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Nervous System > Headache > Flashcards

Headache Flashcards

1
Q

What are the types of headaches?

A

Primary- No underlying medical cause
Secondary- identifiable cause

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2
Q

What are examples of primary headaches?

A
  • Tension type headache
  • Migraine
  • Cluster headache
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3
Q

What are examples of secondary headaches?

A
  • Tumour
  • Meningitis
  • Vascular disorders
  • Systemic infection
  • Head injury
  • Drug induced
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4
Q

What is the treatment basis for primary headache?

A

Modify lifestyle
Abortive treatment
Transitional treatment
Preventative treatment

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5
Q

What is tension type headache?

A

Most frequent primary headache
Not disabling

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6
Q

What is the treatment of tension type headache?

A

Acute: paracetamol, NSAIDs
Prevention: Tricyclic antidepressant

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7
Q

What does a rapid onset headache suggest?

A

SAH
Meningitis
Encephalitis

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8
Q

What does gradual onset headache suggest?

A

Venous sinus thrombosis
Sinusitis
Tropical illness
Intracranial hypotension

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9
Q

What is migraine?

A

Most frequent DISABLING primary headache

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10
Q

What are the symptoms of migraine?

A
  • Headache
  • Nausea
  • Photophobia (light)
  • Phonophobia (sound)
  • Functional disability
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11
Q

What are the features of migraine?

A
  1. Premonitory
  2. Aura
  3. Early headache
  4. Advanced headache
  5. Postdrome
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12
Q

What is aura?

A

Transient neurological symptoms resulting from cortical or brainstem dysfunction
- Visual
- Somatosensory
- Motor
- Speech

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13
Q

What are the features of visual aura?

A

Chaotic distorting
Jumbling of lines
Hemianopia

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14
Q

What are the features of somatosensory aura?

A

Paraesthesia

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15
Q

What are the features of motor aura?

A

Dysarthria
Ataxia
Ophthalmoplegia
Hemiparesis

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16
Q

What are the causes of migraine?

A

CHOCOLATE
C- hocolate
H- angovers
O- rgasms
C- heese/caffeine
O- ral contraceptives
L- ie-ins
A- lcohol
T- ravel
E- xercise

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17
Q

What is the lifestyle treatment for migraine?

A
  • Stress
  • Hunger
  • Sleep disturbance
  • Dehydration
  • Diet
  • Environmental stimuli
  • Changes in oestrogen levels in women
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18
Q

What is the acute treatment for migraine?

A

Oral triptan + paracetamol or NSAID (aspirin)
Anti emetics

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19
Q

What is the prophylactic treatment of migraine?

A
  • Propranolol, Candersartan
  • Anti-epileptics
  • Tricyclic antidepressants
  • Flunarizine
  • Botox
  • CGRP monoclonal antibodies
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20
Q

What is MOH?

A

Headache present on >15 days/month which has developed or worsened whist taking regular symptom meds
Can occur in any primary headache

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21
Q

What are the common culprits in MOH?

A

Mixed analgesics: paracetamol + codeine/opiates
Ergotamine
Triptans

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22
Q

What is cranial neuralgia?

A

Secondary headache caused by irritation of the nerves that mediate sensation in the head:
Intense burning or stabbing pain

23
Q

What is the most common type of cranial neuralgia?

A

Trigeminal neuralgia
Unilateral pain in maxillary or mandibular division

24
Q

What is the common cause of trigeminal neuralgia?

A

Vascular compression of the trigeminal nerve

25
Q

What is the medical treatment of trigeminal neuralgia?

A
  • Carbamazepine
  • Oxcarbazepine
  • Lamotrigine
26
Q

What is the surgical treatment of trigeminal neuralgia?

A
  • Glycerol ganglion injection
  • Stereotactic radiosurgery
  • Microvascular decompression
27
Q

What are Trigeminal Autonomic Cephalalgias (TACs)?

A

Primary headaches characterized by severe unilateral head pain, typically trigeminal distribution, with ipsilateral cranial autonomic symptoms

28
Q

What are the types of TACs?

