Neuro Test Review Questions.docx

Neuro Headache: Tension HA is most common type, Migraine HA is most frequently treated HA in primary care 14%-16%  (⅙ people has headache) : tension, migraine, and cluster headaches Primary headache is the most common chronic pain syndrome in primary health care, you have to rule out the secondary...

Neuro Headache: Tension HA is most common type, Migraine HA is most frequently treated HA in primary care 14%-16%  (⅙ people has headache) : tension, migraine, and cluster headaches Primary headache is the most common chronic pain syndrome in primary health care, you have to rule out the secondary causes. (Ages over 50 years should be considered a secondary headache) Primary headaches: Migraine, Tension Type, Cluster headaches; not associated with other disease processes. Genetic, developmental, environmental risks.  Secondary headaches: Caused by other conditions; those issues that cause an increase in intracranial pressure International  Headache Society (IHS) Assists in diagnosis Establishes standard of care for headache Divides headaches into 2 general categories Primary headaches Secondary headaches Medication overuse is the typical type of secondary headache. How long have you had the headache? What triggers? occipital headache-HTN Worse when I bend over, facial tenderness, congestion - sinusitis  Orbital headache on eyes (acute angle glaucoma )  Associated with exertion maunover ? Sexual activity, cough, sneezing, —subarachnoid  hemorrhage sudden increased intracranial pressure Red Flags  of headaches SNOOPPP (DOG) Systemic symptoms Neurological signs/symptoms Onset Onset (age at onset of headache Younger than 5 over than 50) Previous headache history Positional  Papilledema  Red Flags. Thunderclap Sudden onset of severe pain and neck stiffness associated with altered consciousness or focal neurological deficits- ** Arachnoid Hemorrhage. The presence of ominous warning signs and/or focal symptoms warrant further Dx tests and Refer to neurologists Worst headache ever. Progressively worse Exertion, sexual activity, coughing or sneezing or brain tumor After valsalva maneuver Awakenings at night Change in well established HA pattern HIV patients SNOOPPP!!!! Systemic symptoms Neurological signs and symptoms, nuchal rigidity Onset abrupt (subarachnoid hemorrage) Onset age: >50 <5 = RED FLAG Previous HA history Position Papilledema What are some preferred DX tests for HA? CT without contrast MRI CSF Lumbar puncture Sinus series CBC, CMP, TSH EEG  Xray (cervial) Sed Rate RPR - syphilis. Migraine: nausea, vomiting, photophobia, sonophobia or osmophobia 4-72 hours Tension headache: 30 minutes to 7 days cluster headache: unilateral excruciating pain (a hot poker or stabbing sensation ) in the ocular, frontal, or temporal areas, orbital or periorbital region, pain usually unilateral, last 1-2 hours severe occurs in night, suicidal headache–oxygen IHS: DX of Migraine w/o aura requires 5 attacks with the following criteria HA lasting 4-72 hrs HA with at least 2 of the following: Unilateral location Pulsating  Moderate/severe intensity Aggravated by physical activity During HA, at least 1 of the following occurs: N/V Photo/Phono/Sono/Osmophobia For exam: initial treatment of migraine should be NSAID, Aspirin or acetaminophen  In clinical practice, Prescribe NSAIDS, APAP and ASA.  Triptans (classic) medication Prophylaxis of Migraine can include which other kinds of medications? B-Blockers CCB SSRI TCA Anticonvulsants. Preventive for HA Avoidance of triggers – Emotional or physical stress – Lack or excessive sleep – Missing meals – Specific foods – Alcohol – Menstruation – Use of contraceptives – Nitrate containing foods DX w/o aura Most Common A. At least 5 attacks meeting criteria B-D B. Attacks lasting 4-72 hours C. Has at least two of the following characteristics 1. Unilateral location 2. Pulsating quality 3. Moderate or severe pain intensity D. During headache at least one of the following: 1. Nausea or vomiting 2. Photophobia or phonophobia E. Not better accounted for by another headache classification DX w/aura At least 2 attacks of criteria B-D One or more of these fully reversible symptoms of aura: Visual – Sensory – Speech and/or language – Motor Brainstem – Retinal At least 2 of the following 4: 1. At least one aura symptom spreads gradually > 5 minutes, and/or two or more symptoms occurring in succession 2. Each individual aura symptoms lasts 5-60 minutes 3. At least one aura symptom is unilateral 4. The aura is accompanied or followed within 60 minutes, by headache Not characterized by another headache classification. Transient ischemic attack has been excluded What are the phases of a migraine headache? Prodrome Aura Headache Termination of headache Postdrome Staticus Migrainosis lasts > 72 hours