Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

N - C > Headache > Flashcards

Headache Flashcards

1
Q

How is headache divided?

A

Primary Headache

  • Most headache (90% GP vs 60% A+E)
  • No underlying medical cause

Secondary Headache

  • Has identifiable structural or biochemical cause
  • Not all secondary is sinister
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Give examples of primary headache

A

Tension Type Headache
Migraine
Cluster Headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Give examples of secondary Headache

A 
Tumour
Meningitis
Vascular disorder
Systemic infection
Head injury
Drug-induced
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is Primary headache?

A

Increased sensitivity of normal intracranial pain pathways to what is going on in the environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe tension-type headaches

A

Most frequent primary headache, but is NOT disabling and rarely presents to doctors

Lifetime prevalence of 42% in men and 49% in women

Mild, bilateral headache which is often pressing or tightening in quality, has no significant associated features and is not aggravated by routine physical activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the difference between Infrequent ETTH, Frequent ETTH and CTTH?

A

Infrequent Episodic Tension-Type Headache (/= 15 days / month)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the treatment for tension-type headache?

A

Absorptive treatment:

  • Aspirin or paracetamol
  • NSAIDs
  • Limit to approx 2 days per week to avoid the development of medication overuse headache

Preventative treatment:
-Rarely required
-Tricyclic antidepressents
(AMITRIPTYLINE, dothiepin, nortriptyline)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is migraine?

A

A chronic disorder with episodic attacks

Complex charges in the brain that lead to activation and sensitisation of the trigeminal system

Most frequent DISABLING primary headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the symptoms during attacks of migraine?

A

One of the following symptoms should be present along with headache:

  • Nausea and/or vomiting
  • Photophobia,
  • Phonophobia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the symptoms between attacks of migraine?

A

Enduring predisposition to future attacks

Anticipatory anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the criteria for a migraine?

A

Both with an without aura, headaches must last for 4 to 74 hours.

In addition the headaches must have at least 2 of the following features:
-Unilateral location
-Pulsating quality
-Moderate or severe pain
and/ or aggravation by or causing avoidance of routie physical activity (e.g. walking, climbing stairs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the triggers of migraines?

A 
STRESS
Hunger
Sleep disturbance
Dehydration
Diet
Environmental stimuli
Changes in oestrogen levels in women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does migraine evolve over time?

A

Migraine is manifested clinically as a constellation of symptoms that evolve through the various phases of a migraine attack.

Clinical experience indictaes that symptoms typically associated with each phase of an attack often recur during other pases of the attack, resulting in continuum of symptoms, rather than a succession of distinct phases.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe the premonitory phase of a migraine attack

A

70% with or without aura experience premonitory symptoms

Often seen as predictors of the headache attack

Mood alterations, muscle pain, food cravings, cognitive changes, fluid retention, yawning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is an aura?

A

Transient neurological symptoms resulting from cortical or brainstem dysfunction

May involve visual, sensory, motor or speech symptoms
-Show a slow evolution of symptoms from 1 area to the next (e.g. vision -> sensory -> speech)

Aura symptoms are believed to arise from an electrical disturbance called cortical spreading depression (CSD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the aura phase of migraine

A

Involves focal, fully reversible neurologic symptoms that often precede headache.

Visual somatosensory symptoms often described

Duration = 15-60 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe the early headache phase of migraine

A

Mild pain without the associated symptoms of migraine

Nasal congestion

Muscle pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe the advanced headache phase of migraine

A

Moderate to severe unilateral throbbing pain with associated symptoms of:
-Nausea, photophobia, phonophobia or disability.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe the postdrome phase of migraine

A

Phase of migraine associated symptoms beyond the resolution of the headache (often entails significant disability that can last for 1 or 2 days)

Fatigue
Cognitive changes
Muscle pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Summarise the phases of migraine by listing them in order

A 
Premonitory
Aura
Early headache
Advanced headache
Postdrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What can aura symptoms be confused with?

How do you differentiate?

A

TIA:

TIA differs in that it involves:

  • Loss of function
  • Sudden onset
  • Symptoms all start at same time and can be localised to a specific vascular area
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is chronic migraine?

A

Headache on >/= 15 days per month, of which >/= 8 days have to be migraine, for more than 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is Medication Overuse Headache?

A

Headache present on >/= days/month which has developed or worsened whilst taking regular symptomatic medication

Can occur in any primary headache:

  • Migraineurs are particularly prone to MOH
  • Migraineurs taking pain medication for another reason can develop chronic headache
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What causes Medication Overuse Headache?

