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BRS NEUROLOGY > 1b// Headaches > Flashcards

1b// Headaches Flashcards

1
Q

How are headaches classified?

A

Primary headache syndromes

secondary headaches

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2
Q

What are primary headaches?

A

long lasting:
- migraine
- tension-type headache
- medication overuse headache

short lasting:
- trigerminal autonomic cephalagia
- cluster headahce

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3
Q

What are secondary headaches?

A

Headache is spercipitated by another condition / disorder - local os systemic. Serious causes of secondary headache are uncommon.

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4
Q

Describe the clinical approach to headaches.

A
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5
Q

What are the 4 key red flags suggesting secondary headache?

A

age: new onset or different headaches in a person over 50

onset: sudden, abrupt onset of a severe headache (thunderclap headache)

systemic symptoms: fever, neck stiffness, rash, weight loss

neurological signs: confusion, impaired consciousness, focal neurology, swollen optin discs

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6
Q

Describe migraine central hypothesis pathophysiology.

probably not in exam

A
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7
Q

What type of migraine issue can you have?

A

episodic or chronic (10/15+ a month)

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8
Q

What are the characteristics of migraines? (5)

A
  • Unilateral location
  • Pulsating quality
  • Moderate or severe pain intensity
  • Aggravation by routine physical activity
  • Last hours and sometimes days
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9
Q

What are the symptoms of migraines?

A

nausea and/or vomiting

photophobia and/or phonophobia

+/- auras

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10
Q

What is an aura and when do they occur and how long do they last?

A

sensory disturbance
Complex array of symptoms reflecting focal cortical or brainstem dysfunction
Gradual evolution: 5-30minutes (<60minutes)
Usually before headache (migraine)

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11
Q

What do you see/ experience during auras?

A

expanding Cs
elemental visual disturbances

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12
Q

What are the pahses of migraines?

A

premonitory
aura
headache
resolution
recovery

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13
Q

What is the premonitory phase of a migraine?

A

yawning, polyuria, mood change, irritable, light sensitive, neck pain, concentration difficulty

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14
Q

What is the aura phase of a migraine?

A

Visual, sensory (numbness/paraesthesia), weakness, speech arrest

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15
Q

What is the headache phase of migraines?

A

head and body pain, nausea, photophobia

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16
Q

What is the resolution phase of a migraine?

A

rest and sleep

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17
Q

What is the recovery phase of migraines?

A

mood disturbed, food intolerance, feeling hungover Can take up to 48 hours

18
Q

what is papilloedema?

A

optic disk swelling due to raised ICP

19
Q

What are the management types ofr migraines?

A

lifestyle

pharmacological therapy= acute/ aborative or long term preventative

20
Q

What are the lifestyle management advice for migraines? (5)

A

Avoid triggers
Diet
Sleep
Exercise
Mindfulness

21
Q

What is the acute/ aborative management of migraines? (4)

A
  • Paracetamol
  • NSAIDs (high dose & soluble)
  • Prokinetics
  • Triptans (5-HT1B/1D/1F receptor
    agonists)

hard and fast

22
Q

What are the long term preventative therapies for migraines? And what should be avoided?

A

> 5 days/month

“low and slow” with
doses until at optimal dose

Opiate-based and mixed analgesics should be avoided.

23
Q

What are the types of medications you can give for migraine prevention?

A

Tricyclic anti-depressants (TCA):

Serotonin and norepinephrine reuptake inhibitors (SNRIs):

Β-blockers

Serotonin antagonists

Anticonvulsants

Calcium Channel blockers

Angiotensin-converting enzyme inhibitor Angiotensin II receptor blockers

Parenteral

CGRP antibodies- new medications on the block for preventing migraines

24
Q

Are tension type headaches chronic or episodic?

A

episodic

25
Q

What do patients say tension tpye headaches usually feel like?

A

Tight muscles around head and neck, as though head is in a vice.

26
Q

How long do tension type headaches last, and what is their severity? And where are they in the head

A

Lasts 30mins (but can be hours long):
– Bilateral
– Mild or moderate

27
Q

Does movement aggrevate tension type headaches?

A

No

28
Q

What are the added features of tension type headaches?

A

No added features typically
– No nausea or vomiting
– No photophobia or
phonophobia

29
Q

What is the treatment of tension type headaches?

A
  • Reassurance may suffice in the majority of patients.
  • Individual attacks can be treated with simple analgesics
    such as Aspirin or Paracetamol.
  • Preventative medications rarely required
30
Q

What are cluster headaches and how long can they last?

A

severe unilateral pain (nop switching, but the next one can be on the other side)

last 15-180 mins if untreated
1-8x a day short but come in bursts

31
Q

What must there at least be one of for cluster headaches?

A

At least one of the following, ipsilaterally:
- Conjunctival redness and/ or lacrimation
- Nasal congestion and/ or rhinorrhoea
- Eyelid oedema

32
Q

What are other possible symptoms of cluster headaches? And what there must not be?

A
  • Forehead and facial sweating
  • Miosis and/ or ptosis
  • A sense of restlessness or agitation
  • Not associated with a brain lesion on MRI
33
Q

What is the acute treatment for cluster headaches? and why?

A

Triptan. Nasal or subcutaneous route

High flow oxygen. Oxygen inhibits neuronal activation in the trigeminocervical complex

34
Q

How do you prevent cluster headaches?

A

Verapamil (Calcium channel inhibitor)
- Get an ECG first!

Greater occipital nerve block

35
Q

Are you happy with this table?

A

Y/ N

36
Q

how do you investigate brain tumours?

A

head CT or MRI

37
Q

typical SOCRATES for a migraine

A

S- unilateral
O- sudden recurrence/intensification of symptoms
C - pulsating/throbbing
R- none
A- nausea/vom, aura (lights, halluc), tingling, tinitis, paralysis, photophobia, phonophobia
T - 4-72 hrs
E - physical activity, foods, bad sleep, hormones
S - moderate/severe

38
Q

lifestyle recommendations for migraines

A 
dietary - fresh foods, avoid MSG takeaways
hormonal - OCP
drink plenty of water
dont have late nights or oversleep
avoid caffeine
39
Q

what are positive and negative auras

A

positive - flashes, zigzags

negative - blindspots

40
Q

what is the SOCRATES of a tension headache

A 
S - generalised, bilateral
O - gradual onset usually
C - dull, tight band-like
R - neck/shoulders
A- pericranial muscle tenderness, NO NAUSEA/vomiting/photophobia etc
T - 3-4hrs
E - analgesics, rest
S - moderate
41
Q

SOCRATES for cluster headaches

A

S - strictly unilateral, behind eye common, usually same side each time
O- acute onset, same time of day
C - excruciating, steady pain
R - none
A - eye watering, nose blocked, ptosis, eye redness, sweating, restlessness (autonomic features), photophobia, phonophobia
T - 15min-3hr, same length each time, often nocturnal, come in clusters with long remissions
E -
S - worst pain ever experienced

BRS NEUROLOGY (22 decks)

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