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Neurology > 1: Headaches > Flashcards

1: Headaches Flashcards

1
Q

What is the most common cause of headaches

A

Tension-type headache

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2
Q

What. are the 6 types of sudden-onset headaches

A 
Meningitis
SAH
Encephalitis 
Acute Glaucoma 
GCA
Head trauma
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3
Q

How does encephalitis present

A
  • Odd behaviour
  • Decrease consciousness
  • Fever
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4
Q

How does acute glaucoma present

A

Red injection eye
Severe eye pain radiating to the forehead
Reduced vision and halos

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5
Q

What are the 8 sub-acute headaches

A
  • Venous sinus thrombosis
  • Tension Type Headache
  • Cluster Headache
  • Sinusitis
  • Migraine
  • Trigeminal Neuralgia
  • Raised ICP
  • Medication over-use headache
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6
Q

How does venous sinus thrombosis present

A

Papilloedema

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7
Q

How does sinusitis present

A
  • Pain over frontal and maxillary sinuses
  • Pain is worse on learning forwards
  • Post-nasal drip
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8
Q

How do tension headaches present

A

Tight band across the head

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9
Q

Explain cluster headache presentation in acute-stage

A

Sudden-onset painful eye, erythematous with lid welling.

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10
Q

When are cluster headaches more common

A

Pain is more common at night

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11
Q

Explain timing of cluster headaches overall

A

Cluster headaches may occur several weeks in a row followed by months without symptoms

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12
Q

How will raised ICP as a cause of headache present

A
  • Chronic progressive headache
  • Worse in the morning
  • Worse on leaning forward, sneezing and coughing
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13
Q

Describe pain in tension headache

A

Bilateral tight-band around the head

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14
Q

What intensity is tension headache

A

Mild-Moderate

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15
Q

How long do tension headaches usually last

A

30-minutes

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16
Q

What defines episodic tension headache

A

Less than 15-days a month

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17
Q

What defines chronic tension headache

A

More than 15-days a month

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18
Q

Describe pain in migraine

A

Unilateral throbbing pain

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19
Q

How long do migraine typically last in

a. Adults
b. Children

A

a. 4-72h

b. 1-48h

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20
Q

What symptoms may be associated with migraine

A
  • Aura
  • Nausea and Vomitting
  • Phonophobia
  • Photophobia
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21
Q

What is time-frame for episodic migraine

A

Less than 15 episodes a year

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22
Q

What is time-frame for chronic migraine

A

More than 15 episodes a year

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23
Q

Describe pain in cluster headache

A

Unilateral severe pain focused around one eye

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24
Q

How long do cluster headaches last

A

50-180 minutes

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25
Q

What features are associated with cluster headaches

A
  • Red, Swollen Eye

- Nasal congestion

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26
Q

If suspecting a primary headache what is done

A

Ask individual to keep a headache diary for 8-Weeks

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27
Q

Who created diagnostic criteria for migraines

A

International Headache Society

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28
Q

Outline International Headache Society, Diagnosis of migraines

A

A. Required at least 5-headaches fulfilling B-D

B. 4-72h

C. Two Of: Unilateral, Throbbing, Moderate-Severe, Exacerbated by physical exercise

D. One of: phonophobia. photophobia, N+V

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29
Q

What is a mnemonic to remember triggers of migraines

A

CHOCOLATES

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30
Q

What are the triggers of migraines

A 
Cheese
Hangover 
Orgasm 
Caffeine, Chocolate, Change weather 
Oral contraceptive 
Lie-ins 
Alcohol 
Travel 
Exercise
Stress
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31
Q

What are three risk factors for migraines

A
  • FH
  • Female
  • Obese
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32
Q

What % patients present with migraine with aura

A

25%

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33
Q

How long does aura usually last

A

15-30 minutes (Can continue during headache)

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34
Q

What does aura involve

A

Visual: Zig-zags, Scintillating scotoma

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35
Q

How does the headache present in migraine

A
  • Unilateral, pulsating
  • Nausea and Vomitting
  • Phonophobia
  • Photophobia
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36
Q

What is different about migraines in children

A

Shorter

GI Disturbance

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37
Q

Explain investigations in migraines

A

Clinical Diagnosis

Any investigation is to exclude secondary causes headache

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38
Q

What conservative management is given for management

A
  • Avoid triggers
  • Keep headache diary (8W)
  • Sleep hygiene
  • Maintain Fluid
  • Regular exercise
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39
Q

What is first-line for acute migraine

A

NSAIDs and oral sumatriptan

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40
Q

In 12-17 year-olds what is given opposed to oral sumatriptan

A

Nasal sumatriptan

41
Q

What is given second-line if suffering from nausea in headaches

A

Metclopramide

Prochlorperazine

42
Q

What should not be given in migraines and why

A

Opioids - as can worsen headache

43
Q

When is prevention in migraines indicate

A

More than two migraines a month

44
Q

What is first-line for prevention of migraines

A

Topiramate

45
Q

When is topiramate contraindicated

A

Pregnant Women

46
Q

What is used as an alternative to topiramate in women of child-bearing age

A

Propanolol

47
Q

What are two alternative therapies recommended for migraines

A
  • Acupuncture

- Riboflavin (Vitamin B12)

48
Q

What is given for menstrual migraines

A
  • zolmatriptan

- frovatriptan

49
Q

What is an absolute contraindication to COCP

A

migraines with aura

50
Q

what ‘surgical’ management can be used for migraines

A

botox type A

51
Q

when is botox type A injection used for

A
  • Headaches great 15-days a month
  • More 8 episodes
  • Tried three weeks prophylaxis
  • Being managed for medication over-use headache
52
Q

during pregnancy how should migraines be used an why

A

Paracetamol.

