Term
| What are the 5 phases outlined for a migraine |
|
Definition
Prodrome (in 50-80% of pts)
Aura (in 10-20%)
Headache
Resolution
Postdrome ("migraine hangover) |
|
|
Term
Name some common internal triggers of migraines
|
|
Definition
| stress, hormonal changes/fluctuations, change in sleep habits |
|
|
Term
| Name some common external triggers of migraines |
|
Definition
| Food, weather, trauma, motion, light, smells, sounds |
|
|
Term
| What are 2 aspects of the pathology of migraines? |
|
Definition
Neurologic &
Vascular
Events |
|
|
Term
| How is serotonin related to migraines? |
|
Definition
| As it is depleted it causes symptoms ranging from fatigue, to cognitive dysfunction to vascular changes to pain. |
|
|
Term
| Specify some of the neurovascular events thought to be responsible for migraines |
|
Definition
- Reduced threshold for neuronal excitability
- Serotonin depletion/dopamine stimulation
- Glutamate in initial excitation then a spreading depression
- Release of vasoactive neuropeptides
- Calcitonin Gene-related peptide
- Substance P
- Neurokinin A
|
|
|
Term
| How is dopamine correlated to migraines? |
|
Definition
As its levels increase symptoms go from:
yawning
mood change
nausea
gastrokinetic changes
hypotension
vomiting
dyskinesias |
|
|
Term
| What is the difference between common and classic migraines? |
|
Definition
Common do not have an aura phase
Classic do have an aura phase |
|
|
Term
| Common migraine-4 characteristics |
|
Definition
1. begins upon wakening and builds
2. GI upset
3. pt feels chilled
4. lasts 4-72 hours |
|
|
Term
|
Definition
Dictionary.com
A transient visual sensation of bright shimmering colors, as
that preceding scintillating scotoma in migraine |
|
|
Term
| How long does a migraine aura usually last? |
|
Definition
|
|
Term
| What is the common duration of a classic migraine |
|
Definition
|
|
Term
| What time frame/frequency of headache is considered to fall into the chronic migraine category? |
|
Definition
| HA on >/= 15 days/month for >/= 3 months |
|
|
Term
| Correlation of frequency of chronic migraines and symptoms |
|
Definition
| Symptoms become less severe as frequency increases |
|
|
Term
| What must be ruled out when dealing with chronic migraines |
|
Definition
Have to rule out that the headaches are being caused by medication : Medication Overuse Headache
This is because the effectivity of a headache med may be reduced with frequent use and cause pain instead of helping.
|
|
|
Term
| What are some nonpharmacologic treatments that can be recommended to migraine patients. |
|
Definition
Regular sleep
Regular meals
Regular exercise
Healthy lifestyle
Relaxation/Stress Reduction
Acupuncture
Magnetic pulse (during aura) |
|
|
Term
| Name 3 OTC migraine medications and their dosage |
|
Definition
NSAIDS
Excedrin (or extra strength) 2 tabs q6h
Ibuprofen 400-800mg every 1-2 hours
High dose ASA (1000mg) |
|
|
Term
| Name 3 Narcotics that may be used to treat migraines |
|
Definition
Butorphanol (IV)
Percocet
Percodan |
|
|
Term
|
Definition
|
|
Term
| Name 4 options for abortive therapy (for migraines) |
|
Definition
Serotonin agonists (triptans)
Ergotamine tartrate (vasoconstrictor)
Dihydroergotamine (DHE 45)
Parenteral Dexamethasone (with triptan)
|
|
|
Term
| Name 2 Antiemetics used in migraine treatment |
|
Definition
Metoclopramide (Reglan)
Chlorpromazine (Thorazine) |
|
|
Term
| Name 5 types of preventative migraine treatment that are recognized as effective |
|
Definition
Anticonvulsants
Triptans
Beta blockers
Tricyclic antidepressants
Botulinum toxic type A |
|
|
Term
| Name 2 preventative migraine treatments discussed in class that are not recognized as effective |
|
Definition
Calcium channel blockers (Verapamil)
Gabapentin (Neurotonin) |
|
|
Term
| Name 2 anticonvulsants that may be used to treat migraines |
|
Definition
Valproic acid (Depakote)
Topiramate (Topomax) |
|
|
Term
| Why is Frovatriptan only used as a preventative method rather than abortive like other triptans? |
|
Definition
It is slow in onset and long in duration
(with very few side effects) |
|
|
Term
| Give an example of a beta blocker used to treat migraines |
|
Definition
|
|
Term
| Name a tricyclic antidepressant used to treat migraines |
|
Definition
Amitryptiline (GABA potentiation)
Can use this if pt cant be on triptans |
|
|
Term
| Subset of migraine with an aura that can resemble a stroke |
|
Definition
|
|
Term
| Why are triptans avoided in treatment of hemiplegic migraines |
|
Definition
| because of their vasoconstrictive properties and the concern of stroke |
|
|
Term
T/F
Hemiplegic migraines
Hemiparesis lasts longer than the headache |
|
Definition
|
|
Term
T/F
Hemiplegic migraines
Recovery may take a few weeks but is usually complete |
|
