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3.2 Neurology > Headache > Flashcards

Headache Flashcards

1
Q

What are the different types of onset of a headache?

A

Acute
Sub-acute
Gradual

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2
Q

What are some relieving features of a headache?

A

Posture

Headache behaviour

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3
Q

What are some exacerbating features of a headache?

A

Posture
Valsalva (sneezing, coughing, straining etc)
Diurnal variation

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4
Q

What are some associated features of a headache?

A 
Autonomic features (N+V)
Photophobia
Phonophobia
Positive visual symptoms
Ptosis
Miosis
Nasal stuffiness
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5
Q

What are red flags for headaches?

A 
New onset headache >55
Known/previous malignancy
Immuno-suppressed
Early morning headache
Exacerbation by valsalva
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6
Q

What is important in the PMHx for headache?

A

Beware previous CA, predisposition to thrombosis

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7
Q

What is important in the FHx for headache?

A

Migraines in family members

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8
Q

What is important in DHx for headache?

A

Headache diary- need to account for OTC medication

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9
Q

Are migraines more common in men?

A

No women!

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10
Q

What percentage of migraines are with aura?

A

20%

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11
Q

What is the IHS criteria for migraine without aura?

A

At least 5 attacks
Duration 4-72 hours
2 of: moderate/severe, unilateral, throbbing pain. worst movement
1 of: autonomic features, photophobia/phonophobia

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12
Q

What is the pathophysiology of migraines?

A

Vascular and neural influences in susceptible individuals
Stress triggers- cause serotonin to be released
Blood vessels constrict and dilate
Substance P irritates nerves and blood vessels causing pain

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13
Q

What is the duration of a migraine with aura?

A

20-60 minutes

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14
Q

What is the onset of headache after a migraine with aura?

A

<1 hour later

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15
Q

What are the symptoms of a migraine with aura?

A

Mostly visual- positive symptoms usually monochromatic)

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16
Q

What are the 3 types of visual aura?

A

Central scotomata
Central fortification
Hemianopic loss

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17
Q

What are some triggers of migraine?

A 
Sleep
Dietary
Stress
Hormonal
Physical exertion
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18
Q

What are the non-pharmacological treatments for migraine?

A

Set realistic goals
Education- avoid triggers
Headache diary
Relaxation/stress management

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19
Q

What are the pharmacological treatments for migraine?

A

NSAIDS +/- anti-emetic

Triptans- 5HT agonist

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20
Q

Which triptans can be used in treatment of migraine?

A

Rizatriptan = electrician > sumatriptan

Frocatriptan for sustained relief

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21
Q

When is prophylaxis for migraines indicated?

A

More than 3 attacks per month or very severe

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22
Q

How is prophylaxis used for migraines?

A

Titrate drug as tolerated to achieve efficacy at lowest dose
Go slow and keep low
Trial each for minimum 4 months

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23
Q

What drugs can be used for prophylaxis?

A

Propranolol
Topiramate (Carbonic anhydrase inhibitor)
Others: Amitriptyline, gabapentin, pizotifen, Na valproate, Botox, Anti-calcitonin gene related peptide Ab

24
Q

When should propranolol be avoided?

A

Asthma
Peripheral vascular disease
Heart failure

25
Q

What are the side effects of topiramate?

A

Weight loss
Paraesthesia
Impaired concentration
Enzyme inducer

26
Q

What are the side effects of amitriptyline?

A

Dry mouth
Postural hypotension
Sedation

27
Q

How can lifestyle be modified for treatment of migraines?

A

Diet- regular intake, avoid triggers
Hydration- 2L/day minimum. decrease caffeine
Decrease stress
Regular exercise

28
Q

Give examples of more complex migraines

A 
Acephalgic
Basilar
Retinal
Ophthalmic
Hemiplegic
Abdominal
29
Q

What are the characteristics of a tension type headache?

A 
Pressing tingling quality
Mild to moderate
Bilateral
Absence of N+V
Absence of photophobia or phonophobia
30
Q

What are treatments for tension type headache?

A

Relaxation physiotherapy
Antidepressants- dothiepin or amitriptyline
Reassure

31
Q

What are trigeminal autonomic cephalgias (TACs)?

A

Group of primary headache disorders characterised by unilateral trigeminal distribution pain
Associated with ipsilateral cranial autonomic features

32
Q

What are ipsilateral autonomic features?

A 
Ptosis
Miosis
Nasal stuffiness
Nausea/vomiting
Tearing
Eye lide oedema
33
Q

What are the 4 main types of TAC?

A

Cluster
Paroxsymal hemicrania
Hemicrania continua
SUNCT

34
Q

Who gets cluster headaches?

A

Young (30-40s)

Men > women

35
Q

When do cluster headaches occur?

A 
Striking circadian (around sleep)
Seasonal variation
36
Q

What are the features of a cluster headache?

A

Severe, unilateral headache
Occurs 1-8 per day
Cluster bout may last from a few weeks to months

37
Q

What is the duration of cluster headaches?

A

45-90mins

20mins-3hrs

38
Q

What is the treatment for cluster headaches?

A

High flow O2 100% for 20mins
Sub-cutaneous sumatriptan
Steroids- reducing over 2 weeks
Verapamil for prophylaxis

39
Q

Who gets paroxysmal hemicrania?

A

Elderly (50-60s)

Women> men

40
Q

What are the features of a paroxysmal hemicranial?

A

Severe unilateral headache with unilateral autonomic features

41
Q

What is the duration of paroxysmal hemicrania?

A

10-30 minutes (2mins-45mins)
1 to 40 times a day
N.B. shorter duration and more frequent than cluster

42
Q

What is the treatment for paroxysmal hemicrania?

A

Absolute response to indomethicin

43
Q

What does SUNCT stand for?

A 
S= short lived (15-120 secs)
U= unilateral
N= neuralgiaform headache
C= conjunctival injections
T= tearing
44
Q

What is the treatment for SUNCT headaches?

A

Lamotrigine

Gabapentin

45
Q

What investigations are done for new onset unilateral cranial autonomic features?

A

MRI brain

MR angiogram

46
Q

Who gets idiopathic intracranial hypertension?

A

Females> males

Obese

47
Q

What are some symptoms of idiopathic intracranial hypertension?

A

Headache- diurnal variation
Morning N+V
Visual loss

48
Q

What investigations can be done for IIH and what would be found?

A

MRI brain w/ MRV sequence- normal
CSF- elevated pressure, normal constituents
Visual fields- impaired

49
Q

What are treatments for IIH?

A

Wgt loss
Acetazolamide
Ventricular atrial/lumbar peritoneal shunt
Monitor visual fields & CSF pressure

50
Q

Who gets trigeminal neuralgia?

A

Elderly (>60)

Women > men

51
Q

When does trigeminal neuralgia occur?

A

Triggered by touch

Usually V2/3

52
Q

What are the features of trigeminal neuralgia?

A

Severe stabbing unilateral pain

53
Q

What is the duration of trigeminal neuralgia?

A

1 -90secs
10-100 times per day
Bouts pain may last from few weeks to months before remission

54
Q

What is the treatment for trigeminal neuralgia?

A 
Carbamazepine
Gabapentin
Phenytoin
Baclofen
Surgical: ablation/decompression
55
Q

What investigations can be done for trigeminal neuralgia?

A

MRI brain

56
Q

What structures should be considered with facial pain?

A 
Eyes
Ears
Sinuses
Teeth
TMJ

3.2 Neurology (9 decks)

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