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Y3 Conditions > Headache > Flashcards

Headache Flashcards

migraine + tension

1
Q

Headache

What is a primary headache and secondary headache?

A

primary: headache is the primary problem

secondary: other condition precipitates the headache

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2
Q

Headache

Causes of secondary headaches include the following:

  • D
  • A
  • M
  • A
  • T
  • C
  • H
  • A
A

Drugs
Acute angular glaucoma

Meningitis
Giant cell Arteritis
Trauma
Cancer (space occupying lesions)
Haemorrhage (intracranial or venous thrombosis)
Anatomical (TMJ, ENT)

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3
Q

Headache

If the headaches were due to raised ICP, what would you expect the visual fields to show?

A

enlarged blind spots and constricted fields

Papilloedema is optic disc swelling due to raised ICP. In the subacute stages, this results in enlarged blind spots and peripheral constriction of the visual fields. In more advanced cases, there will be loss of central vision and visual acuity.

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4
Q

Headache

What time frame differentiates a short headache from a long headache?

Name some long lasting headaches and short lasting hedaches.

A

Long >4hr:
- migraine
- tension-type

Short <4hr:
- trigeminal autonomic cephalgia
- cluster headache

NB: medication can cause headaches (codeine)

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5
Q

Headache

What are 4 key red flags suggesting a secondary headache?

A

age: >50y (new or different)
onset: thunderclap headache
systemic symptoms: fever, neck stiffness, rash, weight loss
neurological signs: confusion, impaired consciousness, focal neurology, swollen optic discs

+ head trauma

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6
Q

Headache

Give a DDx:

headache + fever + neck stiffness + rash

What test might be indicated to further investigate this?

A

meningitis

lumbar puncture

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7
Q

Headache

Give a DDx:

headache, thunderclap

What test might be indicated to further investigate this?

A

subarachnoid haemorrhage

CT

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8
Q

Headache

Give a DDx:

headache + papilloedema

What test might be indicated to further investigate this?

A
  • inflammation?
  • pressure?

brain tumour

CT

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9
Q

Headache

Give a DDx:

headache + focal neurological symptoms (arm weakness)

What test might be indicated to further investigate this?

A

stroke

tumour

CT

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10
Q

Headache

Give a DDx:

headache with scalp tenderness or jaw claudication

What test might be indicated to further investigate this?

A

temporal arteritis

serum ESR

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11
Q

Headache

Give a DDx:

headache + wake up at night + worse in mornings + nausea/vomitting

What test might be indicated to further investigate this?

A

brain tumour

CT

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12
Q

Headache

What is the Valsava maneuvre? How is it used in relation to brain tumours?

A

the popping your ears thing

worsens headache in brain tumours

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13
Q

Headache

What is the maneuvre called which is popping your ears?

A

Valsava maneuvre

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14
Q

Migraine

Migraines can be an episodic or chronic disorder.

Name the characteristics of a migraine.

A
  • unilateral location
  • throbbing / pulsating
  • moderate to severe pain
  • aggravated by physical activity
  • can last hours to days

usually also has 1+ of:
- nausea/vomitting
- photo/phonobobia

+/- auras

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15
Q

Migraine

What are some common triggers for migraines?

A
  • Emotional stress
  • Alcohol / chocolate / cheese
  • Poor sleep
  • Menstruation
  • Physical activity
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16
Q

Migraine

When do we class a headache as chronic (rather than episodic)?

A

affects for 15+ days in a month

17
Q

Migraine

What is a migraine aura?

How long do they usually last and when do they begin?

A

Complex array of symptoms reflecting focal cortical or brainstem dysfunction

Gradual evolution: 5-30minutes (<60minutes)

Usually before headache

18
Q

Migraine

What do we can the aura that is described as “moving zigzag shapes”?

A

scintillating scotoma

19
Q

Migraine

What do we call this migraine aura?

A

expanding Cs

20
Q

Migraine

Name the 5 migraine headache phases and what each of them consist of?

A
  1. premonitory / prodrome
    - yawning, polyuria, mood change, irritable, light sensitive, neck pain, concentration difficulty
  2. aura
    - Visual, sensory (numbness/paraesthesia), weakness, speech arrest
  3. headache
    - Head and body pain, nausea, photophobia
  4. resolution (postdrome)
    - rest and sleep
  5. recovery (postdrome)
    - mood disturbed, food intolerance, feeling hungover Can take up to 48 hours
21
Q

Migraine

How do we manage migraine?

A
  1. lifestyle
  2. pharmacological theraoy
    - acute/abortive
    - long term preventative
22
Q

Migraine

What are some lifestyle managements for migraines?

A
  • avoid triggers
  • diet
  • sleep
  • exercise
  • mindfulness
23
Q

Migraine

What are some acute/abortive pharmacological therapies for migraines?

A
  • paracetamol
  • NSAIDs
  • prokinetics
  • triptans
24
Q

Migraine

When might long term and preventative pharmacological therapy be offered to a pt with migraines?

A

if they struggle with migraines 5 or more days a month

25
Q

Migraine

Medications used as prophylaxis or as preventative measures include…(3)

A
  • propranolol
  • amitriptyline
  • topiramate
26
Q

Migraine

What kind of antibodies are a new medication on the block for preventing migraines?

A

CGRP antibodies (monoclonal)

27
Q

Tension Headache

Name the features of a tension type headache?

A

“Tight muscles around head and neck, as though head is in a vice.”

lasts 30mins
- bilateral
- mild / moderate pain
- not aggravated by movement
- no added features (like nausea etc in migraine)

28
Q

Tension Headache

Tension type headaches are episodic/chronic?

A

episodic (can be chronic)

29
Q

Tension Headache

What may the trigger of a tension-type headache be?

A
  • Stress and anxiety
  • Tiredness
  • Dehydration
  • Missing meals
  • Lack of physical activity
  • Poor body posture
30
Q

Tension Headache

What treatment may be offered to those with tension type headaches?

A

reassurance that it is not a big issue

  • paracetamol / NSAIDs / aspirin
31
Q

Tension Headache

For cases of chronic tension headaches, NICE also recommends a course of up to 10 sessions of ____ over a ____-____ week period.

A

For cases of chronic tension headaches, NICE also recommends a course of up to 10 sessions of acupuncture over a 5-8-week period.

32
Q

Headache

Use a piece of paper to fill this out.

A

Y3 Conditions (55 decks)

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