Definition
|
|
Term
T/F
Hemiplegic migraines
Unilateral or bilateral motor and sensory symptoms? |
|
Definition
|
|
Term
| 2 treatments of hemiplegic migraine (although not agreed upon) |
|
Definition
Anticonvulsants
Calcium channel blocker |
|
|
Term
| Migraine characterized by constriction of CRA or ophthalmic artery and subsequent monocular scotoma, lasts about 1 hour |
|
Definition
|
|
Term
What must be ruled out in a patient experiencing a retinal migraine
|
|
Definition
TIA
vitreoretinal disease |
|
|
Term
T/F
Retinal Migraine
Little to no headache follows the aura |
|
Definition
|
|
Term
T/F
Similar to hemiplegic migraine, retinal migraines completely resolve |
|
Definition
False
Irreversible vision loss is indeed possible from migrainous infarction |
|
|
Term
T/F
All migraine scotomas are bilateral |
|
Definition
False
Retinal migraines cause monocular scotomas |
|
|
Term
| Which type of migraine is asssociated with a patent foramen ovale? |
|
Definition
| Migraine aura without headache |
|
|
Term
| Which of the trigeminal autonomic cephalalgias has the longest attack duration and low attack frequency |
|
Definition
|
|
Term
| Which of the trigeminal autonomic cephalalgias has intermediate duration and frequency? |
|
Definition
|
|
Term
| How many headaches generally occur in a 'cluster'? |
|
Definition
|
|
Term
Which type of headache has these characteristics? unilateral, excruciating pain
often periocular
no N&V
builds rapidly
Ipsilateral congestion, rhinorrhea and epiphora |
|
Definition
|
|
Term
| Name 2 places in the brain where stimulation has been used as a treatment for cluster headaches? |
|
Definition
Posterior Hypothalamic region
Occipital nerve |
|
|
Term
| What is believed to be the underlying cause of Cluster headaches? |
|
Definition
|
|
Term
100% O2 for 20 minutes
Treats what? |
|
Definition
|
|
Term
| In addition to regular migraine medications, what are some treatments for cluster headaches |
|
Definition
100 O2 for 20 minutes
Intranasal lidocaine
Verapamil for prophylaxis
Neural stimulation |
|
|
Term
| Which of the trigeminal autonomic cephalalgias is a rare condition most often found in women |
|
Definition
|
|
Term
Unilateral, brief, severe attacks with cranial autonomic features, usually ophthalmic trigeminal distribution
Lasts up to 30 minutes, up to 40 times per day
Which trigeminal autonomic cephalalgia? |
|
Definition
|
|
Term
| What is the treatment for paroxysmal hemicrania? |
|
Definition
Indomethacin 75-200mg/day
Very straightforward treatment |
|
|
Term
| Brief, severe, unilateral attacks of pain in orbital, periorbital or temporal regions, lasting only minutes and occuring up to 200 times per day |
|
Definition
|
|
Term
| What does SUNCT syndrome stand for? |
|
Definition
| Short-lasting Unilateral Neuralgiform headaches with Conjunctival injection and Tearing |
|
|
Term
| Describe some symptoms of SUNCT syndrome an optometrist might observe |
|
Definition
Conjunctival injection
lacrimation
Nasal congestion
rhinorrhea
ptosis
eyelid edema
|
|
|
Term
| Describe some triggers of SUNCT syndrome |
|
Definition
| touch, chewing, exercise, light, neck movement |
|
|
Term
| What is the ACUTE treatment for SUNCT syndrome? |
|
Definition
IV lidocaine
(risky because it could stop the heart) |
|
|
Term
| What are used as preventive treatment of SUNCT syndrome? |
|
Definition
Anticonvulsants
Most effective is Lamotrigine
Also use topiramate and gabapentin |
|
|
Term
| What sort of surgical treatment is there for SUNCT syndrome? |
|
Definition
(For debilitating cases)
Occipital nerve blockade
Deep brain stimulation |
|
|
Term
| Vice-type, non pulsatile, bilateral, constant, mild-to-moderate, headaches |
|
Definition
|
|
Term
| Is N&V associated with tension type headaches? |
|
Definition
| No, but possibly anorexia |
|
|
Term
| What is the typical duration of tension type headache |
|
Definition
|
|
Term
What are the 3 subtypes of tension type headaches
|
|
Definition
1. Infrequent episodic
2. Frequent episodic
3. Chronic |
|
|
Term
| How often do INFREQUENT TTH occur? |
|
Definition
|
|
Term
| How often to FREQUENT EPISODIC TTH occur? |
|
Definition
|
|
Term
Pathophyisology:
Heightened sensitivity to pericranial myofascial tissue signals
Which type of headache? |
|
Definition
|
|
Term
| Name 2 non-pharmacologic treatments for Tension type headaches |
|
Definition
Patient education
Stress reductoin |
|
|
Term
| Name 2 types of pharmacologic therapy for tension type headaches |
|
Definition
Analgesics for acute attacks (ibuprofen, acetaminophen)
Tricyclic antidepressants (Amitryptyline) |
|
|
Term
| What are true sinus headaches caused by? |
|
Definition
| Inflammation of the paranasal sinuses |
|
|
Term
Pain exacerbated by changes in position, sneezing or coughing.
