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CNS CLERKSHIP > Headache > Flashcards

Headache Flashcards

1
Q

Migraine tends to occur in whom?

A

Young females.

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2
Q

What features may be associated with headaches?

A
  • Photophobia.
  • Phonophobia.
  • Positive visual symptoms.
  • Ptosis, miosis.
  • Nasal stuffiness.
  • Autonomic features e.g. n+v.
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3
Q

Red flags in headaches?

A
  • New onset >55 y/o.
  • Known/previous malignancy.
  • Immuno-suppressed.
  • Early morning headache.
  • Exacerbated by valsalva/coughing/sneezing (which raise ICP).
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4
Q

Are most migraines with or without aura?

A

Without- 80%.

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5
Q

IHS criteria for migraine without aura.

A
  • At least 5 attacks.
  • Duration of 4-72 hours.
  • 2 of: moderate/severe pain, unilateral pain, throbbing pain, pain worse on movement.
  • 1 of: autonomic features, photophobia or phonophobia.
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6
Q

How may migraines be induced by stress?

A
  • Serotonin release in the brain causes constriction and dilation of blood vessels.
  • Chemicals e.g. substance P irritate nerves and blood vessels to cause pain.
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7
Q

How long does aura last in migraine?

A

20-60 minutes.

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8
Q

Do migraine and aura always occur simultaneously?

A

No.

Aura may occur an hour before headache onset or simultaneously.

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9
Q

What types of aura are associated with migraine?

A
  • Visual.
  • Sensory.
  • Motor.
  • Language symptoms.
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10
Q

Describe visual aura of migraine.

A
  • Central scotoma.
  • Central fortification.
  • Hemianopic loss.
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11
Q

Migraine may be triggered by?

A

Sleep, diet, stress, hormones, physical exertion.

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12
Q

Non-pharmacological treatment of migraine?

A
  • Set realistic goals.
  • Avoid triggers.
  • Headache diary.
  • Relaxation/stress management.
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13
Q

Pharmacological treatment of acute migraine?

A
  • Acute: NSAID (aspirin, naproxen, ibuprofen, triptans ASAP +/- anti-emetic if gastroparesis.
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14
Q

Dose of aspirin in acute migraine?

A

ASAP 900mg +/- anti-emetic if gastroparesis.

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15
Q

Dose of Naproxen in acute migraine?

A

ASAP 250mg +/- anti-emetic if gastroparesis.

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16
Q

Dose of ibuprofen in acute migraine?

A

ASAP 400mg +/- anti-emetic if gastroparesis.

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17
Q

Pharmacological prophylaxis of migraine should be considered when?

A

If more than 3 attacks per month or if very severe.

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18
Q

What is the aim of migraine prophylaxis?

A

To titrate drug as tolerated to achieve efficacy at lowest dose possible.

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19
Q

How long must migraine prophylaxis drugs be trialed?

A

A minimum of 4 months each.

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20
Q

Which beta-blocker reduces migraine frequency in 60-80% of patients?

A

Propranolol.

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21
Q

Daily dose of propranolol to reduce migraine frequency?

A

80-240mg.

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22
Q

When should propranolol be avoided?

A

Asthma, PVD, heart failure.

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23
Q

What is topiramate?

A

Carbonic anhydrase inhibitor (Na+/GABA).

24
Q

Daily dose of topiramate in prevention of migraine?

A

25-100mg.

25
Q

Adverse effects of Topiramate?

A
  • Weight loss, paraesthesia, impaired concentration, enzyme inducer.
26
Q

Side effects of amitriptyline?

A

Dry mouth, postural hypotension, sedation.

27
Q

Describe a tension type headache.

A
  • Pressing tingling quality.
  • Mild to moderate pain.
  • Bilateral.
  • Absence of N+V.
  • Absence of photophobia/phonophobia.
  • Episodic or chronic nature.
28
Q

Management of tension type headache?

