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Neurology Headache
Neurology CM
| Question | Answer |
|---|---|
| Most common type of headache | Tension. |
| Dietary triggers of headache | ETOH, Chocolate, Aged Cheeses, MSG, Aspartame, Caffeine, Nuts, Nitrates, wine, cured meat, dark leafy greens, beets, carrots |
| Hx to obtain | age, aura, frequency, intensity, duration, days/month, time and mode of onset, quality, site, radiation of pain, associated sx |
| POUND criteria (5 criteria) | Pulsatile/throbbing headache, hOurs (4-72), Unilateral, Nausea, Disabling |
| Thunderclap headache "the worst HA of my life" | Subarachnoid hemorrhage (or intracranial mass lesion) |
| Ipsilateral tearing and runny nose is associated with | cluster migraines |
| Dangers Signs | Absence of similar HA previously, worsening pattern, focal neurologic s/s, fever (infection), mental status change, rapid onset with strenuous exercise (carotid dissection, intracranial hemorrhage) |
| New headache in a pt with HIV suggests | opportunistic infection |
| New headache in a pt with Lyme dz suggests | meningeal encephalitis |
| Sudden, severe, unilateral vision loss may be | optic neuritis |
| HA, fatigue, genl. aches and pains, night sweats, >55 may suggest | temporal arteritis |
| Intermittent HA with HBP | rare, but may be pheochromocytoma |
| Indications for imaging | warning signs, clinical judgement. If classic headache with normal neurologic exam, don't image |
| MRI or CT? | CT with or without contrast. |
| Indications for LP | Clinical suspicion for Subarachnoid Hemorrhage, or of an infectious or inflammtory etiology |
| Migraines more common in men or women? | Women. (F17%, M6%). Without arua is most common (80%) |
| which hormone has direct action on cranial vasculature? | serotonin |
| _____ is potent vasodilator | Calcitonin gene-related peptide (CGRP). may mediate trigeminovascular pain transmission |
| Right-left cardiac shunt | migraine with aura, patent foramen ovale |
| _____is a neurologic deficit that precedes the migraine | Aura. Migraine aura precedes migraine, with HA onset just after it stops. Actually can develop during or after onset |
| Most common disturbance associated with aura | visual disturbance. Second most common is numbness or tingling or lips, face, fingers of one hand (cheio-oral) |
| Nasal congestion and rhinorrhea are common in | migraine. Sinusitis is different and has fever, purulent discharge |
| Which type of cutaneous allodynia is most common? | cephalic (ipsilateral). |
| Decreased estrogen levels | associated with migraines |
| Repetitive HA | Cluster. Uncommon <1%, men>women, peak age of onset 25-50 |
| Features of Cluster HA | unilateral, begins quickly, patient tends to walk around restless (as opposed to migraine patients who lay in a dark room). Begins around the eye. Ipsilateral tearing, stuffy nose, rhinorrhea, sweating, pallor |
| Which type of cluster HA is most common? | Episodic cluster. 1-3 attacks/day for 6-12 weeks, followed by remission for 6-12 weeks. Remission may last years. treatment is difficult. |
| Band-like, squeezing pain across the forehead is a description of | tension headache. No aura, photophobia, phonophobia. food triggers less likely. Can have daily ha for years. analgesic abuse. Psychologic factors common. |
| Do you use Triptan in tension ha? | no, use naproxen/aleeve |
| This is generally in conjunction with fever and purulent discharge | acute sinusitis. uncommon cause of recurrent HA. |
| This type of HA is typically bilat/peri-orbital, pressure-like, dull, a/w nasal obstruction or congestion, lasts days | Sinus HA |
| Risks for Idiopathic intracranial HTN | Women of childbearing age,Overweight/obese, |
| What time of the day is migraine common? | morning |
| Features of Idiopathic intracranial HTN (pseudotumor cerebri) | Daily or near daily generalized HA, fluctuating intensity, +/- nauseaTransient visual obscurations , “graying out”, diplopia - horizontal displacement, dizziness, N/V, tinnitus, headache is diffuse, increased in the morning and with valsalva. |
| Physical exam finding of idiopathic intracranial htn | papilledema. Indistinguishable from papilledema by intracranial space-occupying lesion. Eventually leads to loss of vision |
| Urgent neuroimaging | if BP is normal in idiopathic intracranial HTN. r/o malignant HTN as well |
| Idiopathic Intracranial HTN treatment | weight control, cessation of exogenous agents, use diuretics, acetozolamide, corticosteroids |
| Chronic vasculitis of large and medium sized vessels | Giant cell (temporal) arteritis. Affects elderly. tenderness or decreased pulse of the temporal artery. |
| Biopsy of GCA reveals | giant cells! ESR is elevated also |
| Which population has higher incidence of Giant cell arteritis? | Scandanavian descent. |
| jaw claudication - fatigue and amaurosis fugax (visual sx) are symptoms of | Giant cell arteritis |
| V1 of CN 5 | opthalmic |
| V2 of CN5 | maxillary |
| V3 of CN5 | mandibular |
| Aberrant loop of an artery or vein which leads to compression of the trigemminal nerve route near the entry into the pons which leads to demyelination | Trigeminal Neuralgia Pathophysiology |
| Which branch of CN5 is most commonly affected in postherpetic neuralgia | V1 |
| tic douloureux is a facial muscle spasm associated with | trigemminal neuralgia |
| Which dermatomes are affected in postherpetic neuralgia | thoracic, cervical, trigemminal (V1 most often) |
| Daily, persisten facial pain with pain confined at onset to a specific region (usually not in an area involved in mastication), deep, unilateral is called | Persistent idiopathic (atypical) facial pain |
| Paroxysmal pain associated with CN IX and X | Glossopharyngeal neuralgia. Severe, unilateral pain of the ear, larynx, tonsil, or tongue. |
| Sore points in tension HA | Temporalis, masseters, trapezius, splenius muscles (along the neck) |
Created by:
ltm12