Also pain with percussion
Pain and tenderness in certain areas
Headache type? |
|
Definition
|
|
Term
| Name 2 types of medication used to treat sinus headaches |
|
Definition
| Decongestants and Antibiotics |
|
|
Term
| Describe the pain associated with intracranial mass |
|
Definition
Deep, dull and constant
Specific location
Recent HA
Slight nausea
Vomiting if medulla is compressed |
|
|
Term
Pt comes in with recent HA, memory loss, visual changes, disorientation and numbness in extremity
What could this be? (from this lecture on headaches) |
|
Definition
| HA from intracranial mass |
|
|
Term
| In terms of intracranial mass HA, describe the pain associated with supratentorial lesions |
|
Definition
|
|
Term
| In terms of intracranial mass HA, describe the pain associated with infratentorial lesions |
|
Definition
|
|
Term
| In terms of intracranial mass HA, describe the pain associated with occipital lesions |
|
Definition
|
|
Term
| In terms of intracranial mass HA, describe the pain associated with chiasmal tumors |
|
Definition
Vertex pain
(top of the head) |
|
|
Term
Increased resistance in arachnoid villi decreases CSF movement into venous drainage, causing diffuse head pain
Which type of headache? |
|
Definition
| Idiopathic Intracranial hypertension |
|
|
Term
| Name 2 other names for Idiopathic Intracranial hypertension |
|
Definition
Benign Intracranial Hypertension
Pseudotumor cerebri (PTC) |
|
|
Term
Fat, Fertile, Females are most affected
Which headache? |
|
Definition
| Idiopathic Intracranial Hypertension |
|
|
Term
| How common is papilledema in Idiopathic Intracranial Hypertension |
|
Definition
|
|
Term
| Name some of the symptoms of Idiopathic intracranial hypertension |
|
Definition
Pounding HA, increasing intensity
Diplopia (in 36%)
Blurred vision (in 68%)
Papilledema
Dizziness, pulsatile tinnitus
N&V |
|
|
Term
| What are some nutritional findings associated with Idiopathic Intracranial Hypertension? |
|
Definition
Hypervitaminosis A
Vitamin D deficiency |
|
|
Term
| What are some medications associated with Idiopathic Intracranial Hypertension? |
|
Definition
Tetracyclines
Oral Contraceptives
Fluoroquinolones
Retin-A
Steroids
NSAIDs |
|
|
Term
| What are some endocrine disorders associated with Idiopathic Intracranial Hypertension |
|
Definition
Pregnancy
Hyperthyroidism
Hypothyroidism
Cushing's
Addison's |
|
|
Term
| Which vitamin levels are low in obesity? |
|
Definition
|
|
Term
| How is Idiopathic Intracranial Hypertension diagnosed? |
|
Definition
R/O intracranial mass or infection
MRI
MRV
Cerebrospinal fluid evaluation (pressure and cells) |
|
|
Term
| What are we looking for when imaging Idiopathic Intracranial Hypertension with MRI |
|
Definition
|
|
Term
| Why is Acetazolamide used to treat Idiopathic Intracranial Hypertension? |
|
Definition
It is a Carbonic Anhydrase Inhibitor
It decreases the production of CSF |
|
|
Term
| Describe treatment methods of Idiopathic Intracranial Hypertension |
|
Definition
Generally self-limiting
Weight loss
Discontinue causative medications
Acetazolamide
Prednisone |
|
|
Term
|
Definition
|
|
Term
| Sudden, lightning-like paroxysms of facial pain |
|
Definition
|
|
Term
| Describe the duration and frequency of trigeminal neuralgia |
|
Definition
few second to 1-2 minutes
several times a day |
|
|
Term
| What are the most provocative triggers of trigeminal neuralgia |
|
Definition
Light touch
Vibration
(this flash card turned out kinda dirty...) |
|
|
Term
| Name 2 treatment options for trigeminal neuralgia |
|
Definition
1. Carbamazepine (Tegretol, anticonvulsant)
2. Surgery-place teflon shield between nerve and vessel, decompression. |
|
|
Term
| Which type of cranial neuralgia may follow a herpes zoster infection? |
|
Definition
|
|
Term
| Where might a postherpetic neuralgia occur? |
|
Definition
| In the same dermatomes that the herpes zoster infection was |
|
|
Term
| What is a treatment for postherpetic neuralgia? |
|
Definition
Amitryptiline, 25 mg qd within 2 days of rash
Botox possibly |
|
|
