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Year 2 Neuro (JK) > Headache > Flashcards

Headache Flashcards

1
Q

Is most headache primary or secondary?

A

primary

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2
Q

What does primary headache mean and give 3 examples

A

no underlying cause

migraine, cluster headaches and tension type headaches

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3
Q

What does secondary headache mean?

A

identifiable structure or biochemical cause

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4
Q

Give some causes of secondary headache

A

tumour, meningitis, raised IC, head injury, vascular disease, drugs, medication, systemic infection

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5
Q

Which is the most frequent primary headache?

A

tension type

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6
Q

Describe a tension type headache

A

Mild, bilateral headache which is pressing/tightening with no significant features and not precipitated by activity

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7
Q

How many days a month does tension type headache occur to be chronic?

A

> 15

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8
Q

Absorptive treatment of tension type headache (how often is too often to give these and why?)

A

paracetomol or aspirin
NSAIDS
>10 days/month - do not want to cause medication overuse headache

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9
Q

Which is the most frequent disabling primary headache?

A

migraine

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10
Q

What is migraine?

A

A chronic disorder with episodic attacks and complex changes in the brain

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11
Q

Migraine: during attacks

A

nausea, photophobia, phonophobia, headache, functional disability

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12
Q

Migraine: in between attacks

A

fatigue, anticipatory anxiety

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13
Q

Triggers for migraine

A

diet, stress, oestrogen changes, hunger, sleep disturbance, environmental stimuli

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14
Q

What is aura?

A

Transient neurological symptoms resulting from cortical or brainstem dysfunction

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15
Q

What systems can be affected in aura?

A

visual, sensory, motor or speech

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16
Q

What can aura be confused with and why?

A

TIA

15-60 minutes, sudden onset, loss of function

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17
Q

Criteria for a chronic migraine

A

> 15 days a month and 8 have to be migraine and this for more than 3 months

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18
Q

Transformed migraine changes

A

history of episodic migraine

increasing frequency of headaches over time and migrainous symptoms become less

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19
Q

How is medication overuse headache treated?

A

stopping the medication

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20
Q

What is medication overuse headache?

A

> 15 days a month which has developed or worsened since starting regular symptomatic medication

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21
Q

What can cause medication overuse headache?

A

analgesics and caffeine

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22
Q

Migraine - absorptive treatment

A

NSAIDS, aspirin

triptans

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23
Q

Tension type headache - prophylactic treatment

A

Rarely needed - tricyclic antidepressants eg amytriptiline

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24
Q

Migraine - prophylactic treatment

A

propranolol
anti epileptics eg valproate
tricyclic antidepressants

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25
Q

Does migraine with or without aura get better in pregnancy?

A

without aura

26
Q

Treatment in pregnant women for migraine

A

paracetomol

propranolol/amytriptiline

27
Q

4 trigeminal autonomic cephalalgias

A

cluster headache
paroxysmal hemicranias
SUNCT
SUNA

28
Q

What are the cranial autonomic symptoms?

A

lacrimation, sweating on forehead, eyelid oedema, miosis/ptosis, nasal congestion

29
Q

In trigeminal autonomic cephalalgius where is the pain?

A

unilateral - usually V1 - very severe

30
Q

Do autonomic symptoms occur on the contralateral or ipsilateral side?

A

ipsilateral

31
Q

Where is pain mostly in cluster headaches?

A

temporal and orbital

32
Q

3 cycles of cluster headache

A

episodic
circadian
chronic

33
Q

Cluster headaches - pain description

A

unilateral, rapid onset, 15mins-3hours, rapid cessation

34
Q

How often do paroxysmal hemicranias last?

A

2-30minutes

35
Q

What can paroxysmal hemicranias be precipitated by?

A

turning or rotating head

36
Q

Treatment for paroxysmal hemicranias

A

nitric oxide

37
Q

SUNCT - pain and duration

A

unilateral, supraorbital, orbital and temporal

10-240s

38
Q

cutaneous triggers of SUNCT and trigeminal neuralgia

A

cold, wind, chewing, touch

39
Q

Are autonomic features common in SUNCT or trigeminal neuralgia?

A

SUNCT

40
Q

What type of headaches do tablets not work quick enough?

A

cluster

41
Q

Secondary headaches - sinister if..

A

recent onset, recent head trauma, change in character or pattern, sudden onset and new headache

42
Q

What groups would you be particularly aware of secondary headaches in?

A

over 50s

immunosuppression and cancer

43
Q

Neck stiffness/fever red flag of?

A

meningitis, subarachnoid haemorrhage

44
Q

High pressure headaches worse when?

A

lying down, valsava manoeuvre

45
Q

Causes of low pressure headaches

A

epidural

lumbar puncture

46
Q

When are low pressure headaches worst?

A

standing up

47
Q

Giant cell arteritis - 3 signs/symptoms

A

visual disturbance
prominent temporal artery
jaw claudication

48
Q

What is thunderclap headache?

A

A high intensity headache running at maximal intensity in less than a minute and is a whole head headache which can be primary or secondary

49
Q

Differential diagnosis of thunderclap headache

A

primary eg migraine, cluster
haemorrhage
TIA/stroke
meningitis

50
Q

Main cause of subarachnoid haemorrhage?

A

aneurysm

51
Q

Investigation of subarachnoid haemorrhage?

A

CT brain, lumbar puncture, angiography

52
Q

Meningism symptoms

A

Nausea with or without vomiting, photo/phonophobia, stiff neck

53
Q

Encephalitis symptoms

A

Altered consciousness/mental state, focal symptoms, signs, seizures

54
Q

Always look for what in suspected CNS infection?

A

rash, fever, headache

55
Q

Causes for raised ICP

A

glioblastoma multiforme, abscess, venous infarct, haemorrhage, hydrocephalus, meningioma, papilloedema

56
Q

Space occupying lesion features

A

Progressive headache with associated symptoms and signs

57
Q

Warning symptoms of raised ICP

A

worse in morning and awakens from sleep
worse lying flat
seizures

58
Q

What can cause intracranial hypotension (with examples)

A

dural CSF leak

idiopathic or iatrogenic eg lumbar puncture

59
Q

Intracranial hypotension investigation and treatment

A

MRI brain and spine

bed rest, fluids, caffeine, epidural blood patch, analgesia

60
Q

GCA - blood findings and investigations/treatment

A

ESR and CRP

temporal artery biopsy and prednisolone

Year 2 Neuro (JK) (50 decks)

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