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Neurology (Calum) > Headache > Flashcards

Headache Flashcards

1
Q

What are the red flags in headache?

A 
new onset in over 55 
known/previous malignancy 
immune-supressed 
early morning headache 
exacerbation by valsalva
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2
Q

Are headaches more common in men or women?

A

women 2.5:1

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3
Q

What is the criteria for migraine without aura?

A

at least 5 attacks of 4-72 hour duration

2 0f : moderate/severe, unilateral, throbbing pain, worse on movement

1 Of: autonomic features, photophobia, photophobia

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4
Q

What is the pathophysiology behind migraines?

A 
Susceptible individual 
stress causes changes in the brain 
serotonin released 
blood vessels constrict and dilate 
chemicals (substance P) irritate nerves and blood vessels 
pain
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5
Q

Where is the migraine centre?

A

dorsal ralphe nucleus

lock coeruleus

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6
Q

What is aura?

A

reversible visual, sensory, motor or language symptom

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7
Q

How long do aura last?

A

20-60 minutes

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8
Q

What is the most common kind of aura?

A

visual

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9
Q

Name some migraine triggers

A 
sleep 
dietary 
stress 
hormonal 
physical exertion
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10
Q

What tool can be used to help identify triggers?

A

headache diary

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11
Q

What non-pharmacological treatment of headaches is there?

A

education - avoid triggers
headache diary
relaxation

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12
Q

What is the first line abortive treatment for migraine?

A

NSAID
aspiring 900mg
naproxen 250mg
ibuprofen 400mg

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13
Q

What are triptans?

A

serotonin agonists

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14
Q

When should triptans be given?

A

at the start of a headache

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15
Q

Name some commonly used triptans

A

rizatriptan
eletriptan
sumatriptan (less effective)

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16
Q

When should prophylaxis be considered?

A

More than 3 attacks per month

very severe

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17
Q

What is the aim with drug dosage?

A

achieve effect at the lowest dose possible

18
Q

How long should each drug be trialled for?

A

4 months

19
Q

Propranolol can be used in migraine prophylaxis, which conditions should contraindicate it?

A

asthma
PVD
CCF

20
Q

What is topiramate?

A

carbonic anhydrase inhibitor

21
Q

What is the problem with topiramate?

A

poor side effect profile - start slowly!

22
Q

what are some possible side-effects of topiramate?

A

weight loss
paraesthesia
impaired concentration
enemy inducer

23
Q

What are some side-effects of amitriptyline?

A

dry mouth
postural hypotension
sedation

24
Q

What dietary triggers are there for migraines?

A

caffeine
chocolate
dehydration

25
Q

What is acephalgic migraine?

A

migraine with no headache

26
Q

What are trigeminal autonomic cephalgias?

A

group of primary headaches characterised by unilateral trigeminal distribution of pain that occurs in association with cranial autonomic features

27
Q

What are cranial autonomic features?

A 
ptosis 
miosis 
nasal stuffiness 
nausea + vomiting 
tearing 
eye lid oedema
28
Q

What are the 4 main TCA’s?

A

cluster headache
paroxysmal hemicrania
hemicrania continua
SUNCT

29
Q

What are the common features of cluster headache?

A

30s-40s
circadian and seasonal variation

severe unilateral headache
45-90mins
1-8/day
cluster may last from weeks to months

30
Q

How do you treat cluster headaches?

A

high flow oxygen 20 mins
subcut sumatriptan
steroids for 2 weeks
verapamil prophylaxis

31
Q

What drug is used in cluster headache prophylaxis?

A

verapamil

32
Q

Describe paroxysmal hemicrania?

A

50s-60s
unilateral headache and autonomic features

10-30mins
1-40/day

33
Q

What drugs are used to treat paroxysmal hemicranial?

A

INDOMETHICIN

34
Q

What is SUNCT?

A 
short lived
unilateral 
neuralgiform headache 
conjunctival injections 
tearing
35
Q

What drugs are used to treat SUNCT?

A

lamotrigine

gabapentin

36
Q

What investigation must be done in a new onset unilateral cranial autonomic features?

A

MRI brain and MR angiogram

37
Q

Describe trigeminal neuralgia?

A

elderly women>men
triggered by touch - V2/3

severe stabbing unilateral pain
1-90seconds
10-100/day
bouts may last weeks to months before remission

38
Q

What is the medical treatment for TN?

A

carbamazepine
gabapentin
phenytoin
baclofen

39
Q

What can be injected in TN?

A

glycerol

40
Q

What surgical options are there for treatment in TN?

A

ablation

decompression

41
Q

What is 1st line in treatment for uncomplicated migraine?

A

OTC medication

Neurology (Calum) (21 decks)

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