A

Cluster headache
Paroxysmal Hemicrania/ Hemicrania continua
SUNCT/SUNA

29
Q

What is SUNCT?

A

Short lasting unilateral neuralgiform headache with Conjunctival injection and Tearing

30
Q

What is SUNA?

A

Short lasting Unilateral Neuralgiform headache with Autonomic Symptoms

31
Q

What are the main characteristics of TACs?

A

Strictly unilateral pain
Predominantly V1
Excruciating pain
Cranial autonomic symptoms
- Conjunctival lacrimation
- Nasal congestion
- Eyelid oedema
- Forehead and facial swelling
- Miosis/ptosis (Horner’s)
Restless

32
Q

What is the attack frequency and duration of cluster headache?

A

1-8 daily
15-180 mins

33
Q

What is the attack frequency and duration of paroxysmal hemicrania?

A

1-40 daily
2-30 mins

34
Q

What is the attack frequency and duration of SUNCT?

A

3-200
5-240 secs

35
Q

Where is the pain in cluster headache?

A

Orbital and temporal

36
Q

Where is the pain in Hemicrania?

A

Orbital and temporal

37
Q

Where is the pain in SUNCT/SUNA?

A

Orbital
Supraorbital
Temporal

38
Q

What is the treatment for cluster headaches?

A

Abortive: s/c triptans, oxygen
Transitional: oral prednisolone taper, greater occipital block
Preventative: verapamil, lithium, melatonin

39
Q

What is the treatment of Hemicrania?

A

Absolute response to indomethacin (NSAID)

40
Q

What is the treatment of SUNCT/SUNA?

A

Abortive: lamotrigine, carbamazepine
Transitional: GO block
Surgical: occipital nerve stimulation

41
Q

What are examples of sinister secondary headaches?

A
  • Head injury
  • First or worst
  • Sudden thunderclap onset
  • New daily persistent headache
  • Change in headache pattern or type
  • Returning patient
42
Q

What are specific secondary headache patterns?

A

Thunderclap (SAH)
Meningitis and encephalitis
High pressure
Low pressure
Giant cell arteritis

43
Q

What is thunderclap headache?

A

High intensity headache reaching maximum intensity in less than 1 minute
Aneurysmal rupture and bleeding into subarachnoid space

44
Q

What is the treatment of subarachnoid haemorrhage?

A

Early treatment of aneurysm: coiling/clipping
Nimodipine- CCB for vasospasm
Treat complications
HHH therapy
- Hydration
- Hyperoxia
- Hypertension

45
Q

What are the symptoms of meningitis headache?

A

Nausea
Vomiting
Photophobia
Phonophobia
Stiff neck

46
Q

What are the symptoms of encephalitis headache?

A

Altered mental state/consciousness, Seizures
Look for a rash

47
Q

What are the symptoms of high-pressure headache?

A
  • Headache wakens patient up
  • Cough or other Valsalva headache
  • Visual obscuration’s, pulsatile tinnitus
  • Seizures
  • Progressive focal symptoms
  • Cognitive changes
  • Drowsiness
  • Loss of consciousness
  • Papilledema
48
Q

What can cause high pressure headache?

A

Space occupying lesion e.g. tumour
Brain swelling e.g. infection
Raised CSF pressure e.g. hydrocephalus, intracranial HTN

49
Q

What are the features of low- pressure headache?

A

Postural
Venous enlargement
Subdural hygromas

50
Q

What is giant cell arteritis?

A

Inflammation of large arteries

51
Q

What are the features of giant cell arteritis?

A

Non specific headache
Scalp tenderness
Jaw claudication
Visual disturbance
Prominent, beaded or enlarged temporal arteries
Patient may be systemically unwell
Elevated ESR Raised CRP and platelet count

52
Q

When should giant cell arteritis be considered?

A

In any patient >50 years presenting with new headache

53
Q

What is the treatment of giant cell arteritis?

A

High dose prednisolone immediately
Temporal artery ultrasound and biopsy

54
Q

What is the complication of untreated giant cell arteritis?

A

Complete loss of vision or stroke

Nervous System (18 decks)

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