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neurology > headache > Flashcards

headache Flashcards

1
Q

what is a primary headache?

A

headache with no underlying medical cause

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2
Q

what is a secondary headache?

A

headache with an identifiable structural or biochemical cause

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3
Q

what are some types of primary headaches?

A

tension type headache
migraine
cluster headache

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4
Q

what are some characteristics of tension type headaches?

A

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

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5
Q

what is the treatment for a tension headache?

A

aspirin or paracetamol

NSAIDS

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6
Q

what are some features of a migraine attack?

A 
headache
nausea
photophobia
phonophobia
functional disabilty
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7
Q

what are some triggers for a migraine?

A 
dehydration
sleep disturbance
diet
hunger
environmental stimuli
stress
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8
Q

what are some premonitory features of a migraine?

A

mood changes
fatigue
muscle pain
food craving

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9
Q

what are some post-attack features of a migraine?

A

fatigue
cognitive changes
muscle pain

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10
Q

what is “aura” with regard to migraines?

A

transient neurological symptoms resulting from cortical or brainstem dysfunction

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11
Q

what are some features of “aura”

A

loss of function
sudden onset
symptoms all start at the same time and can be localised to a specific vascular area

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12
Q

what is the criteria for a chronic migraine?

A

headache on more than 15 days of the month of which 8 days have to be a migraine for more than 3 months

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13
Q

what is a medication overuse headache?

A

headache present on more than 15 days of the month which has developed or worsened whilst taking regular symptomatic medication

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14
Q

what types of medication may predispose someone to developing a MOH?

A

use of opioids for more than 10 days of the month
caffeine overuse
use of simple analgesics for more than 15 days of the month

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15
Q

how is a migraine treated?

A

aspirin or NSAIDS
triptans
limit to 10 days per month to avoid development of MOH

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16
Q

what are some prophylactic treatments for migraine?

A

propranolol
anti epileptics
tricyclic antidepressants

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17
Q

how is the OCP affected with regards to migraine with aura?

A

contraindicated

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18
Q

how are migraines treated in pregnant women?

A

paracetamol for attacks

propranolol or amitriptyline for prevention

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19
Q

what does SUNCT stand for?

A

short lasting unilateral neuralgiform headache with conjunctival injection and tearing

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20
Q

what does SUNA stand for?

A

short lasting unilateral neuralgiform headache with autonomic symptoms

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21
Q

are cluster headaches unilateral or bilateral?

A

strictly unilateral

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22
Q

where is the pain located in cluster headaches?

A

mainly orbital temporal

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23
Q

what is the typical duration for a cluster headache?

A

45-90 mins

24
Q

what is the frequency of cluster headache attacks?

A

1 every other day to 8 per day

attacks occur at the same time each day

25
Q

what are 3 trigeminal autonomic cephalagias?

A

cluster headache
paroxysmal hemicrania
SUNCT

26
Q

where is the pain typically located in paroxysmal hemicrania?

A

mainly orbital and temporal

27
Q

how long do paroxysmal hemicrania attacks typically last?

A

2-30 mins

28
Q

what drug does paroxysmal hemicrania absolutely respond to?

A

indometacin

29
Q

what are some cutaneous triggers of SUNCT?

A

wind
cold
touch
chewing

30
Q

what kind of pain is associated with SUNCT?

A

stabbing/pulsating

31
Q

what kind of pain is associated with cluster headaches/paroxysmal hemcrania?

A

sharp/throbbing

32
Q

what branches of the trigeminal nerve are more commonly affected in trigeminal neuralgia?

A

maxillary or mandibular division pain is more common than opthalmic

33
Q

what is abortive treatment for cluster headaches?

A

subcutaneous sumatripan

occipital depomedrone

34
Q

what is preventative treatment for cluster headaches?

A

verapamil
lithium
methysergide
topiramate

35
Q

what is the preventative treatment for SUNCT/SUNA

A

lamotrigine
topiramate
gabapentin
carbamAzepine

36
Q

what is the prophylactic treatment for trigeminal neuralgia?

A

carbamazepine

oxcarbamezipine

37
Q

what are some presentations of headache that are more likely to have a sinister cause?

A 
associated head trauma
first or worst
sudden onset
change in headache pattern or type
returning patient
38
Q

what are red flags with regards to headaches?

A 
new onset or change in headache
focal or non focal  neurological symptoms
abnormal neurological exam
neck stiffness/fever
jaw claudication
visual disturbance
headache precipitated by sitting/standing up 
headache worse lying down
39
Q

what is a thunderclap headache?

A

high intensity headache that reaches maximum intensity in less than 1 minute

40
Q

what is the differential diagnosis for a thunderclap headache?

A 
subarachnoid haemorrhage
TIA/stroke
carotid dissection
meningitis
intracerebral haemorrhage
41
Q

what are most subarachnoid haemorrhages caused by?

A

aneurysm rupture

42
Q

when should you suspect a SAH?

A

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

43
Q

what investigations are appropriate in a suspected SAH?

A

CT brain

LP

44
Q

when should you suspect a CNS infection?

A

any patient presenting with headache and fever

45
Q

what are some symptoms of meningism?

A 
nausea with or without vomiting
photophobia
phonophobia
stiff neck
rash
46
Q

what are some symptoms of encephalitis?

A

altered mental state
seizures
focal symptoms/signs

47
Q

what are features suggestive of raised ICP?

A 
progressive headache that is worse in the morning or wakes patient up
seizures
visual obscuration
focal neuro symptoms
non focal symptoms such as drowsiness
48
Q

what can cause intracranial hypotension?

A

dural CSF leak

49
Q

what are some symptoms of intracranial hypotension?

A

clear postural component to the headache

headache develops or worsens soon after assuming an upright posture and lessens or resolves shortly after lying down

50
Q

what investigations would be performed of intracranial hypotension was suspected?

A

MRI brain and spine

51
Q

what is the treatment for intracranial hypotension?

A

bed rest
fluid
analgesia
caffeine

52
Q

what is giant cell arteritis?

A

arteritis of large arteries

53
Q

when should giant cell arteritis be considered?

A

any patient over 50 who presents with a new headache?

54
Q

what are the characteristics of giant cell arteritis?

A 
usually diffuse, persistent and may be severe
patient may be systemically unwell
scalp tenderness
jaw claudication
visual disturbance
prominent temporal arteries
55
Q

what investigations are useful in giant cell arteritis?

A

ESR
CRP
both of them being raised supports diagnosis

56
Q

how is giant cell arteritis treated?

A

high dose prednisolone

temporal artery biopsy should be arranged

neurology (29 decks)

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