A

Use of triptans, ergots, opioids and combination analgesics >10days/month

Use of simple analgesics >15 days per month

Caffeine overuse: coffee, tea, cola etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the abortive treatment for migraine?

A
  • Aspirin or NSAIDs
  • Triptans
  • Limit to approx 2 days per week to avoid medication overdose headache
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the prophylactic treatment for migraine?

A
  • Propranolol, Candesartan
  • Anti-epileptics (Topiramate, Valproate, Gabapectin)
  • Tricyclic andtidepressents (amitriptyline, dothiepin, nortiptyline)
  • Venlafaxine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How is migraine effected in pregnancy?

A

Migraine without aura gets better in pregnancy

Migraine with aura usually doesnt change

First migraine can occur during pregnancy
-Particularly migraine with aura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Why should you avoid anti-epileptics in a woman of child bearing age?

A

Teratogenicity of medication

Ensure adequate contraception

29
Q

How is the treatment of migraine different in pregnancy?

A

Treatment is more difficult

Acute attack: Paracetamol
Preventative: Propanolol or Amitriptyline

No anti-epileptics

30
Q

What are the Trigeminal Autonomic Cephalalgias?

A

Cluster Headache

Paroxysmal Hemicrania

SUNCT = Short-lasting Unilateral Neuralgiform headache with Conjunctival injection and Tearing

SUNA = Short-lasting Unilateral Neuralgiform headache with Autonomic symptoms

31
Q

What is the attack in Cluster Headache like?

A

Pain = mainly orbital and temporal

Attacks are UNILATERAL
Radip onset (
32
Q

What migrainous symptoms are often present in cluster headache?

A

Premonitory: tiredness, yawning

Associated symptoms: nausea, vomiting, photo- and phonophobia

Typical aura

33
Q

What autonomic symptoms may be present in Trigeminal Autonomic Cephalalgias?

A 
Conjunctival injection
Nasal congestion
Eyelid oedema
Forehead and facial swelling
Miosis/ ptosis
34
Q

Describe the bouts in Cluster Headaches?

A

Episodic in 80-90%
-Attacks cluster into bouts lasting about 1-3 months with periods of remision lasting at least a month

  • Frequency: 1 every day to 8 per day
  • May be continuous backgorund pain between attacks

Alcohol triggers attacks during a bout but not in remission

35
Q

How does circadian rhythm play a role in cluster headache?

A

Attacks occur at the same time each day

Bouts occur at the same time each year

36
Q

10-20% of patients who have cluster headaches have chronic cluster headache.
What is this?

A

Bouts last >1 year without remission or…

Remission last

37
Q

Describe Paroxysmal hemicrania

A

Attack frequency: 1-40 per day
-(1-8 in Cluster)

Duration of attack: 2-30mins
(15-180mins in Cluster

Pain quality: Sharp throbbing
(Cluster = same)

Pain intensity: very severe
(Cluster = same)

Circadian periodicity = 45%
(70% in cluster)

38
Q

Describe SUNCT

A

Attack frequency:
-3-200
(1-8 in cluster)

Duration: 5-240 seconds
(15-180 mins in cluster)

Pain quality:
-stabbing, burning
(sharp, throbbing in cluster)

Pain intensity: very severe
(same as cluster)

No circadian periodicity

39
Q

What is paroxysmal hemicrania?

A

Pain = mainly orbital and temporal, UNILATERAL, rapid onset, 2-20 mins, rapid cessation of pain

Prominent ipsilateral autonomic symptoms

10% attacks can be preceiptated by BENDING OR ROTATING HEAD

40
Q

What is the treatment for Paroxysmal hemicrania?

A

Absolute response to indometacin as a prophylactic treatment

41
Q

Describe SUNCT

A

Unilateral orbital, supraorbital or temporal pain which is stabbing or pulsating

10-240 seconds duration

Attack frequency = 3-200 per day, no refractory period

Pain accompanied by conjunctival injection and lacrimation

42
Q

How does the pain differ in SUNCT?

A

Stabbing or pulsating pain may be single stabs, group of stabs or have a sawtooth pattern

43
Q

What are the cutaneous triggers for SUNCT?

A

Wind, cold
Touch
Chewing

44
Q

What is trigeminal neuralgia?

A

Unilateral maxillary or mandibular division pain > opthalmic division

Stabbing pain of a single or multiple stabs

5-10 sec duration

Attack frequency similar to SUNCT, has refractory period

Autonomic features uncommon

45
Q

What is the abortive treatment for a cluster headache?

A

SC Sumatriptan 6mg or nasal zolmatriptan 5mg

100% oxygen

46
Q

What is the abortive treatment for a bout of cluster headaches?

