CMN 577 EXAM 2: NEURO #1 | STUDY GUIDE
Migraine - Answers - - PULSATILE UNILATERAL
- Photophobia
- Phonophobia
- +AURA
- Aggravated by: routine activity
Migraine Causes - Answers - - Family HX
- Lack/excess sleep
- Specific foods [EtOH, chocolate]
- Bright lights
- Menstruation
- PO BC
Migraine Prophylactic TX - Answers - - Topiramate
- Valproic
- Propranolol
- Riboflavin
Migraine Abortive TX - Answers - - Cafergot
- Triptans
- NO OPIOIDS
Tension-type headache - Answers - - Vice-like
- Pain in neck and back of head
- Caused by stress and fatigue
Tension-type headache TX - Answers - - Muscle relaxers/ibuprofen
- NO TRIPTANS
Cluster headaches - Answers - - MEN
- No family hx of HA
- EPISODIC SEVERE UNILATERAL PERIORBITAL
- Daily-several wk + rhinorrhea, lacrimation, red eye
- OCCURS AT NIGHT
- AWAKEN FROM SLEEP
- Spontaneous remission
Cluster headaches Abortive TX - Answers - Sumatriptan + inhaled 100% O2 x 15m
Cluster headaches prophylactic TX - Answers - - Lithium
- Verapamil
, - Topiramate
- Prednisone
Trigeminal Neuralgia - Answers - - Onset at >40y
- WOMEN
- UNIL STABBING facial pain
- Exacerbated by touch
- Maxillary branch affected
- If <40yo SUSPECT MS
Trigeminal Neuralgia Diseases to R/O - Answers - TA, stroke , tumor
Trigeminal Neuralgia TX - Answers - Oxcarbazepine/Carbamazepine
Post-Herpatic Neuralgia - Answers - - Hx HERPES ZOSTER
- SEVERE PAIN/RASH + Prodromal pain BEFORE rash
- Females >80yr
Post-Herpatic Neuralgia Prevention - Answers - Zoster vaccination for ages 50 and
older
Post-Herpatic Neuralgia TX - Answers - - Acyclovir/valacyclovir within 72 hours of rash
onset
- NO SYSTEMIC STEROIDS
- Lidocaine topical [not for acute lesions]
- Lyrica or SNRIs [Cymbalta, Effexor]
Subarachnoid Hemorrhage (Trauma/Spontaneous) - Answers - - THUNDERCLAP HA
(Aneurysm) vs. LOC (TRAUMA/FALL)
- Sudden severe headache
- Signs of meningeal
irritation usually
present
- Obtundation is
common
- Focal deficits
frequently absent
Subarachnoid Hemorrhage (Trauma/Spontaneous) Management - Answers - -
Emergency!
- Needs Stat CT!
Causes Altered Mental Status (AMS) in Elderly - Answers - - Polypharmacy
- FFT
- Dehydration
- UTI
Migraine - Answers - - PULSATILE UNILATERAL
- Photophobia
- Phonophobia
- +AURA
- Aggravated by: routine activity
Migraine Causes - Answers - - Family HX
- Lack/excess sleep
- Specific foods [EtOH, chocolate]
- Bright lights
- Menstruation
- PO BC
Migraine Prophylactic TX - Answers - - Topiramate
- Valproic
- Propranolol
- Riboflavin
Migraine Abortive TX - Answers - - Cafergot
- Triptans
- NO OPIOIDS
Tension-type headache - Answers - - Vice-like
- Pain in neck and back of head
- Caused by stress and fatigue
Tension-type headache TX - Answers - - Muscle relaxers/ibuprofen
- NO TRIPTANS
Cluster headaches - Answers - - MEN
- No family hx of HA
- EPISODIC SEVERE UNILATERAL PERIORBITAL
- Daily-several wk + rhinorrhea, lacrimation, red eye
- OCCURS AT NIGHT
- AWAKEN FROM SLEEP
- Spontaneous remission
Cluster headaches Abortive TX - Answers - Sumatriptan + inhaled 100% O2 x 15m
Cluster headaches prophylactic TX - Answers - - Lithium
- Verapamil
, - Topiramate
- Prednisone
Trigeminal Neuralgia - Answers - - Onset at >40y
- WOMEN
- UNIL STABBING facial pain
- Exacerbated by touch
- Maxillary branch affected
- If <40yo SUSPECT MS
Trigeminal Neuralgia Diseases to R/O - Answers - TA, stroke , tumor
Trigeminal Neuralgia TX - Answers - Oxcarbazepine/Carbamazepine
Post-Herpatic Neuralgia - Answers - - Hx HERPES ZOSTER
- SEVERE PAIN/RASH + Prodromal pain BEFORE rash
- Females >80yr
Post-Herpatic Neuralgia Prevention - Answers - Zoster vaccination for ages 50 and
older
Post-Herpatic Neuralgia TX - Answers - - Acyclovir/valacyclovir within 72 hours of rash
onset
- NO SYSTEMIC STEROIDS
- Lidocaine topical [not for acute lesions]
- Lyrica or SNRIs [Cymbalta, Effexor]
Subarachnoid Hemorrhage (Trauma/Spontaneous) - Answers - - THUNDERCLAP HA
(Aneurysm) vs. LOC (TRAUMA/FALL)
- Sudden severe headache
- Signs of meningeal
irritation usually
present
- Obtundation is
common
- Focal deficits
frequently absent
Subarachnoid Hemorrhage (Trauma/Spontaneous) Management - Answers - -
Emergency!
- Needs Stat CT!
Causes Altered Mental Status (AMS) in Elderly - Answers - - Polypharmacy
- FFT
- Dehydration
- UTI
