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Session 4 CM-Neuro-1
CM- Neuro -1- HA and Facial Pain
| Question | Answer |
|---|---|
| What is the most common type of primary headache | tension HA |
| What is the least common type of primary HA | Cluster HA |
| What are secondary HA | HA caused by other disease/traumas IE hypoxia, temporal arteritis, space occupying lesions etc etc etc that you don't want to miss because they can be life threatening or serious |
| What are the 5 major categories of migraines | Migraine without aura, with aura, childhood periodic syndromes, retinal migraine/ocular, complications of migraine |
| What is the pathophysiology of migraine HA | related to serotonin, neuropeptides at branches of trigeminal nerve cause inflammation, possible activation of dorsal raphe nucleus, dopamine hypersensitivity and vasodilation of cerebral vessels |
| What brain area is associated with migraine HA | dorsal raphe nucleus |
| Who is more likely to have migraines male or female | F>M 3:1 |
| is there a hereditary component to migraines | likely as 70% of patients have a 1st degree relative with migraines |
| Which ethnicity has the lowest incidence of migraines | Asians |
| when are migraines most likely to begin and what age is the peak occurrence | 2-3rd decade onset with age 22-55 peak ages |
| What is the criteria for diagnosing a pt with migraine w/o aura | at least 5 prior attacks lasting 4-72hrs, w/ two of the following (unilateral location, pulsating quality, moderate/severe intensity, aggravated by walking stairs or similar activity); one of the following during HA N/V, photophobia or phonophobia |
| What are the likely etiologies of HA | distention, traction or dilation of intracranial and extracranial arteries or spinal nerves or trauma spasms irritation to meninges and muscles |
| What are the 4 types of primary HA discussed in the lecture | Migraine, Acute/Chronic tension type HA, Episodic TTH, Cluster HA |
| What are the 4 types of prodromes associated with migraines | psychologic, neurologic, constitutional symptoms, aura |
| Name at least 3 psychologic prodromes associated with migraines | 1. Depression, 2. Euphoria, 3. Irritability, 4. Restlessness, 5. Mental Slowness, 6. Hyperactivity, 7. Fatigue, 8. Drowsiness |
| Name the 3 Neurologic prodromes associated w/ migraines | Photophobia, Phonophobia, Hyperosmia |
| Name 3 of the constitutional symptoms that can be associated as a prodrome for migraines | 1. Cold Feeling, 2. Sluggishness, 3. Increased thirst, 4. Increased Urination, 5. Anorexia, 6. Diarrhea, 7. Constipation, 8. Fluid Retention, 9. Food Cravings |
| What is the prodrome of migraines called an aura? What percent of migraineurs have aura? | An aura is a focal neurologic symptom it could be a smell or a visual aura such as a halo. 20% of migraineurs have aura visual is the most common |
| What is the classic presentation of the headache phase of migraines IE describe locality, duration, character | usually unilateral, throbbing, almost always accompanied by N(90%)/V(33%), anorexia, and lasts 4-72 hours |
| What is the postdrom of a migraine marked by | patient feels listless, tired or washed out and may take 24-48 hours to return to feeling themselves |
| What are the criteria for migraines w/o aura | 5 attacks that Last at least 4-72 hours, with 2 of following: Unilateral location, Pulsating quality, Mod-Severe intensity, aggravated by physical act. And has one of the following: N/V or Photophobia & phonophobia |
| To diagnose migraines w/ aura what are the criteria needed | 2 attacks with an aura (fully reversible visual, sensory or dysphasic speech disturbance), Two of following: Homonymous or unilateral visual symptom, aura symptom over 5 min, symptoms last >5 to <60 minutes, and have N/V or photophobia or phonophobia |
| How does a basilar artery migraine differ from the others | the s/sx are different and similar to ischemia in posterior circulation (bilateral disturbance of vision, ataxia, dysarthria, vertigo, tinnitus, paresthesias, altered consciousness, followed by throbbing HA in occipital region) |
| What is migrainous vertigo | condition where migraine presents with vertigo symptoms must be present during two or more migraine attacks often is a response to migraine meds though |
| What are the criteria for a retinal migraine/ocular migraine | 2 attacks of scintillation, scotoma, or blindness affects only one eye followed by migrainous HA, fully reversible probably due to vasospasm of choroidal or retinal arteries |
| What type of migraine present with oculomotor palsy, ptosis, and dilated pupil | ophthalmoplegic migraine |
| What is the difference between a menstrual related and pure menstrual migraine | Pure menstrual migraine occurs on the day of onset or following day after onset of menses. Related can occur 2 days before and 2 days after beginning menses both must occur 2 out of 3 menstrual cycles. |
| What is the tx for menstrual migraines | begin prophylactic pain meds (naproxen, mefenamic acid, frovatriptan, naratriptan, percutaneous estradiol) 2 days before onset of menses |
| Parents bring a child into your clinic who has unexplained N/V they just threw up 4 times an hour ago but don't have any GI diseases what is the likely dx | cyclic vomiting syndrome |
| What is an abdominal migraine | recurrent attack of abdominal pain, periumbilical/midline or poorly localized that lasts 1-72 hours. Associated with N/V and no signs of GI disease |
| Child complains of a spinning sensation that comes on suddenly this is their 5th time having it what could they have | Benign Paroxysmal Vertigo of childhood |
| If pt has migraines 15 days per month for 3 months what would you classify them as | chronic migraine |
| What is migralepsy | where epileptic seizure is triggered by migraine |