A

Occipital depomedrone injection (same side as the headache)

Or tapering course of oral prednisolone

47
Q

What is the preventative medication in cluster headache?

A
  • Verapamil (high doses possibly)
  • Lithium
  • Methysergide (risk of retroperitoneal fibrosis)
  • Topiramate
48
Q

What is the abortive treatment in paroxysmal hemicrania?

A

No abortive treatment only prophylactic

49
Q

What is the treatment for SUNCT/SUNA?

A

No abortive treatment

Prophylaxis

  • Lamotrigine
  • Topiramate
  • Gabapentin
  • Carbamazepine
50
Q

What is the treatment in Trigeminal Neuralgia?

A

No abortive

Prophylaxis:

  • Carbamazepine
  • Oxcarbazepine

Surgical Intervention:

  • Glycerol ganglion injection
  • Steriotactic radiosurgery
  • Decompressive surgery
51
Q

What presentations of headache are more likely to have a sinister cause?

A
  • Associated head trauma
  • First or worst headache
  • Sudden (thunderclap) onset
  • New daily persistent headache
  • Change in headache pattern or type
  • Returning patient (keeps getting worse)
52
Q

What are some of the red flags in headache?

A

New onset headache

New or change in headache:

  • aged over 50
  • Immunosupression or cancer

Change in headache frequency, characteristics or associated symptoms

  • Focal neurological symptoms
  • Non-focal neurological symptoms
  • Abnormal neurological examination

Neck stiffness/ fever

high pressure
Low pressure

Giant cell arthritis

53
Q

What are the signs of high intracranial pressure in headache?

A
  • Headache worse when lying down
  • Headache wakening patient up
  • Headache precipitated by physical exertion
  • Headache precipitated by valsalva manoeuvre
  • Risk factors for cerebral venous sinus thrombosis
54
Q

What are the signs of low intracranial pressure in headache?

A

Headache precipitated by sitting/standing up

55
Q

What are the signs of Giant Cell Artiritis

A

Jaw claudication or visual disturbance

Prominent or beaded temporal arteries

More common in 70’s/80’s

56
Q

What is a thunderclap headache?

A

A high intensity headache reaching maximum intensity in less than 1 minute

Majority are peak intensity

May be primary or secondary although no differentiating features

57
Q

What is the differential diagnosis of thunderclas headache?

A
  • Subarachnoid haemorrhage
  • Intracerebral haemorrhage
  • TIA/Stroke
  • Carotid/ vertebral dissection
  • Cerebral venous sinus thrombosis
  • Meningitis/ encephalitis
  • Pituitary apoplexy
  • Spontaneous intracranial hypotension
58
Q

How many patients with a thunderclap headache are having a subarachnoid haemorrhage?

A

1 in 10

59
Q

Who should you act on when especially suspect a SAH in?

A

All patients presenting with a sudden severe headache that peaks within a few minutes and lasts for at least 1 hour

Examination is often normal

Never consider a patient “too well” for SAH

60
Q

How do you treat someone with suspected SAH?

A

SAME DAY hospital assessment
CT brain
Lumbar Puncture (must be done >12 hours after headache onset)

CT +/- LP is unreliable beyond 2 weeks and angiography is required beyond this time

61
Q

When should CNS infection be considered?

A

Any patient presenting with headache and fever

62
Q

How to spot meningism?

A

Nausea +/- vomiting, photo/phono-phobia, stiff neck

look for a rash

63
Q

How to spot encephalitis?

A

Altered mental state/ consciousness
Focal symptoms/ signs
Seizures

Look for a rash

64
Q

How do you investigate Intracranial Hypotension?

A

MRI brain and spine

65
Q

WHat is the treatment for Intracranial hypotension?

A

Bed rest, fluids, analgesia, caffeine (red bull)

IV caffeine

EPIDURAL BLOOD PATCH

66
Q

What is giant cell arteritis?

A

Arteritis of large arteries (on spectrum with polymyalgia rheumatica)

Should be considered in any patient over the age of 50 presenting with new headache

67
Q

What are the symptoms and signs of giant cell arteritis?

A

Headache usually diffuse, persistant and may be severe.

Patient mey be systemically unwell.

Specific features include scalp tenderness, jaw claudication and visual disturbance.

Prominent, beaded or enlarged temporal arteries may be present

68
Q

What investigations can you perform to confirm Giant Cell Artiritis?

A

An elevated ESR supports diagnosis (usually >50, often much higher, rarely normal)

Raised CRP and platelet count are other useful markers

69
Q

What is the course of action if giant cell arteritis is the likely diagnosis?

A

High dose prednisolone should be started and a temporal artery biopsy arranged

N - C (35 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions