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Neurology Week 3 2018/19 > 1:: Headache > Flashcards

1:: Headache Flashcards

1
Q

What mnemonic should you use to take a headache history?

A

SOCRATES

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2
Q

Sudden headaches are usually caused by intracranial ___.

A

haemorrhage

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3
Q

What are some exacerbating factors for headaches?

A

Drugs, alcohol (including caffeine)

Diurnal / seasonal variation (cluster headaches)

Menstruation (related to oestrogen levels)

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4
Q

Some types of headache are accompanied by autonomic symptoms.

What are some examples?

A

N&V

Sweating

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5
Q

Apart from autonomic symptoms, what are some other symptoms associated with headaches?

A

Nasal stuffiness

Horner’s symptoms (miosis, ptosis)

Diplopia

Photophobia

Phonophobia (aversion to loud noises)

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6
Q

What are some red flags for headaches?

A

New/sudden onset in those > 55

Early morning onset

Hx malignancy, systemic illness

Exacerbated by valsalva manoeuvres

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7
Q

Headaches occurring at which time are a red flag?

A

Early morning

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8
Q

New or sudden onset headache in a patient aged > ___ years old is a red flag.

A

> 55

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9
Q

What does the oral contraceptive pill increase your risk of?

A

Stroke

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10
Q

What are the symptoms of a migraine?

A

Headache

of a short/medium course

+/- a visual aura

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11
Q

Are migraines unilateral or bilateral?

A

Unilateral

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12
Q

Migraines are more common in (men / women).

A

women

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13
Q

The headache of a migraine tends to be worst on ___.

A

movement

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14
Q

Which

a) severity
b) frequency

of headache is required to diagnose migraine?

A

a) Moderate/severe
b) 5 attacks

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15
Q

Often, patients suffering a migraine are averse to light.

What is this symptom called?

A

Photophobia

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16
Q

How long after an aura sets in does a migraine usually follow?

A

Within an hour

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17
Q

What are some triggers for migraine?

A

Poor sleep

Diet

Stress

Hormonal factors

Exercise

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18
Q

What is thought to be the biggest risk factor for migraine?

A

Stress

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19
Q

How can you help a patient to identify their migraine triggers?

A

Headache diary

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20
Q

What is the general non-pharmacological management for migraine?

A

Avoid triggers

Rest in a dark room

Complimentary therapies e.g acupuncture

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21
Q

What is the abortive pharmacological management for acute migraines?

A

NSAID OR Triptan e.g rizatriptan

+/- antiemetic

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22
Q

___ medication can be given to prevent migraines in people who suffer frequent episodes.

A

Prophylactic

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23
Q

What beta blocker is given prophylactically for migraines?

A

Propranolol

24
Q

Beta blockers for migraines must be avoided in people with which diseases?

A

Asthma

Peripheral vascular disease

Heart failure

25
Q

Which carbonic anhydrase inhibitor can be given prophylactically for people who suffer migraines?

A

Topiramate

26
Q

Which drugs can be given prophylactically to people who suffer migraines?

A

Propranolol

Topiramate

Adjuncts e.g amitryptyline, gabapentin, Botox…

27
Q

With prophylactic drugs, what dose is aimed for in migraine patients?

A

Lowest possible

28
Q

How long are prophylactic drugs for migraine trialled for?

A

4 months

29
Q

What is the important dietary advice for migraine patients?

A

Healthy, balanced diet (avoid things like chocolate)

Plenty of water

Avoid caffeine

30
Q

Prophylactic treatment should be considered in patients having more than ___ migraines per month.

A

3 migraines per month

31
Q

Which type of headache tends to be a pressing, bilateral pain with few associated symptoms?

A

Tension headache

32
Q

Tension-type headaches are the most ___ type of headache.

A

most common

33
Q

Tension headaches are (unilateral / bilateral).

A

bilateral

compared to migraines and trigeminal neuralgias

34
Q

How are tension headaches treated?

A

Reassurance

+/- simple analgesics or adjuvants e.g amitryptyline

non-pharmacological management e.g acupuncture, relaxation

35
Q

Which group of primary headaches are often found in the distribution of the trigeminal nerve and are accompanied by autonomic symptoms?

A

Trigeminal autonomic cephalalgias (TAGs)

36
Q

Autonomic symptoms accompany TACs are found on the (ipsilateral / contralateral) side to the headache.

A

ipsilateral

37
Q

What are the autonomic symptoms which often accompany trigeminal autonomic cephalgias?

A

N&V

Nasal stuffiness

Ptosis

Miosis

Tearing

38
Q

(Men / Women) tend to get cluster headaches.

A

Men

Women get migraines, men get cluster headaches

39
Q

Which type of headache is very severe, unilateral, commoner in young men and can last for sustained periods of time?

A

Cluster headaches

40
Q

How are cluster headaches treated acutely?

A

High flow oxygen

Triptan e.g sumatriptan

Low dose steroids

41
Q

What is a cluster bout?

Which drug may be used to prevent it?

A

Sustained period of cluster headaches

Verapamil

42
Q

Which type of headache is a shorter duration, more frequent version of cluster headaches?

A

Paroxysmal hemicrania

43
Q

How frequent are

a) cluster headaches
b) paroxysmal hemicrania?

A

a) 1 to 8 per day

b) 1 to 40 per day

cluster headaches last longer but occur less often

paroxysmal hemicrania doesn’t last as long but occurs far more often

44
Q

How long are individual episodes of

a) cluster headache
b) paroxysmal hemicrania?

A

a) 45-90 mins

b) 10-30 mins

i.e paroxysmal hemicrania is more frequent but shorter lived

45
Q

How is paroxysmal hemicrania treated?

A

Indomethacin

46
Q

Paroxysmal hemicrania has an ___ response to indomethacin.

A

absolute

will work 100% of the time (touch wood)

47
Q

What is SUNCT?

A

Short-lived

Unilateral

Neuralgiform headache

Conjunctival injections

Tearing

48
Q

How long does SUNCT last?

A

15-120 secs

Very short lived compared to cluster headaches and paroxysmal hemicrania

49
Q

Which specific drug is used to treat

a) paroxysmal hemicrania
b) SUNCT?

A

a) Indomethacin

b) Lamotrigine

50
Q

Which imaging is done for people with suspected trigeminal autonomic cephalgias?

A

MRI head

MR angiogram brain

51
Q

Which conditions are included in trigeminal autonomic cephalalgias?

A

Cluster headache

Paroxysmal hemicrania

SUNCT

52
Q

Which condition tends to affect obese women and causes visual loss?

A

Idiopathic intracranial hypertension

53
Q

Which investigations are carried out for suspected idiopathic intracranial hypertension?

A

Direct fundoscopy (for papilloedema)

Lumbar puncture

Visual field testing

MRI head

54
Q

What is found on lumbar puncture of a patient with idiopathic intracranial hypertension?

A

Elevated CSF pressure

55
Q

What lifestyle modification is curative for intracranial hypertension?

A

Weight loss

56
Q

Which carbonic anhydrase inhibitor is used to reduce intracranial pressure in patients with idiopathic intracranial hypertension?

A

Acetazolamide

57
Q

Which type of headache involves short-lived pain in response to sensation in areas supplied by the trigeminal nerve?

A

Trigeminal neuralgia

Neurology Week 3 2018/19 (10 decks)

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