Term
| What is the most common type of HA pt's will present with? |
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Definition
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Term
| Do tension type HA's throb? |
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Definition
|
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Term
| What is the nature of the pain in tension type HA? |
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Definition
| constant pain of moderate intensity in a bilateral band across the head. |
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Term
| What secondary sx are tension type HA's associated with? |
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Definition
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Term
| Do tension type HA's cause nausea and vomiting? |
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Definition
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Term
| Can chronic tension type HA's cause anorexia? |
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Definition
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Term
| How long does a tension type HA last? |
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Definition
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Term
| What type of HA often disturbs the pt's sleep cycle? |
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Definition
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Term
| Does physical activity aggravate tension-type HA? |
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Definition
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Term
| What are the 3 types of tension type HA's? |
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Definition
Infrequent
frequent
chronic |
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Term
| What is the criteria for a HA to be considered an infrequent episodic TTH? |
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Definition
| occurs less than on day a month |
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Term
| What is the criteria for a HA to be considered an frequent episodic TTH? |
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Definition
| occurs 1-14 days per month |
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Term
| What is the criteria for a HA to be considered a chronic TTH? |
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Definition
| Occurs more than 15 days per month |
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Term
| If TTH are more frequent, does the pain increase in intensity? |
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Definition
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Term
| What is the pathophysiology of TTH? |
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Definition
| Suspected to be pericranial myofascial neural signals that are misinterpreted as pain. |
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Term
| Is there a strong genetic component to TTH sufferers? |
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Definition
| No, this is opposite of migraineurs who do show familial tendency |
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Term
|
Definition
pt education
stress reduction
pharmacotherapy |
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Term
| What are drugs for TTH tx? |
|
Definition
For acute attack: analgesics (ibuprofen or acetaminophen)
Amitryptiline nightly for prophylaxis (tricycle antidepressant) |
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Term
| What should TTH pt's be taught? |
|
Definition
How to identify and eliminate triggers (HA diary)
It will not kill them or cause blindness (some pt legitimately worry since the pain is so acute) |
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Term
| What drugs should be avoided for TTH? |
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Definition
| opioid medications, they do not relieve the pain and may exacerbate it. |
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Term
| Are sinus HA's recurrent? |
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Definition
| If pt has this complaint it is probably a TTH |
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Term
| What is the cause of true sinus HA? |
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Definition
| inflammation of paranasal sinuses |
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Term
| Where is the pain located in a sinus HA? |
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Definition
| pain and tenderness in area around affected sinus |
|
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Term
| What exacerbates sinus HA pain? |
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Definition
changes in position
percussion (tapping on sinus)
sneezing
coughing |
|
|
Term
| What are tx for sinus HA? |
|
Definition
decongestants
AB's (PCN, cephalosporins)
sinus lavage (neti pot) |
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Term
| What is the cause of HA for 2% of HA sufferers? |
|
Definition
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|
Term
| What % of intracranial mass pt's suffer from HA? |
|
Definition
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Term
| What causes the pain in intracranial mass pt's? |
|
Definition
| The increased intracranial pressure that the mass exerts |
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Term
|
Definition
| HA due to increased intracranial pressure; e.g. intracranial mass is present |
|
|
Term
| What age do intracranial mass HA tend to present? |
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Definition
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|
Term
