx for migraine SEVERE attack?

A

Ergotamines

  • Dihydroergotamine
  • Ergotamine/caffeine
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19
Q

What is alternative tx for migraine attack?

A

Opioids

  • Regular use can lead to tolerance, opioid-induced hyperalgesia, & med overuse HAs
  • Abuse & dependence
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20
Q

What is adjunct tx for migraine attacks?

A
  1. Antiemetic: For pts w/ N/V
    - Metoclopramide
    - Prochlorperazine
    - Promethazine
  2. Hydration
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21
Q

What type of pts should you administer migraine prophylaxis?

A
  • Pts w/ frequent (≥ 3 attacks/month), recurring & disabling sx
  • Migraines lasting over 48hrs
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22
Q

How do you prevent migraines?

A

Avoid triggers & modify behavior

  • Regular meals, exercise, sleep hygiene
  • Relaxation techniques, CBT
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23
Q

What was recently FDA approved for chronic migraine?

A

Botulinum toxin

- Inject into face, neck, head

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24
Q

How do you dx migraines?

A

Based upon subjective & objective findings

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25
What is the MC primary HA disorder? What population is mostly affected?
- Tension HA | - Mid teens to < 50, Men
26
What are the RFs for tension HAs?
- stress/anxiety - depression - too little or too much sleep - OSA - muscular tension - cervical spondylosis
27
What are the clinical findings of tension HAs?
- daily or episodic HAs lasting from 30mins to 7 days - Bilateral - Pressing/tightening - Mild-mod intensity - Increased tenderness of pericranial tissue
28
What is the 1st line tx for acute tension HA attack?
- NSAIDs (ibuprofen = drug of choice, naproxen) - Acetaminophen - ASA
29
When are tension HAs considered "chronic"?
If > 7-9 HAs per month
30
How do you tx chronic tension HAs?
Amitriptyline - Reduces frequency & intensity - Start w/ low dose
31
What is non-pharmacological therapy for tension HAs?
- CBT, relaxation, EMG | - PT, acupuncture, spinal manipulation
32
What is the least common primary HA d/o? What population is most affected?
- Cluster HA | - > 30 yrs (peak in 40s), men
33
What are RFs for cluster HAs?
- 1st degree relative - prior head injury - ciggs - high alcohol - male - type A personality
34
What are triggers of cluster HAs?
- d/o of circadian rhythm - sleep - volatile smells - smoking - sildenafil
35
How do cluster HAs present?
- 15 to 180 mins, up to 8 times/day | - Piercing, exploding, penetrating
36
What are the 2 forms of cluster HAs? Describe them.
1. Episodic (80-90%): lasts 2-16 wks followed by free period of 6 mos to yrs 2. Chronic: no sustained free episodes for > 1 month
37
What are sx of a cluster HA?
On the affected side: - injection, lacrimation - eyelid edema - Miosis, ptosis - nasal congestion, rhinorrhea - forehead & facial sweating - Fullness in ear
38
How do you tx acute cluster HAs?
- 1st line = O2 & sumatriptan/ zolmitriptan - Prednisone taper - Intranasal lidocaine
39
What can be used for prophylaxis of cluster HAs?
CCB verapamil
40
Secondary HAs can be attributed to...
- head/neck trauma - vascular d/o - non-vascular intracranial d/o - substance or its withdrawal - Infection - d/o of homeostasis - psychiatric d/o
41
What type of HAs are considered secondary?
- Post-concussion - Analgesic rebound - Pseudotumor cerebri - Temporal arteritis - Trigeminal neuralgia - Subarachnoid hemorrhage
42
What are features of a concussion? What is it caused by? What does it result in?
Mild TBI - Caused by direct blow - Results in rapid onset of neurological impairment that resolves spontaneously
43
What type of imaging is used to r/o intracranial hemorrhage?
CT & MRI
44
How are concussions managed?
Rest (physical & cognitive)
45
What are drug rebound HAs (AKA - overuse HAs) related to?
Acute symptomatic meds: - opioids - butalbital/analgesic - ASA/acetaminophen/caffeine
46
What is the most significant factor in the development of rebound HAs?
Lack of awareness by health providers & pts
47
What are sx of rebound HA?
- nausea - asthenia - difficulty concentrating - memory problems - irritability
48
When do rebound HAs resolve?
2 months after discontinuation of analgesia
49
What is pseudotumor cerebri? What population is most affected?
AKA - idiopathic intracranial HTN | - Women of childbearing age
50
What are the MC presenting sx of pseudotumor cerebri?
- variable, non-specific - pain of unusual severity - intermittent or persistent - +/- exacerbation w/ changes in posture - +/- relief w/ NSAIDs or rest
51
What are PE findings of pseudotumor cerebri?
- Papilledema * - Visual field loss - Abducens palsy
52
How do you tx pseudotumor cerebri?
- wt loss - decrease Na - carbonic anhydrase inhibitors - loop diuretics - serial LPs - optic nerve fenestration - CSF shunting
53
Describe: temporal arteritis. What population is most affected?
AKA - Giant cell arteritis - MC systemic vasculitis - Peak = 70-79 yo
54
What is the clinical presentation of temporal arteritis?
- Abrupt or insidious - HA - Neck, torso, shoulder, pelvic pain - jaw claudication - fever - constitutional s/s (malaise, wt loss, night sweats)
55
What are PE findings of temporal arteritis?
- 50% have tenderness over SF temporal artery - nodularity/thickening over SF temporal artery - scalp pain - 10% develop central retinal artery occlusion
56
What is the hallmark of GCA?
Elevated ESR & CRP
57
What is the standard diagnostic procedure for temporal arteritis?
Temporal artery biopsy
58
How do you tx temporal arteritis?
High dose corticosteroids due to danger of blindness | - Sx improve in 72hrs
59
Describe trigeminal neuralgia. What population is most affected?
"Tic Douloureux" - compression of trigeminal root - Peak = 60-70 yo - MS pts, females
60
What are clinical features of trigeminal neuralgia?
- sharp electric shock, lasting few secs to several mins | - may be triggered by simple actions
61
What are dx studies for trigeminal neuralgia?
- Based on H & P | - MRA w/ gadolinium
62
What are red flags of TN?
- trigeminal sensory loss - bilateral - < 40 yrs of age
63
How do you tx TN?
- Antidepressant & anti-seizure (carbamazepine effective) - Narcotics rarely effective - Surgical decompression
64
What are RFs for subarachnoid hemorrhages?
- HTN - Smoking, alcohol - sympathoimetic drugs - polycystic kidney disease - coarctation of aorta - marfans
65
What are sx complaints of SAHs?
- sudden onset worst HA of life - worse on exertion - N/V - meningism - neck stiffness
66
SAH emergency workup should include...
Noncontrast CT | - If negative, get LP
67
How do you tx SAH?
Emergent surgery | - Surgical clip
Foundations II (Cholley)
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