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BRS YR2 > Headache > Flashcards

Headache Flashcards

1
Q

What are possible causes of acute, single headaches?

A
  • febrile illness, sinusitis
  • first attack of migraine
  • head trauma
  • subarachnoid haemorrhage
  • meningitis
  • tumour
  • drugs, toxins
  • stroke
  • thunderclap
  • low pressure
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2
Q

What are the possible causes of a dull headache, increasing in severity?

A
  • benign
  • overuse of medication
  • contraceptive pill
  • HRT
  • neck disease
  • temporal arteritis
  • benign intracranial hypertension
  • cerebral tumour
  • cerebral venous sinus thrombosis
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3
Q

What tends to cause a dull headache, unchanged for months?

A
  • chronic tension headache
  • depressive, atypical facial pain
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4
Q

What are different forms of recurrent headaches?

A
  • migraine
  • cluster headache
  • episodic tension headache
  • trigeminal/post-herpetic neuralgia
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5
Q

What are the red flags for a secondary headache?

A
  • age
  • onset
  • systemic symptoms
  • neurological signs
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6
Q

What types of onset are red flags?

A
  • thunderclap
  • acute
  • subacute
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7
Q

Which systemic symptoms are red flags?

A
  • fever
  • rash
  • weight loss
  • neck stiffness
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8
Q

Which neurological symptoms are red flags?

A
  • confusion
  • impaired consciousness
  • focal neurological deficit
  • swollen optic disc
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9
Q

What does orthostatic mean?

A

the headache is better when lying down

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10
Q

How does migraine disorder present?

A
  • tendency of repeated attacks
  • triggers
  • easily hung over
  • visual vertigo
  • motion sickness
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11
Q

What are the different forms of migraine attacks?

A
  • pain only
  • pain and focal sings
  • focal symptoms only
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12
Q

What are the 5 phases of a migraine?

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
  • light sensitivity
  • neck pain
  • difficulty concentrating
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14
Q

What is the aura phase of a migraine?

A
  • visual changes
  • sensory numbness/paraesthesia
  • weakness
  • speech arrest
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15
Q

What is the headache phase of a migraine?

A
  • head and body pain
  • nausea
  • photophobia
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16
Q

What is the resolution phase of a migraine?

A
  • rest
  • sleep
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17
Q

What is the recovery phase of a migraine?

A
  • disturbed mood
  • food intolerance
  • hungover feeling
  • can take up to 48hrs
18
Q

What visual symptoms happen during the aura phase of a migraine?

A

positive and negative symptoms simulatenously:

  • scintillations
  • blindspots
  • expanding C’s
  • elemental visual disturbances
19
Q

What is the treatment for an acute migraine attack?

A
  • NSAIDS (aspirin, ibuprofen)
  • Anti-emetic (paracetamol, metoclopramide)
  • prokinetics
  • triptans (tablets, melts, nasal sprays, sc injection)
20
Q

How does TMS help treat acute migraine attacks?

A

interrupts complex networks that trigger and perpetuate migraines - caused by spreading electrical depression across the cerebral cortex

21
Q

What are the long term treatments for migraines?

A
  • lifestyle issues due to overstimulation
  • identify and avoid triggers
  • hydrate and avoid caffeine
  • avoid ready meals and take-aways
  • good sleep
  • exercise
  • mindfulness
22
Q

What prophylaxis can be taken for migraines?

A
  • over the counter
  • tricyclic antidepressants
  • beta-blockers
  • serotonin antagonists
  • calcium channel blockers
  • anticonvulsants
  • greater occipital nerve blocks
  • botox
  • suppress ovulation
  • Erenumab
23
Q

What is the new treatment for migraines?

A

CGRP antibodies

24
Q

What is a risk of using painkillers for headaches?

A

Medication overuse headaches

25
Q

What does a tension headache feel like?

A

tight muscles around the head and neck bilaterally

26
Q

What is the treatment for tension headaches?

A
  • simple analgesics e.g. paracetamol and aspirin
  • reassurance that it will pass
27
Q

What is a cluster headache?

A
  • severe unilateral pain lasting 15-180 minutes untreated
  • trigeminal autonomic cephalgia
28
Q

How does a cluster headache present?

A
  • forehead and facial sweating
  • miosis and/or ptosis
  • restlessness or agitation
  • 1-8 daily
  • (at least one) ipsilaterally:
    conjunctival redness and/or lacrimation
    nasal congestion and/or rhinorrhea
    eyelid oedema
    (most common site of pain is the eye)
29
Q

What is the acute treatment of a cluster headache?

A
  • inhaled oxygen (inhibits neuronal activation in the trigeminocervical complex)
  • s/c or nasal sumatriptan
30
Q

What can prevent a cluster headache?

A
  • Verapamil (calcium channel inhibitor)
  • greater occipital nerve block
  • need ECG first
31
Q

What is the difference in distribution between migraines and cluster headaches?

A

migraines are more common in women, vice versa for cluster headaches

32
Q

What are the most common primary headaches?

A
  • migraine
  • tension headaches
  • cluster headaches
33
Q

What should NOT be given to treat cluster headaches according to NICE?

A
  • paracetamol
  • NSAIDS
  • oral triptans
  • ergots
  • opioids
34
Q

What are secondary headaches?

A
  • Headache is percipitated by another condition / disorder - local os systemic
  • Serious causes of secondary headache are uncommon
35
Q

What are the two types of primary headache?

A

Long-lasting (>4 hours) and short lasting (<4 hours)

36
Q

Which headaches are long lasting?

A

Migraine and tension headache

37
Q

Which headaches are short-lasting?

A

Trigeminal autonomic cephalagias e.g cluster headaches

38
Q

What are red flags for headaches?

A

Presences indicates secondary rather than primary headache

39
Q

What are the age related red flags?

A

New onset or different headaches in a person >50yrs

40
Q

What are the characteristics of migraines?

A
  • Unilateral
  • Pulsating
  • Moderate or severe pain
  • Aggravation by routine physical activity
  • Last hours and sometimes days
  • premonitory symptoms
  • last 4-72hr
41
Q

What causes aura?

A

Focal cortical or brainstem dysfunction

42
Q

What are the characteristics of tension headaches?

A
  • bilateral
  • mild to moderate
  • not aggravated by movement
  • no added features

BRS YR2 (67 decks)

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