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CNS > Headache > Flashcards

Headache Flashcards

1
Q

What is the difference between primary and secondary headache?

A

Primary headache has no underlying causes, while secondary headache has an identifiable structural or biochemical cause.

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2
Q

What are the types of primary headache?

A

Migraine, tension type headache, cluster headache.

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3
Q

What is thought to be the cause of primary headache?

A

Problems in the brainstem, corticospinal cord, and trigeminal vascular system, as well as calcitonin gene peptide problems.

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4
Q

How to deal with primary headaches?

A

Modify lifestyle triggers, abortive treatments (i.e., stop unnecessary medications), and preventive treatments (take medication when it first starts).

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5
Q

Is investigation required for primary headache?

A

None in most cases unless a secondary cause is suspected.

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6
Q

What type of imaging can be used for headaches?

A

MRI, CT, and CT angiogram.

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7
Q

What is a tension type headache?

A

A headache that is not disabling, characterized by light pain in the head and some tightening.

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8
Q

What percent of people have a tension type headache?

A

40-50%.

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9
Q

Does anything make tension type headache worse?

A

No, it is not affected by physical activity.

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10
Q

What is the treatment for tension type headache?

A

Paracetamol and NSAIDs, tricyclic antidepressants.

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11
Q

How common is migraine?

A

About 10-20% of people suffer from them.

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12
Q

What are the premonitory changes in a migraine?

A

Mood change, fatigue, cognitive changes, muscle pain, food cravings.

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13
Q

What is the early headache stage in migraine?

A

Dull headache, nasal congestion, muscle pain.

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14
Q

What is the advanced headache phase in a migraine?

A

Unilateral headache, throbbing, nausea, photophobia, phonophobia, osmophobia (fear of odors).

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15
Q

What is the postdrome of migraine?

A

Fatigue, cognitive changes, muscle pain.

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16
Q

What are the stages of migraine in order?

A

Premonitory, aura, early headache, advanced headache, postdrome.

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17
Q

What percent of people with migraines are affected by the aura?

A

33%.

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18
Q

What is the cause of aura in migraine?

A

Transient neurological symptoms from cortical or brainstem dysfunction.

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19
Q

What are the signs of aura in migraine?

A

Speech changes, motor or visual symptoms lasting 15-60 minutes.

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20
Q

What is the aura associated with in migraine?

A

TIA.

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21
Q

What is the criteria for episodic migraine?

A

Less than 15 days per month.

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22
Q

What are low and high frequency episodic migraines?

A

Low frequency: 1-9 per month, high frequency: 10-14 per month.

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23
Q

What is chronic migraine classification?

A

Headache that occurs 15 or more days per month for 3 months or more, with at least 8 days per month being a headache.

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24
Q

What are the signs of chronic migraines?

A

Previous episodic migraines, increased frequency of migraine symptoms, less frequent migraine symptoms, episodes of severe migraine on a background of less severe headaches.

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25
Q

How frequent is a medication overuse headache?

A

More than 15 days a month.

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26
Q

How much local pain relief should someone with migraine take?

A

No more than 15 days per month for migraine or 10 per day for opioids or ergots.

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27
Q

What are the prophylactic treatment examples for migraines?

A

Propranolol, tricyclic antidepressants, candesartan.

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28
Q

What are second line migraine treatments?

A

Topiramate, flunarizine, Botox, CGRP monoclonal antibodies.

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29
Q

How is migraine affected in pregnancy?

A

It gets better in pregnancy if there is no aura; if there is an aura, it is not affected in pregnancy.

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30
Q

Should OCP be stopped if a migraine with aura occurs?

A

Yes.

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31
Q

How long does it take for overuse migraine to get better?

A

2-4 weeks.

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32
Q

What are cranial neuralgias symptoms?

A

Intense burning or stabbing pain, normally brief but severe, travels the course of the affected nerve due to irritation of the nerve.

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33
Q

What is the cause of cranial neuralgias?

A

Irritation of nerves that have sensation in the head, including trigeminal, glossopharyngeal, vagus, nervus intermedius, and occipital.

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34
Q

What is trigeminal neuralgia?

A

Spontaneous stabbing pain in the trigeminal area lasting about 5-10 seconds.

35
Q

What are triggers of trigeminal neuralgia?

A

Wind, touch, chewing.

36
Q

What is the cause of trigeminal neuralgia?

A

Vascular compression of the nerve, multiple sclerosis, intracranial arteriovenous malformation, intracranial tumor, brainstem lesion.

37
Q

What is the medical treatment for trigeminal neuralgia?

A

Carbamazepine, oxcarbazepine, lamotrigine (less effective as it takes a long time to build up effectiveness).

38
Q

What are the surgical treatments for trigeminal neuralgia?

A

Glycerol ganglion injection/balloon compression, stereotactic radiosurgery, microvascular decompression.

39
Q

What are trigeminal autonomic cephalalgias?

A

Headaches associated with trigeminal nerve issues and sympathetic problems.

