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Neurology System > Headache > Flashcards

Headache Flashcards

1
Q

What are primary headache?

A

Headache without underlying cause

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2
Q

What are common types of primary headache?

A

Tension
Migraine
Cluster

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3
Q

What can cause secondary headaches?

A 
Tumours 
Meningitis 
Vascular disorders
- e.g GCA 
Systemic infection 
Head injury 
- e.g SAH
Drug induced
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4
Q

Are all secondary headaches sinister?

A

No

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5
Q

What is the most frequent headache?

A

Tension

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6
Q

Do TTH often present to the doctors?

A

No

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7
Q

What are the symptoms of a tension headache?

A

Mild
Bilateral headache
Often pressing or tightening in quality
Band round the head

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8
Q

What is classed as an infrequent tension headache?

A

<1 day/month

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9
Q

What is classed as a frequent tension headache?

A

1-14 days/month

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10
Q

What is classed as a chronic tension type headache (CTTH)?

A

> 15 days/month

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11
Q

What is the treatment for TTH?

A

Aspirin or paracetemol

NSAID’s

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12
Q

What should be the limit for TTH Rx?

A

Limit to 10 days per month to avoid the development of medication overuse headache

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13
Q

What is the most frequent disabling primary headache?

A

Migraines

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14
Q

Why are migraines more common in females?

A

Due to their hormone cycle

Change in oestrogen levels

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15
Q

What is a migraine?

A

Chronic disabling headache with features

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16
Q

What other symptoms can present in a headache?

A 
Nausea
Vomiting 
Photophobia 
Phonophobia 
Functional disability
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17
Q

What are common triggers of migraine?

A 
Stress
Hunger 
Sleep disturbance 
Diet 
Environmental stimuli 
Changes in oestrogen in women
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18
Q

What is the premonitory phase of a migraine?

A

Prediction of the headache attack
Mood alterations
Muscle pain,
Food cravings

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19
Q

What is the aura phase of a migraine?

A

An aura involves focal, reversible neurologic symptoms that often precede the headache
Seeing stars and fuzzy

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20
Q

What is aura?

A

Transient neurological symptoms

May involve visual, sensory, motor or speech systems

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21
Q

What can aura be confused with?

A

TIA

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22
Q

What is the duration of aura?

A

15-60 minutes

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23
Q

What is a chronic migraine?

A

Headache on ≥ 15 days per month, of which ≥ 8 days have to be migraine, for more than 3 months

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24
Q

What is the abortive treatment for migraine?

A

Triptans
Paracetemoy
NSAIDS

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25
Q

What is the prophylactic treatment for migraine?

A

Propanolol

Amitriptyline

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26
Q

How does migraine without aura change in pregnancy?

A

Gets better

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27
Q

How does migraine with aura change in pregnancy?

A

Usually does not change

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28
Q

What contraceptive is contraindicated in active migraine with aura?

A

Combined OCP

Oestrogen and progesterone

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29
Q

What is a migraine?

A

Chronic disorder with episodic attacks

Due to complex changes in the brain

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30
Q

What % of migraineurs ecperience aura?

A

33%

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31
Q

Who are particularly prone to medication overuse headaches?

A

Migraineurs

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32
Q

What is the limit for the use of drugs for migraine?

A

Limit to 10 days per month to avoid development of MOH

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33
Q

When can woman with migraines and aura go on the OCP?

A

If she hasn’t had an attack in 5 years

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34
Q

Why should anti-epileptics be avoided in pregnancy?

A

Because they are teratogenic

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35
Q

What should be used in a woman of child bearing age for pain relief?

A

Paracetemol

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36
Q

What is a trigeminal autonomic cephalalgia?

A

Trigeminal autonomic cephalgia (TAC) is the name for a type of primary headache that occurs with pain on one side of the head in the trigeminal nerve area and symptoms in autonomic systems

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37
Q

What are the 3 main TAC?

A

Cluster headache
Paroxysmal Hemicrania
SUNCT/SUNA

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38
Q

What is the pain experienced in TAC?

A

Predominantly of the area V1 supplies (eye and forehead area)
Very severe and excruciating
With ipsilateral autonomic symptoms

39
Q

What cranial autonomic symptoms are there in TAC?

A 
Red eye 
Nasal conjection 
Lacrimation 
Eyelid oedema 
Forehead and facial sweating
40
Q

Where is the pain in cluster headache?

A

Mainly orbital and temporal

41
Q

Are cluster attacks bi or unilateral?

A

Unilateral

42
Q

What is the onset in cluster headaches?

A

Rapid

Max onset is 9 minutes

43
Q

What is the duration of a cluster headache?

A

15mins to 3 hours

44
Q

What are the symptoms of a cluster headache?

A

Excruciating unilateral pain
Suicide headache
Restlessness and agitation during an attack
Prominent ipsilateral autonomic symptoms

45
Q

What are some assocaited symptoms of cluster headaches?

A

Tiredness, yawning, nausea, vomiting, photophobia, phonophobia

46
Q

What is a bout in cluster headaches?

A

Attacks cluster into bouts typically lasting 1-3 months with periods of remission lasting at least 1 month

47
Q

What is the attack frequency in a bout of cluster headaches?

A

1 every other day

to 8 per day

48
Q

Can alcohol trigger cluster headaches?

A

During a bout yes

During remission no

49
Q

What is cluster headache all about in the history?