| What is critical for you to dx a pt with primary migraine HA | they must not show evidence of organic disease or it could be a secondary HA |
| What are the criteria for infrequent Episodic TTH | 10 episodes occurring on <1 day/month lasting 30min-7hrs. W/ 2 of following: bilateral location, pressing/tightening (non pulsating) quality, mild-moderate intensity, not aggravated by physical activity. No N/V no more than 1 of photophobia or phonophobia |
| What is the criteria for frequent episodic TTH | same as infrequent but happens more than one day a month but less than 15 days/month |
| What is the criteria for Chronic Episodic TTH | HA occurs on > 15 days/month and same criteria as other episodic TTH |
| Pt presents complaining of HA that is excruciating it comes and goes and makes them really restless what type of HA is this likely to be if no secondary causes | Cluster HA |
| What group male or female suffers more from cluster HA | Male 8:1 |
| What eye s/sx accompany many cluster HA | Lacrimation, Ptosis, myosis, nasal congestion, or conjunctival injection (Horner's syndrome) |
| Do cluster HA occur at random times of the day or are they more likely to occur at the same time daily/nightly | Generally recurs same time daily/nightly |
| What are chronic paroxysmal hemicrania | similar to cluster HA but lasting >3months present as multiple, short, severe HA occurring on daily basis. Pt are almost always female. Attacks are shorter responds almost 100% to indomethacin |
| What is the tx for chronic paroxysmal hemicrania | Indomethacin responds almost 100% |
| What is trigeminal neuralgia | pain localized to one of the branches of 5th cranial nerve, pain is due to compression of nerve by vasculature. More common in elderly triggered by eating, talking or brushing teeth |
| What does SNOOPS stand for in regard to HA | S- systemic symptoms, N- Neurologic symptoms or abnormal signs, O- Onset, O- Older, P-Previous HA history, S- secondary risk factors |
| Pt presents with HA for first time why would you perform a funduscopic exam on them | look for papilledema or retinal hemorrhages |
| What secondary HA cause will generally be accompanied by complaint of worst headache of their life | Subarachnoid hemorrhage |
| What is a major complication of subarachnoid hemorrhage that if it occurs you have a 50% mortality rate | Sentinel Bleed |
| What s/sx may indicate that your pts HA is actually a secondary HA caused by acute glaucoma | pain begins in eye, pt is elderly, no hx of glaucoma, periorbital pain and visual deficits, blurred vision, boring pain associated with ipsilateral HA, corneal and scleral injections, edematous and cloudy cornea |
| This cause of secondary HA usually doesn't occur before age 50 will result in visual loss 60% of time if not treated. And is often accompanied by jaw claudication, fever, wt loss, anorexia, malaise, polymyalgia rheumatica, and an ESR >50 | Temporal Arteritis |
| What is the definitive dx test for temporal arteritis | Temporal Artery Biopsy |
| Your pt has temporal artery tenderness, an ESR > 50, you order a biopsy to confirm your dx of what and what tx should you start | dx of temporal arteritis (confirmed by multinucleated giant cells) and you would start high dose steroids in the meantime until confirmation because untreated can result in visual loss |
| Pt has had a HA that just won't go away accompanied by fever they also haven't seemed them selves and have been forgetful what could be a likely etiology of their HA by the way they are a military cadet | Bacterial Meningitis |
| Pt has abducens palsy on examination and papilledema you order a head ct and lumbar puncture that shows elevated opening pressure >250mm H20. Your pt is a young obese woman who has come in complaining of HA, double vision & pulsatile intracranial noises | Pseudotumor Cerebri |
| What are some things that are known to precipitate HA and you should tell your pt to avoid | stress, aged cheese, dairy, red wine, nuts, shellfish, caffeine withdrawal, vasodilators, perfumes/strong odors, irregular diet/sleep, light, head and neck infection/trauma |
| What is the most common drug probably taken for HA | NSAIDS |
| What drug should not be given for HA if the pt has a G6PD deficiency or bleeding disorder | Aspirin |
| What drug should not be taken for longer than 5 days for HA as it may cause hemorrhage and is contraindicated in NSAID induced asthma, pregnancy | Ketorolac |
| What HA drug should not be given with MAOI or within 15days of pregnancy or lactation | Meperidine |
| What nasal HA drug should not be given to pt with impaired renal, hepatic or pulmonary function or in elderly pt with CNS depression | Butorphanol (Stadol) |
| This HA tx is actually and adjunctive therapy that should not be given in pheochromocytoma, seizure disorders, GI bleeding or GI obstruction | Metoclopramide (Reglan) |
| This HA drug is contraindicated in pt with CNS depression or with use of an adrenergic blocker it is primarily used to treat nausea, vertigo and emesis | Prochlorperazine (Compazine) |
| This HA drug should not be combined with Triptans use, in pregnancy or lactation and is a combination of dichloralphenazone, acetaminophen, and isometheptene | Midrin |
| When you combine ergotamine, belladonna, and phenobarbital to tx HA what drug do you get | Bellargal-S |
| This HA drug may actually cause MI, Pleuropulmonary fibrosis, and vasospastic ischemia so be careful | Dihydroergotamine (migrainol) |
| What is the most effective acute tx for cluster HA | 100% oxygen |
| What class of drugs can be prescribed for prophylaxis of cluster HA | CCBs |
| what are the two strategies for tx HA | stepped give stronger drugs as symptoms persist or worsen, Stratified= giving stronger drugs for worse symptoms |
| What new tx involves paralyzing facial muscles has shown some promise for controlling migraine HA | Botox |
Created by:
smaxsmith
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