| What is the nature of the pain in intracranial mass HA? |
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Definition
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|
Term
| Does intracranial mass HA cause nausea? |
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Definition
|
|
Term
| If vomiting is present what is an intracranial mass exerting pressure on? |
|
Definition
|
|
Term
| Can intracranial mass HA increase in pain with a change in position? |
|
Definition
| Yes, but it is a poor ddx |
|
|
Term
| What are associated s/sx of intracranial mass HA? |
|
Definition
memory loss
disorientation
visual changes
seizures
numbness or weakness in extremity |
|
|
Term
| What is the tx of intracranial mass HA? |
|
Definition
| Need to get the mass out! Surgery. |
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|
Term
| What is an idiopathic intracranial HTN HA? |
|
Definition
pseudotumor cerebri (PTC)
Increased resistance in arachnoid villi decrease CSF movement into venous drainage
Pt presents with s/sx of an intracranial mass, but they in fact do not have one |
|
|
Term
| What is the main cause of idiopathic intracranial HTN HA? |
|
Definition
| 90% unknown. Increased resistance in arachnoid villi decreases CSF movement into venous drainage --> diffuse head pain due to increased intracranial pressure |
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|
Term
| What is the nature of the pain in idiopathic intracranial HTN HA? |
|
Definition
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|
Term
| What physiological change can cause an idiopathic intracranial HTN HA? |
|
Definition
| Increased thickness of basement membrane --> poor CSF drainage --> diffuse head pain |
|
|
Term
| What is the incidence of idiopathic intracranial HTN HA? |
|
Definition
| .9 per 100,00; primarily in women |
|
|
Term
| What is a common comorbidity in idiopathic intracranial HTN HA? |
|
Definition
|
|
Term
| What is the ratio of men to women in idiopathic intracranial HTN HA? |
|
Definition
|
|
Term
| What is the primary age for idiopathic intracranial HTN HA? |
|
Definition
|
|
Term
| What is the pain of an idiopathic intracranial HTN HA like? |
|
Definition
| pounding HA that increases in intensity |
|
|
Term
| What are ocular SE of idiopathic intracranial HTN HA? |
|
Definition
diplopia (CN VI) in 36%
blurred vision in 68%
papilledema in 90-100% of cases |
|
|
Term
| What are secondary s/sx seen in idiopathic intracranial HTN HA? |
|
Definition
N&V definitely possible
dizziness
pulsatile tinnitus in 58% |
|
|
Term
| What % of idiopathic intracranial HTN HA sufferers present with tinnitus? |
|
Definition
|
|
Term
| What are nutritional causes of idiopathic intracranial HTN HA? |
|
Definition
hypervitaminosis A
Vit D deficiency |
|
|
Term
| What are medications that are often seen in idiopathic intracranial HTN HA sufferers? |
|
Definition
tetracyclines
oral contraceptives
fluoroquinolones
Retin-A
steroids
NSAIDs |
|
|
Term
| What endocrine disorders are seen with idiopathic intracranial HTN HA sufferers? |
|
Definition
pregnancy
hyper or hypo thyroid disorder
Cushing's
Addison's |
|
|
Term
| What vascular dz is commly comorbid with idiopathic intracranial HTN HA? |
|
Definition
| collagen vascular disorders like SLE |
|
|
Term
| How are idiopathic intracranial HTN HA's diagnosed? |
|
Definition
Dx by exclusion! Must rule out serious infection or intracranial masses
MRI or CT
evaluate CSF |
|
|
Term
| What will be seen in medical imaging for idiopathic intracranial HTN HA? |
|
Definition
MRI or CT will show no mass or lesion
However, will show slit-like ventricles (increased CSF pressure) |
|
|
Term
| What is typically seen in idiopathic intracranial HTN HA sufferers when their CSF is evaluated? |
|
Definition
intracranial pressure > 250 mm H2O (70-180 is normal)
No tumor, infective or inflammatory cells will be seen |
|
|
Term
| What is used to rule out venous sinus thrombosis in idiopathic intracranial HTN HA dx? |
|
Definition
|
|
Term
|
Definition
| magnetic resonance venography |
|
|
Term
| What is the tx for idiopathic intracranial HTN HA? |
|
Definition
weight loss
fenestrate optic nerve sheath to relieve pressure
discontinue causative meds
prednisone for inflammation
acetazolamide or diamox w/ diuretic
May require repeated lumbar puncture |
|
|
Term
| What meds are used for idiopathic intracranial HTN HA tx? |
|
Definition
acetazolamide or diamox
Given with a diuretic
prednisone for inflammation |
|
|
Term
| What is the purpose of a diuretic in idiopathic intracranial HTN HA tx? |
|
Definition
| To reduce CSF production --> reduced intracranial pressure |
|
|
Term
| What is the purpose of repeated lumbar puncture for idiopathic intracranial HTN HA? |
|
Definition
| Drain CSF to reduce intracranial pressure |
|
|
Term
| What is known as the 'suicide dz'? |
|
Definition
|
|
Term
| When is trigeminal neuralgia's often seen? |
|
Definition
| middle to late life (after 50) |
|
|
Term
| What is the nature of pain in trigeminal neuralgia? |
|
Definition
| sudden, lightning like paroxysms of facial pain |
|
|
Term
| How are trigeminal neuralgies different from SUNCT? |
|
Definition
| the pain is very short lived (tic douloureux) and will remit. |
|
|
Term
| How often does trigeminal neuralgia pain present? |
|
Definition
Several times per day for 1-2 minutes per attack
Can be triggered by light touch or vibration |
|
|
Term
| What HA type can be triggered by vibration? |
|
Definition
|
|
Term
| What is used to treat trigeminal neuralgia? |
|
Definition
| carbamazepine (anti-convulsant) |
|
|
Term
| What is a surgical tx for cranial neuralgia? |
|
Definition
| surgical shield between nerve and vessel if compression is cause |
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