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Clinical Neurology > Headache > Flashcards

Headache Flashcards

1
Q

What are the red flags of a headache?

A 
New onset age >55
Malignancy
Immunosuppression
Early morning
Exacerbation by valsalva
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2
Q

Migraines are commoner in men/women

A

Women

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3
Q

Most migraines occur without an aura. True/false?

A

True

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4
Q

Stress causes what substance to be released in the brain?

A

Serotonin

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5
Q

What is the effect of serotonin release?

A

Vasoconstriction/dilation

Substance P release

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6
Q

What effect does substance P have?

A

Nerve and blood vessel irritation

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7
Q

What is an aura?

A

A fully reversible visual/sensory/motor/language symptom

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8
Q

How long does an aura last?

A

20-60 minutes

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9
Q

What is the most common type of aura?

A

Visual

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10
Q

Give some triggers of a migraine

A 
Sleep
Dietary
Stress
Hormones
Physical exertion
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11
Q

What is the main acute treatment for a migraine?

A

NSAIDs (aspirin, naproxen or ibuprofen)

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12
Q

What 5-HTP agonist drugs can be used to treat migraine acutely?

A

Triptans (rizatriptan/eletriptan/frovatriptan)

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13
Q

What is the main benefit of NSAIDs over triptans?

A

Cost - NSAIDs are much cheaper

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14
Q

When is migraine prophylaxis considered?

A

When a patient has >3 attacks per month

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15
Q

What is the main prophylactic drug used in migraines?

A

Propranolol

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16
Q

What other drugs are used in migraine prophylaxis?

A 
Topiramate
Amitriptyline
Gabapentin
Botulinum
Monoclonal antibody
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17
Q

What is the main downside of topiramate?

A

Poor side effect profile (weight loss/impaired concentration)

18
Q

How long should a patient be on a prophylactic drug before stopping?

A

4 months

19
Q

What lifestyle changes can be made in patients with migraines?

A

Healthy diet
Reduced caffeine
Reduced stress
Exercise

20
Q

Give some examples of ‘fancy’ migraines

A 
Acephalgic
Basilar
Retinal
Ophthalmic
Hemiplegic
Abdominal
21
Q

Tension type headaches tend to be worse than migraines. True/false?

A

False - less severe with less adverse effects

22
Q

What drugs can be used to treat a tension type headache?

A

Antidepressants (dothiepin/amitriptyline)

23
Q

What are trigeminal autonomic cephalgias?

A

A group of primary headache disorders characterised by unilateral trigeminal pain with cranial autonomic features

24
Q

Give some cranial autonomic features seen in TACs

A 
Ptosis
Miosis
Nasal stuffiness
N+V
Tearing
Eye lid oedema
25
Q

What are the four main types of TACs?

A

Cluster
Paroxysmal hemicrania
Hemicrania continua
SUNCT

26
Q

Cluster headache tends to affect younger men. True/false?

A

True

27
Q

How long do cluster headaches tend to last?

A

45-90 mins

28
Q

What is the treatment for cluster headaches?

A

High flow O2
Subcutaneous sumatriptan
Steroids

29
Q

Paroxysmal hemicrania tends to affects younger men. True/false?

A

False - elderly women

30
Q

Paroxysmal hemicrania lasts longer/shorter than cluster headache and is more/less frequent

A

Shorter duration and more frequent

31
Q

What is the absolute treatment for paroxysmal hemicrania?

A

Indomethicin

32
Q

What does SUNCT stand for?

A 
Short-lived
Unilateral
Neuralgiaform headache
Conjunctival injections
Tearing
33
Q

What is the treatment for SUNCT?

A

Lamotrigine/gabapentin

34
Q

What imaging is used for new onset unilateral cranial features?

A

MRI brain

MR angiogram

35
Q

Who tends to get idiopathic intracranial hypertension?

A

Obese women

36
Q

What does idiopathic intracranial hypertension present with?

A

Headache
Nausea and vomiting
Visual loss

37
Q

What investigation is done in idiopathic intracranial hypertension?

A

Spinal tap (only ever done in IIH)

38
Q

How is idiopathic intracranial hypertension treated?

A

Weight loss
Acetazolamide
Ventricular atrial shunt

39
Q

Who tends to get trigeminal neuralgia?

A

Elderly women

40
Q

What are the features of trigeminal neuralgia?

A

Severe stabbing unilateral pain

Triggered by touch

41
Q

How is trigeminal neuralgia treated medically?

A

Anticonvulsants (carbamazepine/gabapentin)

42
Q

How is trigeminal neuralgia treated surgically?

A

Ablation

Decompression

Clinical Neurology (20 decks)

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