NSAIDs in third-trimester can cause premature closure PDA

53
Q

what is a complication of migraines

A

Medication over use headache

54
Q

what is defined as medication over-use headache

A

Use of analgesia more than 15-days a month. Use of triptans more than 10-days a month

55
Q

what is the most common cause of headaches

A

Tension-type headache

56
Q

in which gender are tension headaches more common

A

Female

57
Q

what triggers tension headaches

A

Stress
Anxiety
Sleep deprivation

58
Q

how will a tension headache present

A

bilateral tight band across the head, no aura, 30-minutes

59
Q

what is an episodic tension headache

A

<15-days a month

60
Q

what is a chronic tension headache

A

> 15-days a month

61
Q

how are tension headaches diagnosed

A

clinical

62
Q

how are episodic TTH managed

A

Analgesia: NSAID, Paracetamol
Conservative: Sleep hygiene

63
Q

how are chronic TTH managed

A 
Acupuncture 
Amytryptiline (Off-Label)
64
Q

what is a complication of TTH

A

medication over-use headache

65
Q

what can cause TTH

A
  • Use analgesia >15 days a month

- Use triptans over 10 days a month

66
Q

how is medication-overuse headache prevented

A

Restrict analgesia 1-2W

67
Q

what is a cluster headache

A

Intense headache that occurs in clusters lasting several weeks

68
Q

in which gender are cluster headaches more common

A

Male

69
Q

what is the main risk factor for cluster headaches

A

Smoking

70
Q

what is the stereotype for demographic for cluster headache

A

Male smoker

71
Q

what can trigger acute episodes of cluster headache

A

Alcohol

Worse at night

72
Q

when are cluster headache attacks worse

A

Night-time

73
Q

how do cluster headaches present clinically

A
  • Sudden-onset severe unilateral pain around one eye
  • Associated with lacrimation and lid swelling
  • Rhinorrhoea
74
Q

what are two eyes signs that may be present in cluster headaches

A

Miosis

Ptosis

75
Q

how long do episodes usually occur

A

150-180 minutes

76
Q

when are episodes more common

A

Night-time

77
Q

how long do clusters usually last

A

Usually last 2-4W, then have several months without symptoms

78
Q

how may patient present during a cluster attack

A

Irritable and agitated

79
Q

how are cluster headaches managed acutely

A
  • Short burst oxygen therapy: 15L via non-recreate for 15-20 minutes
  • SC sumatriptan
80
Q

explain short-burst oxygen therapy

A

15L is given for 15-20 minutes

81
Q

what medication is given for acute cluster headaches

A

SC Sumatriptan

82
Q

what is used for prophylaxis of cluster headaches

A

Verapamil

83
Q

what is problem with cluster headaches

A

most disabling primary headache disorder

84
Q

define trigeminal neuralgia

A

sharp intense stabbing pain over distribution of trigeminal nerve

85
Q

which gender is trigeminal neuralgia more common

A

female

86
Q

what is ‘classical’ trigeminal neuralgia

A

compression of trigeminal nerve due to adjacent structures

87
Q

what structure most commonly compresses trigeminal nerve

A

superior cerebellar.a

88
Q

what are other causes of trigeminal neuralgia

A
  • Multiple Sclerosis
  • Structural: arnold-chiari, tumour, cyst
  • Ischaemia
89
Q

what can trigger trigeminal neuralgia

A

Washing, shaving. brushing teeth, eating

90
Q

explain presentation of trigeminal neuralgia

A

causes intense sharp-stabbing pain over distribution of the trigeminal nerve. Then later presents as burning

91
Q

what divisions of trigeminal nerve are more commonly affected

A

Maxillary

Mandibular

92
Q

why may face screw up in trigeminal neuralgia

A

Due to facial spasms

93
Q

what is associated with trigeminal neuralgia

A

Suicidal Ideation

94
Q

if a young female patient has bilateral trigeminal neuropathy, what is the likely cause

A

Multiple sclerosis

95
Q

What investigation should always be ordered in trigeminal neuralgia and why

A

MRI - look for underlying lesion

96
Q

What is assessed for in trigeminal neuralgia

A

Psychiatric assessment - for depression

97
Q

What are red-flags for trigeminal neuralgia that indicate sinister cause

A
  • Bilateral
  • Skin Lesion
  • Hearing Loss
  • FH multiple sclerosis
  • Onset before 40-years
  • Pain in ophthalmic devision
  • Sensory changes
  • Optic neuritis
98
Q

If no underlying sinister cause for trigeminal neuralgia, what is first-line

A

Carbamazepine

Neurology (26 decks)

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