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Nervous System > Headache > Flashcards

Headache Flashcards

1
Q

define and give an example of a primary headache

A

there is no underlying medical cause:
> tension
> migraine
> cluster

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2
Q

define of a secondary headache

A

there is an identifiable/biochemical cause

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3
Q

give some examples of causes of secondary headaches

A 
> tumour
> meningitis
> vascular disorders
> systemic infection
> head injury
> drug induced
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4
Q

describe a tension headache

A 
> primary
> most frequent
> not disabling
> mild
> bilateral
> pressure/tightening
> no significant associated features
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5
Q

what abortive treatment can be given for tension headaches?

A

> aspirin/paracetamol
NSAIDs
limit to 10 days per month

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6
Q

why must abortive treatment for tension headaches be limited to 10 days per month?

A

to avoid the development of medication overuse headache

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7
Q

what preventative treatment could you offer for tension headaches?

A

tricyclic antidepressants (amitriptyline, dothiepin, notriptyline)

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8
Q

what is migraine?

A

a chronic disorder with recurrent, reversible episodic attacks due to complex changes in the brain.

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9
Q

describe a migraine attack

A 
> headache
> nausea
> photophobia
> phonophobia
> functional disability
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10
Q

name some triggers for migraine

A 
> dehydration
> sleep disturbance
> diet
> environmental stimuli
> hunger
> stress
> changes in oestrogen levels in women
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11
Q

describe the pre-headache in migraine

A 
premonitory:
> mood change
> fatigue
> congnitive changes
> muscle pain
> food craving

aura
> somatosensory

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12
Q

describe the early headache in migraine

A

> dull headache
nasal congestion
muscle pain

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13
Q

describe the advanced headache in migraine

A 
> unilateral
> throbbing
> nausea
> photophobia
> phonophobia
> osmophobia
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14
Q

describe post headache symptoms in migraine

A

> fatigue
cognitive changes
muscle pain

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15
Q

what is aura?

A

transient neurological symptoms from cortical or brainstem dysfunction that may involve visual, sensory, motor or speech symptoms.

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16
Q

what can aura in migraine be confused with?

A

transient ischaemic attack

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17
Q

how do you differentiate between aura and a transient ischaemic attack?

A

in a TIA the symptoms all start at the same time and can be localised to a specific vascular area. in aura there is a slow evolution of symptoms

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18
Q

define chronic migraines

A

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

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19
Q

what is a transformed migraine?

A

> history or episodic migraine with increasing frequency of headaches
migrainous symptoms becomes less frequent and severe
there are often episodes of migraine on a background of a severe and featureless frequent headache

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20
Q

when patients with chronic migraine with medication overuse what affect can discontinuing the medication have?

A

can dramatically improve the headache frequency

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21
Q

what is a medication overuse headache?

A

a headache that is present on more than or equal to 15 days a months which has developed or worsened whilst taking regular symptomatic medication

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22
Q

what abortive treatment is available for migraine?

A

> aspirin/NSAIDs
triptans
limited to 10 days per month

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23
Q

what prophylactic treatment is available for migraines?

A

> propranolol, candesartan
anti-epileptics
tricyclic antidepressants
venlafaxine

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24
Q

what sort of migraine gets better in pregnancy?

A

migraine without aura

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25
Q

in what migraine in the combined pill contraindicated in?

A

active migraine with aura but it is okay if there is no attacks for 5 years but stop if aura recurrs

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26
Q

in what patients should you avoid anti-epileptic drugs for migraine?

A

in women of child bearing age

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27
Q

what is the treatment for migraine in pregnancy?

A

> paracetamol for an acute attack

> propranolol or amitriptyline for preventative

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28
Q

name some trigeminal autonomic cephalalgias

A

> cluster headache
paroxysmal hemicranias
SUNCT
SUNA

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29
Q

describe the attack in a cluster headache

A 
> pain is mainly orbital and temporal
> very severe
> unilateral
> rapid onset (9mins max)
> lasts 15mins to 3 hours
> pains ceases rapidly
> prominent ipsilateral autonomic symptoms
> patients are restless and agitated in the attacks
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30
Q

what migrainous symptoms may be present in a cluster headache attack?

A

> premonitory symptoms (tiredness and yawning)
associated symptoms (vomiting, photophobia and phonophobia)
typical aura

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31
Q

describe the bouts in cluster headaches

A

> attacks cluster in bouts lasting 1-3months with periods of remission of about a month in between

32
Q

in a bout of a cluster headache how frequently do attacks occur?

A

1 every other day to 8 per day

33
Q

what may be present between cluster headache attacks?

A

background pain

34
Q

what can trigger a cluster headache attack in a bout but not in remission?

A

alcohol

35
Q

is there a rhythm in the time of the attacks and bouts?

A

yes as attacks occur at the same time each day and bouts at the same time each year

36
Q

what is chronic cluster headache?

A

when bouts last more than a year without remission or remission lasts less than a month

37
Q

in what trigeminal autonomic cephalalgia is carcidian periodicity absent?

A

SUNCT, paroxysmal hemicrania

38
Q

what features of pain are different in paroxysmal hemicranias compared to cluster headache?

A

the features of pain are the same but the attacks last 2-30 minutes and only 50% are restless.

39
Q

how frequent can paroxysmal hemicrania attacks be?

