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Tim CP3 @ UoN - Medicine & Surgery > Headache > Flashcards

Headache Flashcards

1
Q

What are the common types of 1o headache disorders?

A

Tension headache
Migraine
Cluster headache

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2
Q

What are the common causes of 2o headache syndrome?

A 
Raised ICP
Idiopathic intracranial HTN
HTN
Meningeal irritation (SAH/meningitis)
Post-traumatic
Giant cell arteritis
Sinusitis
Metabolic disturbances
Drugs (nitrates, vasoactive agents)
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3
Q

What are the common causes of facial pain?

A

Trigeminal neuralgia
Postherpetic neuralgia
Atypical facial pain

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4
Q

How does a tension headache present?

A

Continuous severe pressure
Bilateral over vertex, occiput, eyes
Occurs every day, persists for months/years

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5
Q

In what groups are tension headaches most common?

A

Middle-aged woman

Associated w/ depression

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6
Q

What is the management of tension headaches?

A

If episodic (<15d/mo) –> paracetamol & aspirin/NSAIDs, can lead to overuse headache
Prophylactic –> Amitriptyline (75mg)
Reassurance, relaxation techniques, address underlying stressors

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7
Q

How does a cluster headache present?

A

Short (30-120mins) episodes, several times/day for weeks/mo
Severe, unilateral pain, centered on one eye
Comes on suddenly, often wakes pt
Autonomic features on affected side (ptosis, red eye, eye watering, vomiting)
Aura (20%)

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8
Q

In what groups are cluster headaches most common?

A

Males (3:1)

Alcohol as a precipitant

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9
Q

What is the management of cluster headaches?

A

Exclude 2o causes
s.c./nasal triptan
O2 –> 12L/min through non-rebreather
Prophylactic –> Alcohol avoidance, verapamil

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10
Q

What are the risk factors for migraine?

A 
10% population
Females (3:1)
Menstruation, OCP use
Exercise
Alcohol
Food (cheese, chocolate, red wine)
Emotional stress
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11
Q

What is the underlying pathology behind migraine?

A

Vasodilation after a period of vasoconstriction (aura)

Mediated by vasoactive peptides

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12
Q

What are the subtypes of migraine?

A

Classical migraine w/ aura
Migraine w/o aura (common migraine)
Ophthalmoplegic migraine (Migraine + 3rd/6th nn palsy)
Hemiparetic migraine (Migraine + temp hemiparesis)
Facioplegic migraine (Migraine + unilat facial weakness)

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13
Q

How does classical migraine w/ aura present?

A

Starts w/ sense of ill health (sev hours), followed by visual aura (contralateral to succeeding headache, 1hr)
Sensory aura/speech disturbance rare
Throbbing headache w/ anorexia, N/V, photophobia
-begins locally, spreads bilaterally
-aggravated by movement
-can last hrs/days

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14
Q

How does migraine w/o aura present?

A

Visual/sensory aura absent

Pts feel non-specifically unwell prior to onset of headache

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15
Q

What investigations are appropriate in suspected migraine?

A

Examination - focal neurology, raised ICP, meningism, temporal arteritis, retinal haemorrhage (SAH)
Headache diary - fre/sev, precipitants, exac/reliev factors

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16
Q

What is the acute management of suspected migraine?

A

Oral NSAID/paracetamol + anti-emetic (metoclopramide)
Oral triptan if attacks severe (avoid if IHD/HTN/coronary artery spasm)
Avoid opioids

17
Q

What is the preventative management of migraine?

A

Topiramate/Propranolol
Amitryptiline/anti-convulsants
Mefanamic acid (menstrual-related)
Use if >2/mo

18
Q

How can migraine be distinguished from TIA?

A

In TIAs max deficit present immediately

Headache unusual

19
Q

In what group is Idiopathic Intracranial HTN (IIH) most common?

A

Young, obese women

20
Q

How does IIH present?

A

Sx/signs of raised ICP w/ no mass lesion on imaging
Visual disturbances (diplopia/obscurations)
Headaches
Pulsatile tinnitus/6th nn palsy
Bilateral papilloedema

21
Q

What is the underlying pathology behind IIH?

A

Disorder of CSF resorption

22
Q

What investigations are appropriate in suspected IIH?

A

CT/MRI (normal)

LP (raised CSF pressure)

23
Q

What is the management of IIH?

A

Wt loss may cause spontaneous remission
Corticosteroids
Surgical shunt

24
Q

What is the main complication of prolonged IIH?

A

Optic atrophy due to prolonged raised pressure

25
Q

What is trigeminal neuralgia?

A

Agonising sharp pain over distribution of facial nn on one side
Lasting only seconds
Sensory trigger

26
Q

What causes trigeminal neuralgia?

A

Compression/pathology (MS) of trigeminal nn root

27
Q

What is the management of trigeminal neuralgia?

A

Exclude post herpetic neuralgia
Simple analgesics ineffective
Carabamazepine/TCAs offer good sx control

28
Q

How can post herpetic neuralgia be distinguished from trigeminal neuralgia?

A

Pain less severe
Associated w/ itching & sensory changes
Prev herpes zoster (shingles)

29
Q

What is atypical facial pain?

A

Episodic aching in non-anatomical distributions of head/neck

30
Q

How is atypical facial pain managed?

A

Associated w/ depression/anxiety so treated w/ anti-depressants

Tim CP3 @ UoN - Medicine & Surgery (136 decks)

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