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syposium control and movement > headache > Flashcards

headache Flashcards

1
Q

what percentage of people have migraines?

A

1 in 10

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2
Q

what perecentage of people people seen in Neurology clinics have benign headaches?

A

1 in 10

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3
Q

if the onest of the headache is sudden, what does that indicate?

A

Vascular problem

SAH/Intra-cerebral haemorrhage/coital/thunderclap

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4
Q

if the onset of headache evolves over hours to days what does it indicate?

A

Infection/inflammatory/↑ICP ( intra cranial pressure)

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5
Q

if the onset of headache evolves over weeks to months(chronic) what does it indicate?

A

Chronic daily headache/ ↑ICP

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6
Q

if the headache is constant and does not stop what is that a indication of?

A

Medication overuse/chronic migraine/hemicrania continua

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7
Q

If the headache is episodic in periodicity what is that a indication of?

A

Migraine /Cluster headache

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8
Q

what is hemicrania continua? How do you treat it?

A

is a persistent unilateral headache responds to indomethacin

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9
Q

what are the assoicated symptoms of headaches?

A

Diurnal variation/postural element
Nausea and vomiting
Photophobia/ phonophobia
Autonomic features (lacrimation/Horners/red eye)  runny nose

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10
Q

what are the red flags for headaches?

A 
Cognitive effects  
Seizures  
Fever 
Visual disturbance 
Vomiting 
Weight loss
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11
Q

if a patient who has a headache lies down in a dark room to help relieve the pain what is that a indicate of?

A

migraine

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12
Q

if a patient who has a headache is agitated and paces to help relieve the pain what is that a indicate of?

A

cluster headache

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13
Q

is migraine familial?

A

yes

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14
Q

on examination of someone with a headache what are you looking for?

A

ever/rash/neck stiffness/↑BP/organomegaly
Fundal changes (papilloedema)
Cranial nerve signs/Horners Syndrome
Focal abnormalities
Long tract signs  intracerebral space occupying lesion

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15
Q

what are the primary headache syndromes?

A 
Migraine
Tension headache
Cluster headache
Paroxysmal hemicrania
Exertional headache
Ice-pick headache
Coital headache
Hypnic headache
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16
Q

what are the secondary headache syndromes?

A 
SAH
Intra-cerebral haemorrhage/Stroke
Meningoencephalitis
Intracranial venous thrombosis
Giant cell arteritis
Tumour with raised ICP
Benign intracranial hypertension
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17
Q

what is hypnic headache?

A

headache that wakes a person up at night

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18
Q

when does Coital headache occur?

A

during sexual activity

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19
Q

what is Cluster headache ?

A

a type of severe headache in which the pain is usually limited to one side of the head, tending to recur over a period of several weeks

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20
Q

what are symptoms of SAH?

A

Awoken with severe, sudden onset (seconds) head pains
Back of head

Vomitting and confused

Clinically apyrexial, refusing fundoscopy and globally hyper-reflexic

Ocular movements appear impaired –> SO and LR unnoposed –>right oculomotor nerve palsy

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21
Q

what is the most common cause of SAH?

A

Coiling/clipping berry aneurysm (85% of cases)

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22
Q

if the Ct scan of a person with suspected SAH what is the next step?

A

Lumbar puncture by experienced hand(>/= 12 hours)

Xanthochromia (bilirubin released from lysing red cells)

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23
Q

when should CT scan be done for a person with SAH??

A

95% sensitive if done within first 48 hours

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24
Q

why would you not give morphine for someone with SAH?

A

morphine increase ICP

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25
Q

if both the LP and CT are normal then should we still suspect SAH?

A

no we shouldn’t unless if the tests were done 48hrs after the person had a SAH. Then it is not sensitive enough and a angiograph should be done

26
Q

wht are diabetics at further risk of infection?

A

because they are immunocompromised

27
Q

what are the reasons for increase ICP?

A

Mass Effect (brain tumour, abscess)
Brain swelling (Hypertensive encephalopathy)
Increased venous pressure
CSF outflow obstruction (hydrocephalus)
Increased CSF production (meningitis/SAH)

28
Q

what are the symptoms of increase ICP?

A

Headache (worse on lying or awakening)
Vomiting
Seizures

29
Q

signs of increaes ICP?

A

Papilloedema

lateralising signs

30
Q

what is done to manage someone who has a headache due to infection? Acute settting

A

Resuscitation

Broad spectrum IV antibiotics (cefotaxime)
Think about other bugs in immunocompromised patient
d/w microbiology

Steroids (dexamethasone) in patients with streptococcus pneumoniae meningitis

Neurosurgical consultation (craniotomy and drainage)

31
Q

if someone had these symptoms:
General malaise and left temporal headache for 2 weeks
Radiates into jaw and worse when eating
Tender temporal area and scalp feels sensitive
Can’t sleep on left side
This morning visual disturbance
Top half of visual completely obscured for several minutes then seemed to resolve
Feels nauseated
what is the diagnosis?

A

Giant cell/ temporal arteritis

32
Q

what age group commonly get giant cell arteritis?

Also is it more common is males or females

A

over 60 and more common in female than male.

33
Q

what is giant cell arteritis assoicated with?

A

PMR (Polymyalgia rheumatic )

34
Q

What is PMR?