A
  • Relaxation physiotherapy.
  • Anti-depressant (dothiepin or amitriptyline) for 3 months.
  • Reassurance.
29
Q

What are trigeminal autonomic cephalgias (TACs)?

A

Primary headache disorders characterised by pain in a unilateral trigeminal distribution in association with prominent ipsilateral cranial autonomic features.

30
Q

Name the ipsilateral cranial autonomic features associated with trigeminal autonomic cephalgias (TACs).

A
  • Ptosis.
  • Miosis.
  • Nasal stuffiness.
  • Nausea/vomiting.
  • Tearing.
  • Eye lid oedema.
31
Q

What are the four main types of trigeminal autonomic cephalgias (TACs)?

A
  • Cluster headaches.
  • Paroxysmal hemicrania.
  • Hemicrania continua.
  • Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT).
32
Q

Cluster headache is most common in who?

A

Men in their 30s-40s.

33
Q

When do cluster headaches typically occur?

A
  • Striking circadian (around sleep).

- Seasonal variation.

34
Q

Features of a cluster headache?

A

Severe unilateral headache lasting 45-90 mins and occurring 1-8x a day.

A cluster bout may last from weeks to months.

35
Q

Management of cluster headaches?

A
  • High flow 100% oxygen for 20 mins.
  • Sub/cut Sumatriptan 6mg.
  • Steroids: reduce course over 2 weeks.
  • Prophylactic Verapamil.
36
Q

Paroxysmal hemicrania is most common in who?

A

Woman in their 50s-60s.

37
Q

Features of paroxysmal hemicrania?

A
  • Severe unilateral headache.
  • Unilateral autonomic features.
  • Last 10-30 mins 1-40x a day.
38
Q

Management of paroxysmal hemicrania?

A

Indomethicin.

If it don’t respond to indomethicin, it ain’t paroxysmal hemicrania.

39
Q

SUNCT stands for?

A
  • Short lived.
  • Unilateral.
  • Neuralgiaform headache.
  • Conjunctival injections.
  • Tearing.
40
Q

Management of SUNCT?

A
  • Lamotrigine, Gabapentin.
41
Q

Who requires investigation for headache?

A

New onset unilateral cranial autonomic features.

42
Q

What is the imaging used in investigating new onset unilateral cranial autonomic features?

A
  • MRI brain.

- MR angiogram.

43
Q

Who is idiopathic intracranial hypertension most common in?

A

Obese females.

44
Q

How does idiopathic intracranial hypertension?

A
  • Diurnal variation.
  • Morning n+v.
  • Visual loss.
45
Q

What will MRI brain with MRV sequence show in idiopathic intracranial hypertension?

A

Normal.

46
Q

What will CSF show in idiopathic intracranial hypertension?

A

Elevated pressure but normal constituents.

47
Q

Management of idiopathic intracranial hypertension?

A
  • Weight loss.
  • Acetazolamide.
  • Ventricular atrial/lumbar peritoneal shunt.
  • Monitor visual fields and CSF pressure.
48
Q

Apart from imaging and CSF tap what should be tested in idiopathic intracranial hypertension?

A

Visual fields.

49
Q

Trigeminal neuralgia is more common in?

A

Elder women (>60 y/o).

50
Q

Trigeminal neuralgia is triggered by?

A

Touch usually in V2/3 dermatome.

51
Q

Features of trigeminal neuralgia?

A
  • Severe stabbing unilateral pain.
  • Lasting 1-90 seconds 10-100x a day.
  • Bouts of pain may last weeks to months before remission.
52
Q

Medical management of trigeminal neuralgia?

A

Carbamazepine, Gabapentin, Phenytoin, Baclofen.

53
Q

Surgical management of trigeminal neuralgia?

A

Ablation, decompression.

54
Q

Investigation of trigeminal neuralgia?

A

MRI brain.

55
Q

What other non-neurological structures should be considered in headaches with facial pain?

A
  • Eyes.
  • Ears.
  • Sinuses.
  • Teeth.
  • TMJ.

CNS CLERKSHIP (43 decks)

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