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Neurology > Headache > Flashcards

Headache Flashcards

1
Q

What are the three categories of headaches?

A

Primary
Secondary

Other: cranial neuropathies, face pains

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2
Q

Give some examples of primary headaches?

A

Migraine
Cluster headache
Tension type headache

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3
Q

Give some examples of secondary headaches?

A

Menigitis

Subarachnoid haemorrhage

Giant cell arteritis

Idiopathic intracranial
hypertension

Medication overuse headache

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4
Q

What are some systemic signs that point to a secondary headache?

A

Fever, neck stiffness, altered consciousness

History of cancer, trauma, HIV

Vomiting

Cognitive dysfunction, abnormal neurological exam

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5
Q

What features of a headache make it likely to be secondary?

A

Jaw claudication

Visual disturbance

Changing in frequency or character

Sudden onset/thunderclap headache

Increased pain on exercise, laughing, sneezing

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6
Q

A patient presents with a history of a 1 week headache, with a temperature and vomiting.

Primary or secondary?

A

Secondary

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7
Q

A patient presents with a headache and on examination you notice sensory dysfunction in his lower limbs.

Primary or secondary?

A

Secondary

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8
Q

A patient presents with frequent, severe headaches over the past 6 months. When she gets them she cannot stand up or look at light.
No systemic or neurological signs.

Primary or secondary?

A

Primary

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9
Q

In what situations would you refer a patient immediately?

A

Thunderclap headache

Seizure and a new headache

Suspected meningitis or encephalitis

Red eye: glaucoma

Headache + focal neurological sign

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10
Q

Name the red flag symptoms associated with headache?

A

New headache with a history of cancer

Cluster headache

Seizure

Altered consciousness

Papilloedema

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11
Q

What should you ask about a headache when taking a history?

A

Type + frequency

Time: onset, duration, how long

Pain: severity, type, spread

Associated: aura, systemic features

Triggers: aggravating + relieving factors

During attack: medication, can you function normally

Between attacks: normal or persistent headache

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12
Q

Examination of a patient with headache?

A

Blood pressure

Altered consciousness

Neck stiffness and fever

Focal neurological signs

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13
Q

What types of migraine are there?

A

With aura
Without aura
Chronic

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14
Q

What does ‘aura’ mean?

A

A sensation perceived just before a migraine or seizure

Could be anything: visual disturbance, olfactory, sensory

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15
Q

Describe what a visual aura could look like?

A

Flashing lights
Zigzag patterns
Bits of visual field missing or blurred

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16
Q

What other symptoms do people get with a migraine, besides headache?

A

Visual, sensory, language, motor aura
Nausea
Vomiting
Photophobia and phonophobia

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17
Q

How long do migraines usually last?

A

4-72 hours

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18
Q

Give an example of sensory aura?

A

Tingling in hand that spreads up the arm

19
Q

What would language aura present like?

A

Dysphasia

20
Q

What is the name of the headache that we consider a normal headache, that everyone gets from time to time?

A

Tension headache

21
Q

What does a tension headache feel like?

A

Dull ache on both sides of head

Pressure behind the eyes

22
Q

How long do tension headaches last?

A

30 minutes to several hours

23
Q

What causes tension headaches?

A 
stress and anxiety 
squinting 
poor posture 
tiredness 
dehydration 
missing meals 
lack of physical activity 
bright sunlight 
noise 
certain smells
24
Q

How would you usually treat a tension headache?

A

NSAIDs

Prevention: hydration, getting enough sleep etc.

25
Q

What does a cluster headache feel like?

A

Pain on unilateral orbital
Or temporal pain

Usually quite severe

26
Q

How long do cluster headaches last?

A

15-180 mins

27
Q

Are there any other features of a cluster headache besides pain?

A

Sometimes people get ipsilateral cranial autonomic features

And a sense of restlessness / agitation

28
Q

What are cranial autonomic features?

A

Lacrimation
Eyelid oedema
Nasal stuffiness
Rhinorrhoea

29
Q

What is classical trigeminal neuralgia?

A

Irritation of the trigeminal nerve resulting in loss of myelin from the sensory fibres within the nerve

This results in severe pain

30
Q

Clinical presentation of trigeminal neuralgia?

A

Sudden, explosive, severe pain that radiates along the trigeminal nerve

Periods of pain-free remission between attacks

One of the most painful conditions known to man

31
Q

What are the branches of the trigeminal nerve?

A

Ophthalmic
Maxillary
Mandibular

32
Q

How long does an attack of trigeminal neuralgia last?

A

From seconds to hours

33
Q

Is an attack of trigeminal neuralgia triggered by anything or is spontaneous?

A

It varies between patients

Often triggered by talking, chewing, brushing teeth

Sometimes the slightest pressure on the area or even air blowing can trigger an attack

In others it is spontaneous

34
Q

Why is trigeminal neuralgia so debilitating?

A

An attack is triggered by activities of daily living

People often become anorexic, and socially withdrawn in the fear that eating or talking might bring on an attack

35
Q

Management of trigeminal neuralgia?

A

Anti-convulsants: carbamazepine

Anti-depressants: amitriptyline

Surgery: if drug treatment is ineffective
Microvascular decompression

36
Q

What two methods of attack should you take when treating migraine?

A

Abortive: stop the migraine once it’s started

Preventative: prevent a migraine happening

37
Q

Abortive treatment of migraine?

A

Combination therapy:

  • oral triptan and NSAID or
  • oral triptan and Paracetamol

Anti-emetic

Don’t use opioids

38
Q

What is triptan?

A

A class of drugs used to treat symptoms of a migraine attack

39
Q

Preventative treatment of migraine?

A

Topiramate or Propanolol

Riboflavin

Botulinum toxin

40
Q

What is idiopathic intracranial hypertension?

A

Raised ICP of unknown cause

It commonly affects overweight young women

Can be very serious

41
Q

What is a medication overuse headache?

A

Headache caused by regular use for over 3 months of a drug that is known to have headache as a side effect

42
Q

To manage headache pain in patients, the WHO analgesic ladder should be used.

True or false?

A

False

43
Q

Management of cluster headache?

A

High flow oxygen via NRB mask for 15 mins
Sumatriptan

Prevention:
Verapamil
Lithium
Steroid injection sub-occipital

Neurology (23 decks)

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