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Neurology > Headache > Flashcards

Headache Flashcards

1
Q

Primary Headache?

A

Headaches without identifiable structural cause

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2
Q

Secondary Headache?

A

Headaches with underlying structural/metabolic cause

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3
Q

Acute Headaches?

A

abrupt-sudden onset, rapid worsening

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4
Q

Subacute Headaches?

A

Gradual onset, progressive buildup

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5
Q

Is the brain parechyma has how many sensory receptors? Is it sensitive to pain?

A

None

No

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6
Q

Underlying cause of headaches?

A

Inflammation or physical traction of pain sensitive nerve fibers

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7
Q

Through what nerves is headache pain transmitted?

A

CN V, VII, IX, X

Upper Cervical roots C 2-3

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8
Q

What innervates pain sensitive structures of the anterior/inferior fossa and scalp?

A

Ophthalmic branch of CN V

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9
Q

What innervates the posterior fossa, the cervical muscles and posterior scalp?

A

CN IX, X, C 2-3

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10
Q

Where do the pain sensitive nerve fibers synapse? Where do they go from there?

A

Trigeminal nucleus caudalis & Dorsal Horn of the upper cervical spine –>
VPL & VPM –> Sensory cortex

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11
Q

What is a migraine?

A

Chronic neurological disorder causing recurrent headaches

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12
Q

Features of migraines?

A 
Freq. unilateral
Pulsating
Moderate to severe intensity
Duratation of 4 - 72 hrs
Photophobia and/or phonophobia
May be preceded by a prodromal phase
May be preceded by an aura
"Triggers" are frequent
Frequent FHx
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13
Q

Prodrome symptoms for migraines?

A 
Mood swings
Odd food cravings
Malaise or vague feeling of un-wellness
Fatigue
Muscle aches and stiffness
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14
Q

Scotoma?

A

Blind spot

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15
Q

Most common location for aura to occur?

A

Occipital (Visual) Cortex

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16
Q

Cause of an aura?

A

A spreading depression wave

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17
Q

When does the occurrence of migraines begin to decline?

A

55

18
Q

In what population are migraines seen more often?

A

Women

19
Q

Is there a correlation between genetics and migraines? If so, what?

A

Yes
Polygenic - one loci at 10q23
Familial hemiplegic migraine (dominant gene)

20
Q

What is the anatomical substrate for migraines?

A

Trigeminovascular System

21
Q

What does the trigeminovascular system involve?

A

CN V1 innervation of pain receptors located in the dura, meninges, and medium/large cerebral arterys and veins that lie on the surface of the brain and above the tentorium

22
Q

What mediates the vascular changes associated with migraines?

A

Trigeminovascular System

23
Q

Pathogenesis of migraines?

A

In hypersensitized pain pathways, migraines may be triggered by either a so-called “Central Generator” located in the brainstem or by internal or external triggers that initiate an aura that stimulates neurogenic inflammation of meningeal vasculature that then excites already hypersensitive peripheral and central pain pathways

24
Q

Where are auras typically located?

A

Cortex

25
Q

Which NTs are important in the pathogenesis of neurogenic inflammatory pain and migraine?

A 
Calcitonin gene related peptide (CRGP)
Substance P (SP)
26
Q

One big function of CGRP and Sub P?

A

Potent vasodilator properties

27
Q

What does CGRP activate? Producing what? Causing what?

A

CRL receptors
To relax vascular smooth muscle (vasodilate) and to cause degranulation of mast cells.
Process causes sensitize this synaptic terminal to become hypersensitive and thereby fire off an antidromic signal (afferent) back through the trigeminal nerve to the brain stem

28
Q

What mediates the local inflammatory reaction in migraines?

A

Mast Cells

29
Q

What else is mediated by CGRP?

A

Mediate the synaptic juncture between the trigeminal nerve and the central brain stem neuron

30
Q

What is MoA of triptans?

A

5-HT1 receptor agonist leading to inhibition of the release of CGRP

31
Q

Where are trigger mechanisms found for migraines?

A

Both peripherally (trigeminovascular) and/or centrally (brain stem)

32
Q

What is a cluster headache?

A

Chronic neurological disorder causing recurrent headaches

33
Q

Characteristics of cluster headaches?

A

Pain always unilateral, frontal, retro-orbital
Unilateral Horner’s Syndrome and lacrimation
Unilateral conjuctival injection and rhinorrhea
Constant, severe, non-pulsating pain
Duration of minutes - 3 hrs
Daily attacks for weeks/months; remit for yrs
Men to women ration 4:1
Triggers are alcohol and tobacco
Rare FHx

34
Q

Cluster Rx?

A 
Acute Rx - Nasal oxygen at 8 -10 l/min
                SubQ Sumatriptan
Prophylaxis - CCBs (Verapamil)
                    Lithium
                    Valproic Acid
                    Prednisone
35
Q

Characteristics of Episodic/chronic tension headaches?

A 
Pain usually bilateral and bandlike
Not associated with auras
Not associated with nausea/vomiting
Not associated with photo- or phonophobia
Duration of minutes - 3 hrs
Daily attacks < 15 days/month = Episodic
Daily attacks > 15 days/month = Chronic
36
Q

Daily headaches > 15 days/month

A

Chronic tension headaches

37
Q

Daily headaches < 15 days/month

A

Episodic tension headaches

38
Q

Clinical features of idiopathic intracranial hypertension (Pseudotumor cerebri)?

A 
Headache of varying character
Pailledema
Transient visual obscurations
Diplopia secondary to CN VI paresis
Tinnitus
Constriction of visual fields, enlarged blind spots
Female to male ratio ~ 9:1
Age 20 - 45 yrs
Overweight (20% over normal body weight)
39
Q

What is special about pseudotumor cerebri?

A

Is a neurologic emergancy and must be treated as soon as possible to prevent loss of vision

40
Q

Causes of pseudotumor cerebri?

A

Primary idiopathic - cause unknown
Primary symptomatic - cause related to underlying metabolic abnormality that alters CSF production or reabsorption
Secondary - cause related to underlying process that physically blocks CSF circulation and/or absorption.

41
Q

Clinical features of Giant Cell (Temporal) Arteritis?

A

Autoimmune, systemic vasculitis causing granulomatous infiltration and occlusion of medium/small elastic arteries.
Headache - usually unilateral
Point scalp tenderness over temporal artery
Monocular obscurations leading to blindness secondary opthalmic artery occlusion
Associated polymyalgia rheumatica
Stroke - particularly involving the vertebral arteries

Neurology (25 decks)

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