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Neuro yr 2 > headache > Flashcards

headache Flashcards

1
Q

what is the one year prevalence of headache disorders? what percentage do neurologists end up seeing?

A

50%
20% seen by docs

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2
Q

what are the 3 types of primary headaches?

A

migraine
cluster headache
tension-type headache

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3
Q

what is a secondary headache? i

A

headache cause by another condition/ disorder local or systemic. (may be serious causes: rarer than primary)

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4
Q

after what time frame is a headache characterised as a long lastin one?

A

> 4h

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5
Q

which headaches are long lasting?

A

migraine and tension type and medication overuse headache

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6
Q

what are the the short lastin headaches?

A

cluster headache

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7
Q

other name for cluster headache

A

trigeminal autonomic cephalagia

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8
Q

what is medication overuse headache

A

You have headache, you start taking a medication for 3/ week or more: you have a medication overuse headache

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9
Q

which patients do you give a diagnostic test to?

A

only the ones you suspect may have secondary headache after either
1) seeing a red flag in their history/ examination or
2) red flag after giving them preliminary primary headache diagnosis

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10
Q

what are the main red flag areas suggesting secondary headaches?

A

NOSA

neurological signs (focal neurology, swollen optic discs)
onset (abrupt really quick)
systemic symptoms (fever neck stiffness)
age (New onset or different headaches in a person >50yrs)

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11
Q

what do these symptoms suggest: Confusion, impaired consciousness, focal neurology (limb related neurology problem: stroke common) , swollen optic discs? (what cetgory of red flag?)

A

neurological, suggest intercranial pressure, encephalopathy

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12
Q

Fever, neck stiffness, rash, weight loss, (symptoms in lower limbs if youre a teen or young) what fo they suggest and what category are they?

A

meningitis, systemic

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13
Q

Sudden, abrupt onset of a severe headache (thunderclap headache: they feel like they have been kicked in the back of the head 10/10 pain, onset in less than a minute

A

brain bleed, onset

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14
Q

what is a headache practically (why/ how does your head hurt?)

A

due to activation of the trigemino-vascular system (trigeminal nerve)

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15
Q

where/how does the whole pathophysiology axis start?

A

abnormal function of some area in brainstem (hypothalamus, PAG ect) (due to some excitation)

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16
Q

what does this abnormal brainstem funstion lead to?

A

cortical spreading depression

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17
Q

what is happening physiologically in cortical spreading depression? what are the symptoms?

A

Abnormal cortical hyperexcitability
(­Ca++, ­Glu, ¯Mg++)

you see auras

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18
Q

what is central sensitization and what triggers it? what is the result?

A

when your start being too sensitive to one/ some of your senses due to the tgvs activation, which further stimulates your headache

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19
Q

what is CGRP? what causes its secretion? what does it do?

A

It is a peptide released by the body in response to activation of TGVS.

it causes vasodilation and neurogenic inflammation

which leads to pain perpetuation and more TGVS activation.

20
Q

when are migraines considered episodic and when a chronic disorder?

A

chronic when more than 10-15 a month

21
Q

characteristics of a migraine pain- location, quality, intensity, trigger, duration

A

-unilateral location
- pulsating quality
- moderate to severe pain (disrupts your task at hand)
-aggrevation by routine physical activity
-last hours and sometimes days

22
Q

what are the other symptoms of migraine (people usually get 1 or more of these)

A

one of these
nausea and/ or vomiting

photophobia and/or phonophobia/ osmophobia

+
extra
(+/- auras )

23
Q

what is an aura? hoe long does it last? when does it happen usually in relation to headache onset?

A

complex array of symptoms reflecting focal cortical or brainstem dysfunction
5-30 mins
usually before headache

24
Q

what are two specific pattern types of auras?

A

elemental visual distur bance (bean shape increasing over roughly 10 mins)

expanding Cs (same: incr size over 8 mins)

25
Q

what are premonitory symptoms? when do they happen?

A

first phase, occur hours or days before migraine (yawning, polyuria, mood change, irritable, light sensitive, neck pain, concentration difficulty)

26
Q

what 2 phases come after the premonitory symptoms?

A

aura (phase- as in, in the same phase as auras you can also get… ): visual, sensory (numbness/ paraesthesia), weakness, speech arrest

headache (same time as headache you can also get) : head and body pain, nausia, photophobia

27
Q

what are the names of two final phases of headaches and when does someone move from headache to the first one?

A

RESOLUTION: rest and sleep
recovery: mood disturbed, food intolerance, feeling hungover can take up to 48 h

28
Q

what is the first line management of migraines?

A

lifestyle changes: avoiding triggers such as having irregular sleeping schedules. have good diet, exercise, mindfulness,

29
Q

why do lifestyle factors such as sleep affect migraines directly?

A

hypothalamus controls waking- sleeping phase: starts anad ends your day- hypothalamus also is the start for migraine

30
Q

what are the 2 types of drugs you can give to treat migraines

A

1) acute/ abortive: hard/ high dose and fast
2) long term preventative: strategy: low and slow

31
Q

main examples of acute/ abortive migraine treatments

A

paracetamol
NSAIDS (high dose and soluble)
Prokinetics
Triptans (5-HT1B/1D/1F receptor agonists)

32
Q

how long does a migraine treatment need to be to be cosidered long term?

A

> 5 days / month
low and slow: low doses until optimal is found

33
Q

what 2 types of dugs should be avoided for migraines?

A

opiate based and mixed analgesics

34
Q

does taking you “acute” med earlier or later after migraine onset make a difference?

A

yes, its more effective if you take it earlier before it becomes very intense

35
Q

(whatever you remember is fine) some migraine preventatives? what categories of drugs are these?

A

not one specific category, tehy were discovered by chance to help headaches during trials for other diseases: some are: anti depressants, anticonvulsants, calcium channel blockers, b blockers

36
Q

what is a new migraine preventative tjat has been discovered and ehy is it better compared to others? what makes them more difficult to use?

A

CGRP antibodies - much less side effects compared to these other heavy drugs, v expensive

37
Q

what is the most common type of primary headache?

A

tension- type headache

38
Q

what do patients report tension type headaches feel like?

A

tight muscles around head and neck as though head is in a vice

39
Q

features of tension type headache: location, intensity, and added features

A

bilateral, mild or moderate
typically no added features such as vomiting or phonophobia/ photophobia

40
Q

are tension type headaches aggregated by movement?

A

no

41
Q

treatment of tension type headaches

A

reassurance may suffice,
individual episodes : light analgesics such as aspirin or paracetamol
preventative meds rarely required

42
Q

pain severity, duration and pattern over time, location of cluster headaches

A

severe,

unilateral,

15-(180 minutes if untreated - 30 mins average:

they come and go 1-8 times a day- same pattern every day for a specific time and then they randomly stop)

43
Q

what are the features out of which at least one is usually present in cluster headaches ipsilaterally ?

A

Conjunctival redness and/or lacrimation: crying on one eye
Nasal congestion and/or rhinorrhoea: fluid coming out of nose
Eyelid oedema

44
Q

other associated cluster headache symotms general?

A

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

45
Q

usual treatment of cluster headache : acute and mechanisms of treatment + route of administr.

A

triptan: nasal or subcutaneous route

high flow oxygen; oxygen inhibits neuronal activation in the trigeminocervical complex

46
Q

cluster headaches preventative medications

A

verapamil (calcium channel inhibitor)
-get an ECG first !
greater occipital verve block (procedure)

47
Q
A

Neuro yr 2 (13 decks)

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