1:: Headache Flashcards by Ross Wilson

What mnemonic should you use to take a headache history?

SOCRATES

How well did you know this?

Not at all

Perfectly

Sudden headaches are usually caused by intracranial ___.

haemorrhage

How well did you know this?

Not at all

Perfectly

What are some exacerbating factors for headaches?

Drugs, alcohol (including caffeine)

Diurnal / seasonal variation (cluster headaches)

Menstruation (related to oestrogen levels)

How well did you know this?

Not at all

Perfectly

Some types of headache are accompanied by autonomic symptoms.

What are some examples?

N&V

Sweating

How well did you know this?

Not at all

Perfectly

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

Nasal stuffiness

Horner’s symptoms (miosis, ptosis)

Diplopia

Photophobia

Phonophobia (aversion to loud noises)

How well did you know this?

Not at all

Perfectly

What are some red flags for headaches?

New/sudden onset in those > 55

Early morning onset

Hx malignancy, systemic illness

Exacerbated by valsalva manoeuvres

How well did you know this?

Not at all

Perfectly

Headaches occurring at which time are a red flag?

Early morning

How well did you know this?

Not at all

Perfectly

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

> 55

How well did you know this?

Not at all

Perfectly

What does the oral contraceptive pill increase your risk of?

Stroke

How well did you know this?

Not at all

Perfectly

What are the symptoms of a migraine?

Headache

of a short/medium course

+/- a visual aura

How well did you know this?

Not at all

Perfectly

Are migraines unilateral or bilateral?

Unilateral

How well did you know this?

Not at all

Perfectly

Migraines are more common in (men / women).

women

How well did you know this?

Not at all

Perfectly

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

movement

How well did you know this?

Not at all

Perfectly

Which

a) severity
b) frequency

of headache is required to diagnose migraine?

a) Moderate/severe
b) 5 attacks

How well did you know this?

Not at all

Perfectly

Often, patients suffering a migraine are averse to light.

What is this symptom called?

Photophobia

How well did you know this?

Not at all

Perfectly

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

Within an hour

How well did you know this?

Not at all

Perfectly

What are some triggers for migraine?

Poor sleep

Diet

Stress

Hormonal factors

Exercise

How well did you know this?

Not at all

Perfectly

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

Stress

How well did you know this?

Not at all

Perfectly

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

Headache diary

How well did you know this?

Not at all

Perfectly

What is the general non-pharmacological management for migraine?

Avoid triggers

Rest in a dark room

Complimentary therapies e.g acupuncture

How well did you know this?

Not at all

Perfectly

What is the abortive pharmacological management for acute migraines?

NSAID OR Triptan e.g rizatriptan

+/- antiemetic

How well did you know this?

Not at all

Perfectly

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

Prophylactic

How well did you know this?

Not at all

Perfectly

What beta blocker is given prophylactically for migraines?

Propranolol

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

Asthma

Peripheral vascular disease

Heart failure

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

**Topiramate**

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

**Propranolol** **Topiramate** **Adjuncts** e.g **a****mitryptyline, gabapentin, Botox...**

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

**Lowest possible**

How long are **prophylactic drugs** for migraine trialled for?

**4 months**

What is the important **dietary advice** for migraine patients?

**Healthy, balanced diet** (avoid things like chocolate) **Plenty of water** **Avoid caffeine**

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

**3 migraines _per month_**

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

**Tension headache**

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

**most common**

**Tension headaches are** (unilateral / bilateral).

**bilateral** compared to migraines and trigeminal neuralgias

How are **tension headaches** treated?

**Reassurance** +/- simple analgesics or adjuvants e.g amitryptyline non-pharmacological management e.g acupuncture, relaxation

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

**Trigeminal autonomic cephalalgias (TAGs)**

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

**ipsilateral**

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

**N&V** **Nasal stuffiness** **Ptosis** **Miosis** **Tearing**

**(Men / Women)** tend to get cluster headaches.

**Men** Women get migraines, men get cluster headaches

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

**Cluster headaches**

How are **cluster headaches** treated **acutely**?

**High flow oxygen** **Triptan** e.g sumatriptan **Low dose steroids**

What is a **cluster bout**? Which drug may be used to prevent it?

**Sustained period** of **cluster headaches** ## Footnote **Verapamil**

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

**Paroxysmal hemicrania**

**How frequent** are a) **cluster headaches** b) **paroxysmal hemicrania**?

**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

How **long** are individual episodes of a) **cluster headache** b) **paroxysmal hemicrania**?

**a) 45-90 mins** **b) 10-30 mins** i.e paroxysmal hemicrania is more frequent but shorter lived

How is **paroxysmal hemicrania** treated?

**Indomethacin**

Paroxysmal hemicrania has an ___ response to indomethacin.

**absolute** will work 100% of the time (touch wood)

What is **SUNCT**?

**Short-lived** **Unilateral** **Neuralgiform headache** **Conjunctival injections** **Tearing**

How long does **SUNCT** last?

15-120 secs Very short lived compared to cluster headaches and paroxysmal hemicrania

Which specific drug is used to treat a) **paroxysmal hemicrania** b) **SUNCT**?

**a) Indomethacin** **b) Lamotrigine**

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

**MRI head** **MR angiogram brain**

Which conditions are included in **trigeminal autonomic cephalalgias**?

**Cluster headache** **Paroxysmal hemicrania** **SUNCT**

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

**Idiopathic intracranial hypertension**

Which investigations are carried out for suspected **idiopathic intracranial hypertension**?

_**Direct fundoscopy** (for papilloedema)_ **_Lumbar puncture_** **Visual field testing** **MRI head**

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

**Elevated CSF pressure**

What **lifestyle modification** is curative for **intracranial hypertension**?

**Weight loss**

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

**Acetazolamide**

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

**Trigeminal neuralgia**