Headache Flashcards

1
Q

types of primary headache

A

tension-type headache
migraine
trigeminal autonomic cephalgias (including cluster headaches)
primary stabbing headaches and benign exertional headaches

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2
Q

what are secondary headaches

A

headaches due to underlying condition
infection (meningitis, covid, flu)
vascular (aneurysmal bleed, stroke, giant cell arteritis)
raised intracranial pressure (trauma, tumour)
medication side effects

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3
Q

symptoms of tension-type headaches

A

whole head
dull pressing character
mild-moderate severity
usually no associated features and rather non-specific
only considered a disease if they arise frequently and spontaneously

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4
Q

treatment of tension headaches

A

NDSAIDs
preventative tricyclic antidepressant if anything

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5
Q

presentation and pathology of trigeminal autonomic cephalgias

A

activation of trigeminal and autonomic pathways
presenting as unilateral headache attacks with ipsilateral autonomic features
often circadian
distinguished by their duration and frequency

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6
Q

autonomic features of TAC headaches

A

red eye, ptosis (drooping of upper eyelid), lacrimation, rhinorrhea (runny nose)

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7
Q

types of TAC

A

cluster headaches
paroxysmal hemicrania
hemicrania continua
short-lasting unilateral neuralgiform with conjunctival injection and tearing (SUNCT)
short-lasting unilateral neuralgiform headache and autonomic features (SUNA)

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8
Q

features of cluster headache

A

tend to occur at night
maybe 3 or 4 times a day
can last for 6 weeks
makes people really agitated

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9
Q

features of migraine

A

often unilateral/retro-orbital
severe pulsating, throbbing
last 4-72 hrs
associated features include photophobia, phonophobia, nausea, vomiting, desire to lie still, exacerbated by movement

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10
Q

what is a migraine with aura

A

precedes the headache
duration of <60mins
spreads over time (different to stroke)
90% visual
can affect sensation in face and hand (usually tingling rather than numbness)
speech issues (dysphasia)
can have aura without the headache (this can be mistaken for TIA)

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11
Q

what are the prodromal and postdromal features of a migraine

A

tiredness
irritability
yawning
poor concentration

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12
Q

what are the two types of migraine

A

episodic - with or without aura
chronic - headache for more than 15 days per month for 3 months, characteristic features for more than 8 days a month (often associated with analgesia overuse)

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13
Q

migraine risk factors

A

postpubertal women 3 times more likely, peaks at 35-40 years
hormonal factors - gender, puberty, periods, pregnancy, menopause, combined oral contraceptive pill
environmental triggers - emotional stress, change in sleep pattern, certain foods, weather changes

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14
Q

migraine pathophysiology

A

incompletely understood
current thinking is it involves activation and sensitisation of trigeminovascular pathways
disorder of sensory processing and altered brain excitabilityt

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15
Q

what is the acute treatment of migraines

A

aspirin - ideally soluble and high dosage (600-900mg)
NSAIDs
triptans - try several types and several routes before giving up (only work for ~50%)
avoid analgesic overuse

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16
Q

when is preventative migraine treatment recommended

A

if migraine is sufficiently frequent/severe to interrupt daily life
not likely to work if analgesia overuse is cause of headache

17
Q

common preventative migraine treatments

A

propranolol - beta blocker
pizotifen - antihistamine with serotonin antagonist
amitryptiline/nortriptyline - tricyclic antidepressants
candesartan - angiotensin ii receptor antagonist
topiramate (antiseizure drug increasing GABA activity, inhibiting glutamate)
flunarizine (calcium channel blocker with antihistamine effects)
riboflavin (vitamin b2. role in cellular energy production/mitochondria)
botulinum injections (neurotoxin blocking presynaptic release of Ach

18
Q

mechanism of CGRP drugs

A

CGRP - neuropeptide in trigeminal ganglions
release triggers a cascade resulting in sensitisation of trigeminal nerves
has a key role in migraine pain pathways through trigeminovascular system
drug gives rise to monoclonal antibodies against CGRP or CGRP receptor for migraine prevention