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Y3 - Neuro > Headache > Flashcards

Headache Flashcards

1
Q

What does a headache with scalp tenderness indicate?

A

Giant cell arteritis

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2
Q

What does a headache that is abrupt and sudden onset indicate?

A

Subarachnoid haemorrhage

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3
Q

What does a headache with changes in vision (+/- papilloedema) indicate?

A

Glaucoma

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4
Q

What does a headache that wakes you up at night indicate?

A

Raised ICP

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5
Q

What does a headache that is worse in the morning/lying down indicate?

A

Raised ICP

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6
Q

What does a headache with fever, neck stiffness, photophobia indicate?

A

Meningitis

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7
Q

What does a headache with focal neurological signs (numbness, tingling, weakness, drowsiness) indicate?

A

Raised ICP

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8
Q

What does a headache with nausea, vomiting indicate?

A

Raised ICP

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9
Q

What features of a headache would indicate raised ICP?

A

Wakes you up at night
Worse in the morning/when lying down
Focal neurological signs (numbness, tingling, weakness, drowsiness)
Nausea, vomiting

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10
Q

Who are more likely to get migraines?

A

Females
Teens to early 20s
Obesity

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11
Q

What proportion of migraines occur with and without aura?

A

With aura - 20%

Without aura - 80%

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12
Q

What are triggers for migraines?

A 
Travel
Exercise
Stress/anxiety
Hormonal changes (pre-menstrual period)
Food (chocolate, cheese, caffeine, alcohol)
May not be one
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13
Q

What is the prodrome phase of a migraine?

A

Early signs that indicate the onset of a migraine that can precede the headache by hours to days

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14
Q

What are examples of symptoms that can occur in the prodrome phase of a migraine?

A

Yawning
Food cravings
Changes in sleep, appetite and mood

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15
Q

What is the aura phase of a migraine?

A

Stereotyped focal neurological symptoms in a migraine that precede the headache by minutes to an hour

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16
Q

What are examples of symptoms that can occur in the aura phase of a migraine?

A

Visual: flashes, distortion, hemianopia
Somatosensory: paraesthesia
Motor: weakness, ataxia, dysarthria

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17
Q

What are the features of the headache in a migraine?

A 
Unilateral
Throbbing and pulsating
Lasts 4-72 hours
Made worse by movement
Associated with at least 2 of: photophobia, phonophobia, or osmophobia (aversion to odours)
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18
Q

What features make a diagnosis of migraine without aura?

A

Unilateral pushing headache
Made worse by movement
Associated with photophobia, phonophobia and nausea/vomiting

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19
Q

What are the 3 strategies of management of migraines?

A

Acute relief
Prophylaxis
Lifestyle

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20
Q

What is the management for acute relief of migraines?

A

1st - NSAIDs (aspirin, naproxen, ibuprofen) + paracetamol

2nd - higher dose of aspirin or triptan (sumatriptan/rizatriptin)

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21
Q

What is the problem with triptans, and what is the guidance to prevent this?

A

Can cause dependency and rebound headaches

Shouldn’t be taken more than twice a week

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22
Q

What can be done for prophylaxis of migraines?

A

Avoid triggers
Medication if >3 attacks per months that are associated with considerable disability
Options: propranolol, amitriptyline, topiramate, gabapentin, valproate

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23
Q

What lifestyle measures can be taken to avoid migraines?

A

Diet - avoid triggers, keep healthy and balanced
Hydration - lots of water, avoid caffeine
Decrease stress
Regular exercise

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24
Q

What are examples of triggers for tension headaches?

