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SA Clinical Neuroscience > Headache > Flashcards

Headache Flashcards

1
Q

what are the subtypes of acute headache

A
  1. Vascular
  2. Infective/inflammatory
  3. Opthalmic
  4. Situational
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2
Q

give some vascular causes of headaches

A
  • Haemmorage:
    1. subarachnoid
    2. subdural
    3. extradural
  • Thrombosis
    1. venous sinus thrombosis
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3
Q

give some infective causes for a headache

A
  • Meningitis A&E
  • Encephalitis A&E
  • Abscess A&E
  • Temporal arteritis A&E
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4
Q

give an opthalmic reason for a headache

A

glaucoma
build up of fluid, in front part of eye

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5
Q

what are some situational reasons for a headache

A
  • Cough
  • Exertion
  • Coitus
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6
Q

what are three reasons for chronic headaches

A
  1. migrane
  2. cluster headaches
  3. tension headaches
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7
Q

what are cluster headaches

A

Drug side effects
* Analgesics
* Caffeine (particularly withdrawal)
* Vasodilators

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8
Q

what are examples of tension headaches

A

 Trigeminal neuralgia (difficult to classify but probably secondary
due to a vascular anomaly)
 Raised intracranial pressure (e.g. tumours) A&E
 Temporal / giant cell arteritis A&E
 Systemic
* Hypertension A&E
* Pre-eclampsia A&E
* Phaemochromocytoma – rare A&E

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9
Q

what history would you take with someone suffering from headaches

A
  1. SQUITARS
  2. triggers?
  3. PMH of headache
  4. drug history (cause headaches)
  5. FH: migrane with aura has heritability
  6. SH: stress, diet, hydration, caffeine
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10
Q

what are some examinations that need to be done when assessing a headache

A

 Vital signs / obs
* E.g. raised ICP can cause bradycardia / hypotension.
Hypertension itself can cause headache
 Neurological examination
* Full peripheral and cranial nerve
 Other relevant systems as guided by history (e.g. if associated
feelings of faintness then examine CVS)

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11
Q

what are some red flag features of headaches

A
  1. systemic signs and disorders (meningitis or hypertension)
  2. neurological symptoms
  3. onset new >50 (malignancy)
  4. thunderclap presentation (vascular)
  5. papilloedema
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12
Q

what features fo headaches caused by space occupying lesions (tumoir) be caused from

A

o Gradual onset
o Progressive
o Associated neurological features
 E.g. visual disturbance or focal signs o Additional features of raised ICP
 Early morning headache
 Nausea and vomiting
 Worse on coughing and bending

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13
Q

what are the features of migranes

A

2% of population
females x2 males
early to mid life
severity decreases as age does

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14
Q

sight of migrane

A

frontal, unilateral

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15
Q

Quality of migranes

A

sudden or gradual
throbbing/pulsating
- moderate to severe

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16
Q

timing of migrane

A

4-72 hours, can have a cyclical character

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17
Q

aggravating factors of migrane

A

photophobia
phonophobia (loud noises)
-> cheese and chocolate
stress and lack of sleep

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18
Q

what helps relieve migrains

A

sleep
meds (triptans)

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19
Q

secondary characteristics of migrains

A

aura (shivering, visual loss, sensory loss)
nausea and vomiting

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20
Q

what is the pathophysiology of migranes

A

not sure but vasodialation
neurogenic inflammation of trigeminal sensory neurones innervating vessels and meningies

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21
Q

tension headache features

A

most common type
females> males
young>old
over 50s

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22
Q

site of tension headache

A

bilateral frontal
can radiate to neck

23
Q

what is the pain described as in tension headaches

A

squeezing like a band and non-pulsatile
mild-moderate

24
Q

what is the timing of tension headaches

A
  • worse at end of day
  • chronic > 15 times a month
  • episodic <15 month
25
Q

what are some aggravating factors that can cause tension headaches

A
  • stress
  • poor posture
  • lack of sleep
26
Q

what are some things that can releive a tension headache

A

analgesic

27
Q

what is the pathophysiology of tension headache

A

tension in muscles of head and neck (occiputo-frontalis)
no family history

28
Q

what are some features of medication overuse headaches

A

3rd most common
20% headaches are due to medication overuse
30-40
females

29
Q

what are some clinical features of medical overuse headache

A
  1. 15 days of month
  2. no improvement after meds
  3. patient is using analgesic at least 10 days a month
  4. headache comes about in people taking analegisc meds for headache in first place
  5. co-exist with sleep and depressio.
30
Q

managment of medication overuse headaches

A

stop meds

31
Q

what is the pathophysiology of medication overuse headaches

A

upregulation of pain receptors

32
Q

what are features of cluster headaches

A

1/1000
males
20-40 yr

33
Q

site of cluster headaches

A

behind one eye and no radiation

34
Q

what is the pain described as in cluster headaches

A

sharp and penetrating
(makes patient want to die, being stabbed

35
Q

intensity of cluster headaches

A

severe and constantly intense
they will be very agitated

36
Q

what is the timing in cluster headaches

A

rapid onset
15mins-3hrs and occur 1-2 times a day
night
2-12 weeks
remission 3months - 3years

37
Q

what are aggravating factors of cluster headaches

A

head injury
alcohol and smoking
heat
exercise
lack of sleep

38
Q

what can help in cluster headaches

A

analgesic
high flow oxygen

39
Q

secondary symptoms with cluster headaches

A

red, water eye
nasal congestion
ptosis

40
Q

what are features of trigeminal neuralgia

A

50-60
25/100000 uk population
females

41
Q

what is the site of trigeminal neuralgia

A

unilateral, over one eye
radiates to lip, nose, eyes and scalp

42
Q

what is the pain described in trigeminal neuralgia

A

sharp and stabbing
electric shock feeling

43
Q

how intense is TN headache

A

severe

44
Q

what is the timing of TN headache

A

sudden
last few seconds to minutes

45
Q

What are aggrivating factors of TN

A

light touch to face
eating
cold winds
vibrations

46
Q

relieveing factors of TN headaches

A

hard to alleviate

47
Q

secondary symptoms of TN

A

numbness and tingling preceding an attack

48
Q

pathophysiology of TN headache

A
  • compression of trigeminal nerve by vascular malformation
  • tumours, MS, skull base anomalies
  • chronic pain
49
Q

when do headaches need to be referred

A

 Suspicion of a tumour
 Suspicion of raised ICP
 Recent onset seizures
 Previous cancer
 Unexplained focal deficit
 Unexplained cognitive/personality changes

50
Q

what are some examples of secondary headaches Vs primary

A

Primary
1. tension type
2. migraine
3. cluster
**Secondary **
1. space occupying lesion (tumour)
2. Intercranial haemmorage
3. meningitis
4. medication overuse headaceh

51
Q

what does a space occupying lesion present as

A
52
Q

temporal arteritis

A
53
Q

what are some secondary causes of headaches that can cause vision loss too

A

glaucoma and giant cell (temporal) arteritis

SA Clinical Neuroscience (23 decks)

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