A

2-40 times a day

40
Q

to what do paroxysmal hemicranias have an absolute response to?

A

indometacin

41
Q

describe the pain in SUNCT

A

> unilateral orbital, supraorbital or temporal
stabbing or pulsating
10-240 second duration

42
Q

what are cutaneous triggers of SUNCT?

A

> wind, cold
touch
chewing

43
Q

what is the attacks frequency of SUNCT?

A

3-200 per day with no refractory period

44
Q

what Is pain in SUNCT accompanied by?

A

conjunctival injection and lacrimation

45
Q

describe the pain in trigeminal neuralgia

A

> unilateral maxillary/mandibular division pain
stabbing
5-10 second duration

46
Q

what are the triggers for trigeminal neuralgia?

A

> wind/cold
touch
chewing

47
Q

what is the difference between trigeminal neuralgia and SUNCT?

A

trigeminal neuralgia had a refractory period

48
Q

what abortive treatment is there for an cluster headache attack?

A

> subcutaneous sumatriptan
nasal zolmatriptan
100% oxygen 7-12 minutes via tight fitting mask

49
Q

what is the abortive treatment for cluster headache bouts?

A

> occipital depomedrone injection (same side as the headache)
tapering course of oral prednisone

50
Q

what is the preventative treatment for cluster headaches?

A

> verapamil
lithium
methysergide
topiramate

51
Q

what is the abortive treatment for paroxysmal hemicrania?

A

there is no abortive treatment for this

52
Q

what is the prophylactic treatment for paroxysmal hemicrania?

A

indometacin

53
Q

what is the preventative treatment for SUNCT/SUNA?

A

> lamotrigine
topiramate
gabapentin
carbamazepine

54
Q

what prophylactic treatment is available for trigeminal neuralgia?

A

> carbamazepine

> oxcarbazepine

55
Q

what surgical intervention in available for trigeminal neuralgia?

A

> glycerol ganglion injection
stereotactic radiosurgery
decompressive surgery

56
Q

what presentation of secondary headache more likely has a sinister cause?

A 
> associated head trauma
> first/worst
> thunderclap
> new daily persistent headache
> change in pattern or type
> returning patient
57
Q

what are some red flags in secondary headache?

A 
> new onset
> change in headache: aged over 50, immunosuppressed or cancer
> change in frequency, characteristic, associated symptoms
> focal neurological symptoms
> non-focal neurological symptoms
> abnormal neurological examination
> neck stiffness
> high pressure
> low pressure
> Giant cell arteritis
58
Q

what would suggest the headache is high pressured?

A 
> worse lying down
> on awakening
> physical exertion
> Valsalva manoeuvre
> cerebral venous sinus thrombosis
59
Q

what would suggest a low pressure headache?

A

> precipitated by standing up

60
Q

what features would point to giant cell arteritis?

A

> jaw claudication
visual disturbances
beaded temporal arteries

61
Q

define a thunderclap headache

A

high intensity headache reaching maximum intensity in less than one minute

62
Q

what is the differential diagnosis for a thunderclap headache?

A 
> primary
> subarachnoid haemorrhage
> intracerebral haemorrhage
> TIA/stroke
> carotid dissection
> cerebral venous sinus thrombosis
> meningitis/encephalitis
> pituitary apoplexy
> spontaneous intracranial hypotension
63
Q

describe the presentation of a subarachnoid haemorrhage?

A

presenting with a sudden severe headache that peaks within a few minutes and last for a at least an hour

64
Q

what investigations are carried out in a suspected sub arachnoid haemorrhage?

A

> CT brain
lumbar puncture after 12hours of headache onset
after 2 weeks an angiography is the only reliable investigation

65
Q

what is the treatment for subarachnoid haemorrhages?

A

surgical clipping or coiling

66
Q

describe meningitis

A

> nausea
photo/phonophobia
stiff neck
rash

67
Q

describe encephalitis

A

> altered metal state
focal symptoms
seizures
rash

68
Q

what should be considered for any patient presenting with headache and fever?

A

CNS infection

69
Q

what features of a headache would suggest that there is an occupying lesion or raised intracranial pressure?

A 
> worse on awakening
> worse lying flat
> focal signs/symptoms
> non-focal symptoms (cognitive)
> seizures
> visual obscurations and pulsatile tinnitus
70
Q

what can cause intracranial hypotension?

A

> dural CSF leak
spontaneous
iatrogenic

71
Q

describe the postural component to the headache in intracranial hypotension

A

> worse upright
better lying down
can lose this postural component when it becomes chronic

72
Q

what investigations are carried out in intracranial hypotension?

A

MRI or spine and the brain

73
Q

what is the treatment for intracranial hypotension?

A 
> bed rest
> fluid
> analgesia
> caffeine (IV)
> epidural blood patch
74
Q

describe the headache in giant cell arteritis

A

> diffuse
persistant
severe

75
Q

what features may accompany the headache in giant cell arteritis?

A 
> systemic upset
> scalp tenderness
> jaw claudication
> visual disturbance
> enlarged temporal arteries
76
Q

what is used to diagnose giant cell arteritis?

A

> elevated ESR
raised CRP
raised platelet count

77
Q

what is the management for giant cell arteritis after a diagnosis is made?

A

> high dose prednisolone

> temporal artery biopsy

Nervous System (45 decks)

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