A

Stress
Tiredness
Noise
Excessive concentration or staring at screen for too long

25
What is the presentation of tension headaches?
Either episodic or chronic Bilateral pressure or tightness in the head Mild to moderate in severity Lasts between 30 mins and a week
26
What features are absent in tension headaches?
Nausea, vomiting Photophobia, phonophobia Not made worse by movement or activity
27
What is the management for tension headaches?
Acute - paracetamol/NSAIDs | Antidepressants - dothiepin or amitriptyline
28
What is the management for chronic tension headaches?
Discourage regular analgesia (not more than 3 times a week) | Relaxation therapies
29
What are cluster headaches?
Clusters of headaches where multiple attacks happen most days over a 1-3 month period
30
How many attacks need to have occurred for a diagnosis of cluster headaches to be made?
At least 5
31
What is the presentation of cluster headaches?
Commonly at night Severe Unilateral - always on the same side of the head Around the orbit, supraorbital or temporal areas Last 30 mins to 3 hours Associated ipsilateral autonomic symptoms Associated restlessness, agitation and relief is sought by wandering
32
What are the ipsilateral autonomic symptoms associated with cluster headaches
Lacrimation Miosis and ptosis Conjunctival injection and swelling Facial flushing and rhinorrhoea
33
What is the management of acute attacks of cluster headaches?
1st - high flow oxygen 2nd - triptan Prednisolone can be given to try to minimise the cluster and should be started along with a prophylaxis
34
What is the prophylactic management of cluster headaches?
1st - verapamil 2nd - topiramate Others are gabapentin, pregabalin, lithium, valproate
35
What are the primary headache disorders?
Migraine Tension Cluster Paroxysmal Hemicrania / Hemicrania Continua Short Lasting Uniform Neuralgiform Headache Post Coital Idiopathic Intracranial Hypertension
36
What are causes of secondary headaches?
``` Meningitis GCA Sinusitis Acute glaucoma Medication overuse (opiates, triptans, paracetamol, benzodiazepines) ```
37
What are paroxysmal hemicrania and hemicrania continua?
Primary headache disorders that have similar types of headache and associated autonomic features as cluster headaches But do not occur in clusters, and they are paroxysmal - lasting 2-30 mins, 5 headaches per day experienced Continua - present for 3 months with attacks of greater intensity Show definite response to indomethacin
38
What are short-lasting uniform neuralgiform headaches?
Unilateral stabbing type headaches similar to cluster headaches Attacks last seconds - 10 mins, numerous (50-60) attacks can be experienced in a single day
39
What is a SUNCT?
Short-lasting Uniform Neuralgiform headache with Conjunctival injection and Tearing
40
What is a SUNA?
Short-lasting Uniform Neuralgiform headache with cranial nerve Autonomic symptoms
41
What is a post-coital headache?
One that builds during sexual excitement and is associated with a burst of intensity just before or during orgasm
42
Who gets idiopathic intracranial hypertension?
Females | Obesity
43
What are red flags for idiopathic intracranial hypertension?
Headache with diurnal variation and morning nausea and vomiting Visual loss - blurred visual disc with haemorrhages
44
What is idiopathic intracranial hypertension?
Unexplained raised ICP causing symptoms
45
What investigations are done for idiopathic intracranial hypertension?
MRI brain - normal CSF - elevated pressure Visual fields Fundoscopy - flattened optic disc
46
What is the treatment for idiopathic intracranial hypertension?
Weight loss Acetazolamide Ventricular atrial/lumbar peritoneal shunt Monitor visual fields and CSF pressure
47
What are symptoms of secondary headache caused by GCA?
Scalp tenderness Jaw claudication Absent temporal pulses
48
What are symptoms of secondary headache caused by sinusitis?
Facial fullness or pain Worse on bending over Associated with URTI and postnasal drip
49
What are symptoms of secondary headache caused by acute glaucoma?
Older patients with severe pain around the eye Nausea, vomiting Reduced visual acuity and visual halos
50
What are symptoms of secondary headache caused by medication overuse?
Similar to tension headache Typical history - someone experiencing episodic headaches so began regularly using analgesics and headache has now become chronic
51
What drugs can cause headache in overuse?
Opiates Triptans Paracetamol Benzodiazepines
52
What are causes of facial pain?
Trigeminal neuralgia | TMJ dysfunction
53
What is trigeminal neuralgia?
Facial pain due to blood dilation and compression of the trigeminal nerve as it leaves the cranium
54
What is the presentation of trigeminal neuralgia?
Sudden onset unilateral intense, stabbing pain in the distribution of the trigeminal nerve Attacks tend to last seconds to minutes Can be caused by triggers
55
What are triggers for trigeminal neuralgia?
Washing Shaving Eating Talking
56
What is the management of trigeminal neuralgia?
1st - anticonvulsants (carbamazepine, oxcarbazepine, lamotrigine) 2nd - surgical intervention
57
Who are more commonly affected by the causes of facial pain?
Trigeminal neuralgia - men | TMJ dysfunction - women 20-40
58
What is the presentation of TMJ dysfunction?
Cyclical or constant facial pain upon using the jaw Noise from and abnormal movements of the TMJ Tenderness over the muscles of mastication
59
What is the management of TMJ dysfunction?
Rest Physiotherapy NSAIDs if it continues after period of rest

Y3 - Neuro (14 decks)

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