40
Q

Where is the pain in cluster headaches?

A

Orbital and temporal.

41
Q

Are the attacks in cluster headaches bilateral or unilateral?

A

Unilateral.

42
Q

How long do cluster headaches last?

A

15 minutes to 3 hours.

43
Q

How quick is the onset of cluster headaches?

A

Within 9 minutes.

44
Q

What are the migraine symptoms in cluster headaches?

A

Tiredness and yawning, nausea, vomiting, photophobia, phonophobia, aura.

45
Q

How long do bouts of cluster headaches last?

A

1-3 months, normally at the same time of the day.

46
Q

How frequent are cluster headaches during bouts?

A

1 every other day to 8 per day.

47
Q

What is the abortive treatment for cluster headaches?

A

Triptans (up to 2 times per day), oxygen therapy (need 2 tanks per day).

48
Q

Can you get medication overuse headache in cluster headaches?

A

No.

49
Q

What is the transitional treatment for cluster headaches?

A

Oral prednisone for 1 week, greater occipital nerve block with lidocaine and depomedrone.

50
Q

What is the preventative treatment for cluster headaches medically?

A

Verapamil (this requires ECG monitoring), lithium, topiramate, melatonin.

51
Q

What are the surgical treatments for cluster headaches?

A

Occipital nerve stimulation, deep brain stimulation.

52
Q

What are the symptoms of paroxysmal hemicrania?

A

Pain in orbital and temporal lobes, sudden and severe, always unilateral.

53
Q

How long does paroxysmal hemicrania last?

A

2-30 minutes.

54
Q

What are the triggers for paroxysmal hemicrania?

A

Rotating head.

55
Q

What can help hemicrania?

A

Indometacin.

56
Q

What is hemicrania continua?

A

A unilateral headache that can last months without getting better.

57
Q

Does hemicrania have worsening points?

A

Yes, it can get worse for 20 minutes to days.

58
Q

What is SUNCT?

A

A headache that is frequent and causes pain in a specific area.

59
Q

What are the triggers for SUNCT?

A

Wind, cold, touch, chewing.

60
Q

What is the pain associated with in SUNCT?

A

Conjunctival injection and lacrimation.

61
Q

What is the medical treatment for SUNCT?

A

Lamotrigine (first line), topiramate, oxcarbazepine.

62
Q

What is the transitional treatment for SUNCT?

A

Gon block.

63
Q

What are the surgical treatments for SUNCT?

A

Occipital nerve stimulation, deep brain stimulation.

64
Q

What are some signs of a secondary headache?

A

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.

65
Q

What are the signs of high pressure headache?

A

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.

66
Q

What are the signs of a low pressure headache?

A

It is caused by sitting up.

67
Q

How long until a thunderclap headache reaches peak?

A

Less than 1 minute.

68
Q

Is a thunderclap headache part of a whole head or howel head?

A

Whole head.

69
Q

What is the differential diagnosis for thunderclap headache?

A

Migraine, primary exertional headache, subarachnoid hemorrhage, TIA, stroke, carotid/vertebral artery dissection, cerebral venous thrombosis, meningitis, pituitary apoplexy.

70
Q

Where does a subarachnoid hemorrhage occur?

A

Bleeding into the subarachnoid space.

71
Q

What are the complications of subarachnoid hemorrhage?

A

Vasospasm, hydrocephalus, seizure, infection, rebleeding.

72
Q

What investigations are done for SAH?

A

CT head, CT angiogram, LP (if CT head negative - need to wait 12 hours).

73
Q

What is the treatment for subarachnoid hemorrhage?

A

Coiling of aneurysms, nimodipine (Ca2+ blocker for vasodilation), triple H therapy.

74
Q

What are the causes of high brain pressure?

A

Tumor, infection, hydrocephalus, intracranial hypertension.

75
Q

What are the signs of high pressure headache?

A

Papilledema, new abnormal neurologic exam.

76
Q

What are the symptoms of intracranial hypertension?

A

Progressive episodic headaches, visual obscuration or pulsatile tinnitus, papilledema with large blind spot.

77
Q

What are the symptoms of intracranial hypotension?

A

Postural headache, gets worse when sitting up.

78
Q

What is the sign on MRI of intracranial hypotension?

A

Venous engorgement, subdural hygromas.

79
Q

What is the treatment for intracranial hypotension?

A

Bed rest, IV caffeine, epidural blood patch.

80
Q

What is an epidural blood patch?

A

Epidural space is opened and patient’s own blood is injected into it.

81
Q

What is giant cell arteritis?

A

Inflammation of the giant cells.

82
Q

What are the signs of giant cell arteritis?

A

Headache, scalp tenderness, jaw claudication, visual disturbances, systematically unwell, enlarged temporal arteries.

83
Q

What tests should be done for giant cell arteritis?

A

ESR blood test, CRP blood test.

84
Q

What is the treatment for giant cell arteritis?

A

High dose prednisolone.

CNS (36 decks)

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