Headache Flashcards
What is the difference between primary and secondary headache?
Primary headache has no underlying causes, while secondary headache has an identifiable structural or biochemical cause.
What are the types of primary headache?
Migraine, tension type headache, cluster headache.
What is thought to be the cause of primary headache?
Problems in the brainstem, corticospinal cord, and trigeminal vascular system, as well as calcitonin gene peptide problems.
How to deal with primary headaches?
Modify lifestyle triggers, abortive treatments (i.e., stop unnecessary medications), and preventive treatments (take medication when it first starts).
Is investigation required for primary headache?
None in most cases unless a secondary cause is suspected.
What type of imaging can be used for headaches?
MRI, CT, and CT angiogram.
What is a tension type headache?
A headache that is not disabling, characterized by light pain in the head and some tightening.
What percent of people have a tension type headache?
40-50%.
Does anything make tension type headache worse?
No, it is not affected by physical activity.
What is the treatment for tension type headache?
Paracetamol and NSAIDs, tricyclic antidepressants.
How common is migraine?
About 10-20% of people suffer from them.
What are the premonitory changes in a migraine?
Mood change, fatigue, cognitive changes, muscle pain, food cravings.
What is the early headache stage in migraine?
Dull headache, nasal congestion, muscle pain.
What is the advanced headache phase in a migraine?
Unilateral headache, throbbing, nausea, photophobia, phonophobia, osmophobia (fear of odors).
What is the postdrome of migraine?
Fatigue, cognitive changes, muscle pain.
What are the stages of migraine in order?
Premonitory, aura, early headache, advanced headache, postdrome.
What percent of people with migraines are affected by the aura?
33%.
What is the cause of aura in migraine?
Transient neurological symptoms from cortical or brainstem dysfunction.
What are the signs of aura in migraine?
Speech changes, motor or visual symptoms lasting 15-60 minutes.
What is the aura associated with in migraine?
TIA.
What is the criteria for episodic migraine?
Less than 15 days per month.
What are low and high frequency episodic migraines?
Low frequency: 1-9 per month, high frequency: 10-14 per month.
What is chronic migraine classification?
Headache that occurs 15 or more days per month for 3 months or more, with at least 8 days per month being a headache.
What are the signs of chronic migraines?
Previous episodic migraines, increased frequency of migraine symptoms, less frequent migraine symptoms, episodes of severe migraine on a background of less severe headaches.
How frequent is a medication overuse headache?
More than 15 days a month.
How much local pain relief should someone with migraine take?
No more than 15 days per month for migraine or 10 per day for opioids or ergots.
What are the prophylactic treatment examples for migraines?
Propranolol, tricyclic antidepressants, candesartan.
What are second line migraine treatments?
Topiramate, flunarizine, Botox, CGRP monoclonal antibodies.
How is migraine affected in pregnancy?
It gets better in pregnancy if there is no aura; if there is an aura, it is not affected in pregnancy.
Should OCP be stopped if a migraine with aura occurs?
Yes.
How long does it take for overuse migraine to get better?
2-4 weeks.
What are cranial neuralgias symptoms?
Intense burning or stabbing pain, normally brief but severe, travels the course of the affected nerve due to irritation of the nerve.
What is the cause of cranial neuralgias?
Irritation of nerves that have sensation in the head, including trigeminal, glossopharyngeal, vagus, nervus intermedius, and occipital.
What is trigeminal neuralgia?
Spontaneous stabbing pain in the trigeminal area lasting about 5-10 seconds.
What are triggers of trigeminal neuralgia?
Wind, touch, chewing.
What is the cause of trigeminal neuralgia?
Vascular compression of the nerve, multiple sclerosis, intracranial arteriovenous malformation, intracranial tumor, brainstem lesion.
What is the medical treatment for trigeminal neuralgia?
Carbamazepine, oxcarbazepine, lamotrigine (less effective as it takes a long time to build up effectiveness).
What are the surgical treatments for trigeminal neuralgia?
Glycerol ganglion injection/balloon compression, stereotactic radiosurgery, microvascular decompression.
What are trigeminal autonomic cephalalgias?
Headaches associated with trigeminal nerve issues and sympathetic problems.
Where is the pain in cluster headaches?
Orbital and temporal.
Are the attacks in cluster headaches bilateral or unilateral?
Unilateral.
How long do cluster headaches last?
15 minutes to 3 hours.
How quick is the onset of cluster headaches?
Within 9 minutes.
What are the migraine symptoms in cluster headaches?
Tiredness and yawning, nausea, vomiting, photophobia, phonophobia, aura.
How long do bouts of cluster headaches last?
1-3 months, normally at the same time of the day.
How frequent are cluster headaches during bouts?
1 every other day to 8 per day.
What is the abortive treatment for cluster headaches?
Triptans (up to 2 times per day), oxygen therapy (need 2 tanks per day).
Can you get medication overuse headache in cluster headaches?
No.
What is the transitional treatment for cluster headaches?
Oral prednisone for 1 week, greater occipital nerve block with lidocaine and depomedrone.
What is the preventative treatment for cluster headaches medically?
Verapamil (this requires ECG monitoring), lithium, topiramate, melatonin.
What are the surgical treatments for cluster headaches?
Occipital nerve stimulation, deep brain stimulation.
What are the symptoms of paroxysmal hemicrania?
Pain in orbital and temporal lobes, sudden and severe, always unilateral.
How long does paroxysmal hemicrania last?
2-30 minutes.
What are the triggers for paroxysmal hemicrania?
Rotating head.
What can help hemicrania?
Indometacin.
What is hemicrania continua?
A unilateral headache that can last months without getting better.
Does hemicrania have worsening points?
Yes, it can get worse for 20 minutes to days.
What is SUNCT?
A headache that is frequent and causes pain in a specific area.
What are the triggers for SUNCT?
Wind, cold, touch, chewing.
What is the pain associated with in SUNCT?
Conjunctival injection and lacrimation.
What is the medical treatment for SUNCT?
Lamotrigine (first line), topiramate, oxcarbazepine.
What is the transitional treatment for SUNCT?
Gon block.
What are the surgical treatments for SUNCT?
Occipital nerve stimulation, deep brain stimulation.
What are some signs of a secondary headache?
A headache that occurs for the first time in a temporal relation to another disorder, or a preexisting primary headache that becomes significantly worse in the temporal area. Sudden onset (thunderclap), new patient, change in pattern, new onset and older than 50, immunosuppression, focal symptoms, non-focal symptoms, neck stiffness, high pressure, low pressure.
What are the signs of high pressure headache?
Made worse by lying down, wakes the patient up, made worse due to physical exertion, happens due to Valsalva maneuver, seizures, progressive focal symptoms, headache.
What are the signs of a low pressure headache?
It is caused by sitting up.
How long until a thunderclap headache reaches peak?
Less than 1 minute.
Is a thunderclap headache part of a whole head or howel head?
Whole head.
What is the differential diagnosis for thunderclap headache?
Migraine, primary exertional headache, subarachnoid hemorrhage, TIA, stroke, carotid/vertebral artery dissection, cerebral venous thrombosis, meningitis, pituitary apoplexy.
Where does a subarachnoid hemorrhage occur?
Bleeding into the subarachnoid space.
What are the complications of subarachnoid hemorrhage?
Vasospasm, hydrocephalus, seizure, infection, rebleeding.
What investigations are done for SAH?
CT head, CT angiogram, LP (if CT head negative - need to wait 12 hours).
What is the treatment for subarachnoid hemorrhage?
Coiling of aneurysms, nimodipine (Ca2+ blocker for vasodilation), triple H therapy.
What are the causes of high brain pressure?
Tumor, infection, hydrocephalus, intracranial hypertension.
What are the signs of high pressure headache?
Papilledema, new abnormal neurologic exam.
What are the symptoms of intracranial hypertension?
Progressive episodic headaches, visual obscuration or pulsatile tinnitus, papilledema with large blind spot.
What are the symptoms of intracranial hypotension?
Postural headache, gets worse when sitting up.
What is the sign on MRI of intracranial hypotension?
Venous engorgement, subdural hygromas.
What is the treatment for intracranial hypotension?
Bed rest, IV caffeine, epidural blood patch.
What is an epidural blood patch?
Epidural space is opened and patient’s own blood is injected into it.
What is giant cell arteritis?
Inflammation of the giant cells.
What are the signs of giant cell arteritis?
Headache, scalp tenderness, jaw claudication, visual disturbances, systematically unwell, enlarged temporal arteries.
What tests should be done for giant cell arteritis?
ESR blood test, CRP blood test.
What is the treatment for giant cell arteritis?
High dose prednisolone.
