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Neurology > Headache > Flashcards

Headache Flashcards

1
Q

What is a headache?

A

Pain and discomfort
Between orbits and occiput
Arising from pain sensitive structures

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2
Q

What is the classification of headache?

A

PRIMARY

  • tension type
  • migraine
  • cluster

SECONDARY (Sinister)

Neurological

  • Intracranial hypertension/SOL/pseudotumor cerebri
  • intracranial infection
  • SAH
  • Arterial dissection

Non-neurological

  • giant cell arteritis
  • glaucoma
  • acute (malignant) hypertension
  • systemic infection
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3
Q

What are the pain sensitive structures causing headache?

A

Anterior headache

Eyes
Sinuses
Teeth
Ear
Face
Carotid arteries

Posterior headaches

Cervical spine
Vertebral arteries

Global

Scalp
Periosteum
Meninges
Venous sinuses
Intracranial arteries
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4
Q

What are the features of secondary headaches?

A

Hyperacute/ Acute/ Subacute onset

Progressive daily

Awakened by/ with headache

Associated fever, meningism, focal signs

Papilloedema

Aggravated by straining

New headache in person >50 years old

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5
Q

What are the causes of acute headaches?

A 
Sinusitis
Migraine
Cluster
Glaucoma
Arterial dissection 
Optic neuritis 
Post traumatic 
Vasodilator drugs
ICH
CNS infection
Hydrocephalus
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6
Q

What are the causes of subacute headaches?

A 
Chronic meningitis 
SOL
CSDH
Hydrocephalus 
Pseudotumour cerebri 
Giant cell arteritis
Low CSF pressure
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7
Q

What are the causes of chronic headaches?

A 
Tension type
Migraine
Analgesic overuse
Ocular strain
Vasodilator drugs
Cervical spondylosis
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8
Q

What are the features of headache due to ICH/SAH?

A

Instantaneous headache
“Worst ever”

Thunderclap / blow to the back of the head type of feeling

Fall / LOC

vomiting

Focal signs

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9
Q

What are features of giant cell arteritis?

A

Chronic daily throbbing focal intractable headache

General malaise / constitutional symptoms

Tenderness over temporal region

Jaw claudication ( pathognomonic)

Blindness transient / permanent

Females > males

Age and ESR > 50

Tender swollen non pulsatile temporal arteries

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10
Q

What are the features of headache from intracranial hypertension?

A

Generalized progressive headache

Awaken by / with headache

Worse in the morning and by straining

Late- vomiting, vision loss, AMS

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11
Q

What are the vasodilator drugs?

A

Nitrates

Bronchodilators

Antihistamines

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12
Q

What are the features of tension type headaches?

A

Most common headache

Chronic daily

Bilateral Diffuse dull aching band like
“Tension”

Non throbbing

Mild to moderate pain lasting for minutes to days

Not limiting activity

No nausea /vomiting / photo or phonophobia

By muscle spasm from stress/ drugs

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13
Q

What is migraine?

A

Common disorder

Unilateral frontotemporal throbbing headache

Moderate to severe pain

Associated with nausea, vomiting, photo and phonophobia

Made worse by simple activity, prefer isolation

Episodic lasting hours to days

Early onset

Female to male 2:1

Family history

Two types
With aura/ classical 20%

Without aura/ common 80%

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14
Q

What is the aura of migraine?

A

A warning of visual, sensory or motor type

Lasting less than one hour

Followed by migraine headache within one hour

Most common is visual aura

  • photopsia (colours flickering dots)
  • fortifications spectra (zig zag lines)
  • scintillating scotomas (central field defects)
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15
Q

What are the types of migraine with aura?

A

Visual aura

Basilar aura

Hemiplegic aura (DDx for stroke)

Retinal aura

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16
Q

What are the factors precipitating migraine?

A

Dietary

  • alcohol
  • chocolate
  • cheese

Hormonal

  • PMS
  • OCP

Other

  • stress
  • fatigue
  • exercise
  • sleep deprivation
  • minor head trauma
17
Q

What is the management of migraine?

A

Avoidance of triggers / precipitants

Acute attacks
1. Simple analgesic + metoclopramide + antiemetic

  1. Triptans Oral or subcut (selective 5HT1 agonist) for reversing vasodilation- sumatriptan
  2. Ergotamine Oral/ inhaled/ iv/ supp (5HT agonist)
  3. Methylprednisolone IM or IV for status migranosus
Prophylaxis
Propranolol
Verapamil
Antidepressants 
Anticonvulsants 
Pizotifen
18
Q

What is cluster headache?

A

A trigeminal autonomic cephalalgia

Men> females, middle age onset

Combination of facial pain and autonomic dysfunction

Episodic clustered severe unilateral eye pain

Lasting minutes to hours

Associated with conjunctival injection, lacrimation, rhinorrhea, transient Horner’s

Precipitated by alcohol

19
Q

What are the causes of facial pain?

A 
Trigeminal neuralgia (V1, V2, V3)
Post herpetic neuralgia  (V1)
Dental pain 
Acute sinusitis
TMJ dysfunction
Cluster headache
Glaucoma
20
Q

What is trigeminal neuralgia or tic douloureux?

A

Sudden severe paroxysmal

Unilateral

electric shock like/ shooting pain/ sharp/ stabbing

Usually in V2 V3

Several times per minute

Lasting seconds to minutes
Elderly

Female > male 2:1

Trigger zones and trigger factors

No sleep disturbance

Exclude secondary trigeminal pathology if sensory loss, young age, Bilateral, poor response to carbamazepine

21
Q

What is postherpetic trigeminal neuralgia?

A

Dull, burning, persistent facial pain

Around V1

Evidence of scarring

And sensory loss

Neurology (21 decks)

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