A

Polymyalgia rheumatica is a condition that causes pain, stiffness and inflammationin the muscles around the shoulders, neck and hips.

35
Q

what are the symptoms of temporal arteritis?

A 
Weight loss
Myalgia
Transient loss of vision
Jaw claudication 
Tender non-pulsatile temporal artery
36
Q

what is temporal arteritis?

A

it is inflammation of the large and medium arteries in the head especially ECA

37
Q

why do you get vision loss in termporal arteritis?

A

because the opthalmic artery become occluded and therefore blood is not going towards the eye

38
Q

what two test are done that shows elevation?

A

C reacting protein is elevated and ESR is elevated most of the time

39
Q

what is the management of temporal arteritis?

A

Commence immediate high dose steroids

Prednisolone 60mg od for 1st week
Slow taper over 6 weeks to 15-20mg od
Response is excellent within 48 hours

Arrange temporal artery biopsy
Can be negative even if ESR high

40
Q

what are symptoms of migraine?

A

long lasting episodes of headaches
Nausea and dizziness
Preceded by black dots moving across the visual field
Lasting up to 24 hours

41
Q

how do you diagnose a migraine?

A

Prodrome 10%(fatigue/ changes in mood)
Aura 30% (typically visual) lasting up to 60 minutes
UNILATERAL headache
Nausea/photophobia/dizziness

42
Q

what are the triggers of migraine?

A

sleep deprivation/hunger/stress/oestrogens

43
Q

what can occur in focal migraine?

A

Basilar: Cranial neuropathies

Hemiplegic

44
Q

what are the conservative measures to managing migraine?

A

Avoid caffeine/ increase water intake
Avoid tyramine foods (cheese/chocolate/red wine)
Sleep hygiene and regular meals

45
Q

what analgesia can be used to stop migraine pain?

A

Triptans/naproxen/paracetomol

46
Q

what is the preventive treatment of migraine?

A

Propranolol/pizotifen/topiramate/valproate/amitriptiline/botox

47
Q

what are the side effects of the preventive treatments of migraine?

A

Propranolol–> cause increae in BP –> so have to monitor it
Pizotifen used at night but cause weight gain
topiramate/valproate –> anti epileptic drugs
Valproate –> cause weight gain and can cause damage to patients that are pregnant
Topiramate –> cause weight loss
Botox –> some response very well to this

48
Q

what is the diagnosis of these symtpoms?

Presents to A&E with severe gradual onset unilateral right orbital pain
Describes someone sticking a knife in eye
On admission; agitated and tachycardic
Clinically streaming red eye with eyelid droop

Smoker and consume 28 units alcohol/week

A

cluster headache

49
Q

what occurs in Trigeminal autonomic cephalgias?

A

Activation of trigeminal/parasympathetic systems

50
Q

what are the characterstics of Trigeminal autonomic cephalgias?

A

short-lasting headaches in trigeminal region

variable autonomic features

51
Q

what are the types of Trigeminal autonomic cephalgias??

A 
Cluster headache (attacks last 30-180 minutes; 1 per 24hrs)
Paroxysmal hemicrania (2-30 minutes; >5 per 24hrs)
SUNCT (v. rare; seconds; up to 200 attacks per 24hrs)
52
Q

what is the management of cluster headache?

A

Sumatriptan (Class A)

High flow 100% oxygen

53
Q

how can cluster headache be prevented?

A

Prednisolone (60mg/day) taper after 2-3 weeks
Verapamil (up to 240mg/day)
Indomethacin (25-75mg TDS)

54
Q

what is the diagnosis of these symtpoms?

Intermittent BILATERAL headache for last few months
Described as tight band around head lasting several hours
Unrelieved by paracetomol
History of hypertension/IBS
Clinically no focal neurology

A

tension headache

55
Q

what is the management of tension headache?

A

Relaxation and massage

If headache frequent consider small dose of amitriptyline

Acupuncture

Ensure patient has recently had optician check  vision straight can be a cause

56
Q

what are the causes of New daily persistent headache?

A

Raised ICP

Unlikely to be tumour if ONLY headache
Idiopathic Intracranial hypertension (IIH)

Low ICP :

Spontaneous intracranial hypotension
Post Lumbar Puncture headache –> as some fluid could have been seeped out
Chronic meningitis (infective and non-infective)
Post head injury

57
Q

how does Idiopathic Intracranial Hypertension occur?

A

Often women of child baring age –> too much CSF floating around –> cause headache and affect vision –> cause papilloedema

increase of ICP with absence of tumor or other diseases

58
Q

what is the treatment and mangement of Idiopathic Intracranial Hypertension?

A

Acetazolamide

Check their venous system –> brain imaging and venougram –> make sure no clot that prevents CSF being recycled

59
Q

what is the definition of Chronic daily headache?

A

Defined as headache lasting >4 hours on >15 days per month, for >3 months

60
Q

Causes of chronic daily headache?

A

De novo
New daily persistent headache

Previous episodic headache
Transformed migraine
Chronic tension type headache
Hemi-crania continua

61
Q

what is the treatment of chronic daily headache?

A

Treatment options limited
Withdraw analgesia if history of overuse
Consider amitriptyline/topiramate for transformed migraine

syposium control and movement (11 decks)

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