A

Timing
Comes in bouts of daily attacks
Then goes away for months at a time

50
Q

What is chronic cluster headaches defined as?

A

Remissions < 1 month or

Bouts last > 1 year without remission

51
Q

Where is pain felt in paroxysmal hemicrania?

A

Mainly orbital and temporal

52
Q

Is paroxysmal pain usually bi or uni later?

A

Unilateral

53
Q

What is the duration of paraoxysmal hemicrania?

A

2-30 mins

54
Q

What is the pain intensity for paroxysmal hemicrania?

A

Very severe

55
Q

Does cluster headache have circadian rhythm?

A

Yes Frequently

56
Q

Does SUNCT have circadian rhythm?

A

Absent

57
Q

Does circadian rhythm occur in paroxysmal hemicrania?

A

Not typically

58
Q

What is SUNCT?

A

Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT syndrome), is a rare headache disorder that belongs to the group of headaches called trigeminal autonomic cephalalgia (TACs).

59
Q

What autonomic symptoms are experienced with SUNCT?

A 
Lacrimation 
Ptsosis
Eyelid oedema 
Nasal conjestion 
Conjunctival injection
60
Q

What is the character of pain in SUNCT?

A

Stabbing or pulsating pain

61
Q

What is the duration of SUCNT?

A

2-240 seconds

62
Q

What is trigeminal neuralgia?

A

Trigeminal neuralgia (TN or TGN) is a chronic pain disorder that affects the trigeminal nerve

63
Q

Which branches are usually affected in trigeminal neuralgia?

A

V2/V3 >V1

64
Q

What is the character of pain in trigeminal neuralgia?

A

Stabbing

65
Q

What is the duration of pain in trigeminal neuralgia?

A

5-10 seconds

66
Q

Are autonomic features common in trigeminal neuralgia?

A

No

67
Q

What is the difference between SUNCT and trigeminal neuralgia?

A

TN- no autonomic features
Predominantly over eye area
SUNCT- autonomic features
Predominant over maxillary and mandibular area

68
Q

What triggers trigeminal neuralgia?

A

Wind
Cold
Touch
Chewing

69
Q

What presentations of secondary headache are more likely to have a sinister cause?

A 
Associated head trauma 
First or worst 
Progression in headache 
Sudden thunderclap headache 
New daily persistent headache 
Changes in pattern or type 
Returning patient
70
Q

What are red flags for headaches?

A 
New onset 
New or change 
>50 
on immunosuppresion 
have cancer 
changes in headache frequency, characteristics or associated symptoms 
Focal neurological symptoms 
Abnormal examination 
Neck stiffness or fever, photophobia
71
Q

What is a thunderclap headache?

A

A high intensity headache reaching maximum intensity in less than minutes
Starts mainly at back of head

72
Q

What is the main worry with thunderclap headaches?

A

SAH

73
Q

What is the main cause of subarachnoid haemorrhage?

A

85% aneurysmal

Berry aneurysms

74
Q

What is the mortality for subarachnoid haemorrhage?

A

50%

75
Q

What is the presentation of SAH?

A

All patients presenting with a sudden severe headache that peaks within a few minutes and lasts for at least 1 hour need to be assessed
Examination is often normal!
Never consider a patient ‘too well’ for SAH

76
Q

When should LP be done for SAH?

A

> 12 hours

77
Q

What are the symptoms of meningitis?

A

Meningism: nausea +/- vomiting, photo/phono phobia, stiff neck
Non blancing rash

78
Q

What are the warning features for a headache that could be due to space occupying lesion or raised ICP?

A 
Headache:
Worse in morning
Worse lying down 
Brought on by valsalva
Focal symptoms or signs 
Seizures 
Visual obscurations
Pulsatile tinnitus
79
Q

What is pulsatile tinnitus?

A

Ear noise that is heard in time with heartbeat

80
Q

What is ICP hypotension due to?

A

Dural CSF leak

81
Q

What causes iatrogenic ICP hypotension?

A

Post lumbar puncture

82
Q

What is distinguishing about headaches with low ICP?

A

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

83
Q

What investigations should be done for low ICP?

A

MRI brain and spine

84
Q

What is the treatment for low ICP?

A 
Bed rest
Analgesia 
Caffeine 
IV caffeine 
Epidural blood patch
85
Q

What is an epidural blood patch?

A

Using the patients own blood to seal the hole

86
Q

What causes the pain in low ICP headaches?

A

Due to low pressure the brain sinks

Pulls on the vessels and the meninges causing pain

87
Q

What is giant cell arteritis?

A

Arteritis of large arteries

Temporal arteritis

88
Q

What type of headache is experience with giant cell arteritis?

A

Diffuse, persistent and may be severe

89
Q

What supports the diagnosis of giant cell arteritis?

A

Raised ESR

90
Q

What are the special clinical features of giant cell arteritis?

A

Scalp tenderness,
Jaw claudication
- pain when eating or chewing
Visual disturbance

91
Q

What are other useful markers for giant cell arteritis?

A

Raised CRP

Raised platelet count

92
Q

Rx for giant cell arteritis?

A

High dose prednisolone

93
Q

What investigation should be done to confirm the diagnosis of giant cell arteritis?

A

Temporal artery biopsy

94
Q

What is giant cell arteritis?

A

Giant-cell arteritis (GCA), also called temporal arteritis, is an inflammatory disease of blood vessels.
Inflammation of the temporal artery

Neurology System (35 decks)

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