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Neurology > Headache > Flashcards

Headache Flashcards

1
Q

What are some red flags in a headache presentation?

A 
New onset >55yo
Known/previous malignancy
Immuno-suppressed
Early morning headache
Exacerbation by Valsalva (coughing, sneezing-raised ICP)
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2
Q

What is the migraine M:F ratio?

A

1:2.5

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3
Q

How many migraines present with aura?

A

20%

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4
Q

What is the IHS criteria for migraine without aura?

A

At least 5 attacks
Duration 4-72hrs
2 of: moderate/severe, unilateral, throbbing pain, worst movement
1 of: autonomic features, photophobia/phonophobia

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5
Q

What is the pathophysiology of migraine?

A

Both vascular and neural influences cause migraines in susceptible individuals
Stress triggers changes in brain, these cause serotonin to be released
Blood vessels constrict and dilate
Chemicals including substance P irritate nerves and blood vessels causing pain

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6
Q

What is the neurophysiology behind migraine with aura?

A

Cortical spreading depolarisation
Activation trigeminal vascular system-dilatation cranial blood vessels
Release of substance P, neurokinin A, CGRP

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7
Q

Describe migraine with aura

A

Aura fully reversible-visual, sensory, motor or language symptom
Duration 20-60mins
Headache follows

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8
Q

What are some migraine triggers?

A 
Sleep
Dietary
Stress
Hormonal
Physical exertion
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9
Q

What is the non-pharmacological treatment of migraine?

A

Realistic goals
Education
Headache diary
Relaxation/stress management

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10
Q

What is the pharmacological treatment of migraine?

A 
Abortive-NSAID (aspirin, naproxen, ibuprofen) (if gastroparesis consider anti-emetic)
Triptans-5HT agonist 
Treat at start of headache 
Rizatriptain=eletriptain > sumatriptan
Frovatriptan for sustained relief
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11
Q

When should headache prophylaxis be considered?

A

More than 3 attacks/month or very severe

Must trial for 4 month minimum

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12
Q

What pharmacological options are there in migraine prophylaxis?

A 
Propranolol-reduction in freq of around 60-80% (avoid asthma, PVD, HF)
Topiramate (CAI)- poor S/E profile
Amitriptyline
Gabapentin
Pizotifen
Sodium valproate
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13
Q

What are some adverse effects of topiramate?

A

Wt loss
Paraesthesia
Impaired concentration
Enzyme inducer

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14
Q

What Ix should be considered in migraine?

A

Typically none required

Consider imaging if >55yo, known malignancy or acephalgic migraine

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15
Q

What are the different types of migraines?

A 
Acephalgic
Basilar
Retinal
Ophthalmic
Hemiplegic (familial/sporadic)
Abdominal
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16
Q

What are the trigeminal autonomic cephalgias (TAC)?

A

A group of primary headache disorders characterised by unilateral trigeminal distribution pain that occurs in association with prominent ipsilateral cranial autonomic features

17
Q

What are ipsilateral cranial autonomic features?

A 
Ptosis
Miosis
Nasal stuffiness
Nausea/vomiting
Tearing
Eye lid oedema
18
Q

What are the 4 main types of TAC?

A

Cluster
Paroxysmal hemicranias
Hemicrania continua
SUNCT

19
Q

Describe a cluster headache

A

30-40s
M>F
Striking circadian (around sleep) and seasonal variation
Severe unilateral, duration 45-90mins
Freq 1-8/day
Cluster bout may last from a few weeks to months

20
Q

What is the treatment for a cluster headache?

A

High flow O2 100% for 20 mins
SC sumatriptan 6mg
Steroids-reducing course over 2 weeks
Verapamil for prophylaxis

21
Q

Describe a paroxysmal hemicrania headache

A 
50-60s
F>M
Unilateral headache/autonomic features
Duration 10-30mins
Freq 1-40/day
22
Q

What is the treatment for a paroxysmal hemicrania headache

A

Indomethicin

23
Q

What is a SUNCT headache

A 
Short lived (15-120s)
Unilateral
Neuralgiaform headache
Conjunctival injections
Tearing
24
Q

What is the treatment for a SUNCT headache

A

Lamotrigine

Gabapentin

25
Q

What do patients with new onset unilateral cranial autonomic features require?

A

Imaging-MRI brain and MR angiogram

26
Q

Describe trigeminal neuralgia

A 
>60yo
F>M
Triggered by touch, usually V2/3
Severe stabbing unilateral pain
Duration: 1s-90s
Freq: 10-100/day
Bouts of pain may last from a few weeks to months before remission
27
Q

What is the treatment of trigeminal neuralgia?

A

Medical- carbamazepine, gabapentin, phenytoin, baclofen

Surgical- ablation vs decompression

28
Q

When should trigeminal neuralgia patients get a brain MRI?

A

If any signs on examination, atypical features, a poor response to medical treatment or if surgical treatment is being considered

Neurology (27 decks)

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