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Neurology Clinical > Headache > Flashcards

Headache Flashcards

1
Q

What are the 3 main types of primary headache?

A

Tension type
Cluster
Migraine

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2
Q

What sex is migraine more common in?

A

Women

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3
Q

What is the average age of sufferers of migraine?

A

20-50yrs

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4
Q

What are migraine features?

A 
Headache
Nausea
Photophobia 
Photophonia 
Functional disability
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5
Q

What are the triggers of migraine?

A 
Normal life events in predisposed people;
Dehydration
Diet
Sleep disturbance
Hunger
Stress
Environmental stimuli
Changes in oestrogen levels in women
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6
Q

What is the preventative treatment for tension type headache?

A

Tricyclics antidepressants i.e. amitriptyline

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7
Q

When is best to treat migraines?

A

After aura but before the advanced headache has begun

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8
Q

What is aura?

A

Transient neurological symptoms resulting from cortical or brainstem dysfunction
Moves from 1 area of the cortex to another causing slow evolution of symptoms
I.e. vision - sensory - speech

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9
Q

What is defined as chronic migraine?

A

Headache on > 15 days per month of which >8 are migraine, for more then 3 months
They have a background tension type headache with attacks of migraine

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10
Q

What is the most common cause of chronic migraine?

A

Medication overuse

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11
Q

What is the maximum dose of analgesia given for treating headaches?

A

<15 per month (2 per week)

Over that then this will cause medication overuse headache

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12
Q

What is the abortive treatment for migraine?

A

Aspirin or NSAIDS

Triptans (2 days per week)

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13
Q

What are the prophylactic treatment for migraines?

A

Propanolol, candesartan
Anti-epileptics
Tricyclics antidepressants
Venlafaxine

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14
Q

What are the changes in migraine during pregnancy?

A

A major trigger for migraine is oestrogen cycles so when that stops during pregnancy then the migraines get better
- aura gets better in pregnancy

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15
Q

When is the oral contraceptive contraindicated?

A

In people with migraine with aura

It isn’t contraindicated in migraine without aura

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16
Q

What’s the difference in the location of trigeminal autonomic cephalalgias headaches and migraines?

A

TAC are unilateral whereas migraines are more widespread

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17
Q

What are the symptoms associated with trigeminal autonomic cephalalgias?

A 
Conjunctival infection 
Lacrimation
Nasal congestion
Rhinorrhoea 
Eyelid edema
Forehead and facial sweating
Mitosis, ptosis (hornets syndrome)
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18
Q

What is the average duration of cluster headache?

A

15-180 mins

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19
Q

What is there pattern of cluster headaches compared to migraines

A

Migraine are slow onset lasts while and slowly settle

Cluster headaches have short severe attacks usually 2 per day

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20
Q

What’s the main difference between paroxysmal hemicrania and cluster headache?

A

PH is more frequent ands brief (2-30mins compared to 15-180mins)

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21
Q

What is the treatment for a paroxysmal hemicrania headache?

A

Non steroidal - Indometacin

22
Q

Where is trigeminal neuralgia mostly felt?

A

Maxillary or mandibular pain

Lower part of the face

23
Q

What are the triggers of trigeminal neuralgia?

A

Wind
Cold
Chewing
Touch

24
Q

What are the red flag symptoms of headaches?

A 
New onset headache
New or change in headache (age over 50 or immunosuppressed)
Change in frequency, characteristics or associated symptoms
Focal neurological symptoms
Non-focal neurological symptoms
Abnormal neurological examination
Neck stiffness/fever
High pressure (worse when lying down)
- Wakening up the patient
- Precipitated by physical activity
- Precipitated by valsalva maneuver 
- Risk factors for cerebral venous sinus thrombosis
Low pressure
- precipitated by sitting/standing up
GCA
- jaw claudication or visual disturbance
- prominent or beaded temporal arteries
25
Q

What is the definition of a thunderclap headache?

A

High intensity headache reaching maximum intensity in less than 1 minute

26
Q

What are the main differential diagnoses of a thunderclap headache?

A 
Subarachnoid haemorrhage 
Meningitis and encephalitis 
Space occupying lesion and/or raised ICP
Intracranial hypotension 
Giant cell arteritis
27
Q

What are the treatments for intracranial hypotension?

A

Bed rest
Fluids
Caffeine
Epidural blood patch

28
Q

What is the pattern of intracranial hypotension?

A

Widespread headache which gets worse when standing up and lessens after lying down
If it becomes chronic then it loses it postural component

29
Q

What are the specific features of giant cell arteritis?

A

Tender scalp
Jaw claudication
Visual disturbance
Prominent, beaded or enlarged temporal arteries

30
Q

How do you diagnose giant cell arteritis?

A

Elevated ESR and CRP & platelet

31
Q

What is defined as an infrequent, frequent and chronic tension type headache?

A

Infrequent <1day per month
Frequent 1-14 days per month
Chronic >15 days per month

32
Q

What is the abortive treatment for tension type headache?

A

Aspirin or paracetamol

NSAIDS

33
Q

What is the dose of Triptans that can result in medication overdose migraine?

A

> 10days /month

>2 per week

34
Q

What does SUNCT stand for?

A

Short-lasting unilateral neuralgiform headache with conjunctival infection and tearing

35
Q

What does SUNA stand for?

A

Short-lasting unilateral neuralgiform headache with autonomic symptoms

36
Q

What is the main nerve involved in trigeminal autonomic cephalalgias?

A

V1 -ophthalmic nerve

37
Q

What are the 3 trigeminal autonomic cephalagias?

A

Cluster headaches
Paroxysmal hemicrania
SUNCT

38
Q

What is the difference between the attack frequency in SUNCT and trigeminal neuralgia?

A

SUNCT has no refractory period so ends up with no break between short-lasting attacks

Trigeminal neuralgia has refractory periods between attacks

39
Q

What is the prophylactic treatment for trigeminal neuralgia?

A

Carbamezapine

Surgical intervention - glycerol ganglion injection, stereotactic radiosurgery and decompressive surgery

40
Q

What is the prophylactic treatment for SUNCT?

A

Carbamezapine
Gabapentin
Topiramate
Lamotrigine

41
Q

What is the pattern of paroxysmal hemicrania headaches?

A

Unilateral attacks
Rapid onset & cessation of pain
10% of attacks precipitated by bending or rotating the head
Mainly orbital and temporal pain

42
Q

what is the average duration of SUNCT?

A

5 seconds to 4 mins

43
Q

what is the pain like in trigeminal autonomic cephalalgies (SUNCT, paroxysmal hemicranial and cluster headaches) ?

A

SUNCT = sharp burning

P.H & cluster = sharp, stabbing

44
Q

what defines a chronic cluster headache?

A

bout lasts <1 year without remission

remission lasts <1 month

45
Q

what are the characteristics of a tension type headache?

A

pressure, tightening pain
aggravated by physical exertion
mild
bilateral

46
Q

what are the characteristics of a cluster headache?

A 
unilateral
premonitory symptom = tiredness
associated symptoms = photophobia, phonophobia, nausea
typical aura
prominent ipsilateral autonomic symptoms
47
Q

in which headaches do you find ipsilateral autonomic symptoms?

A

cluster headaches

paroxysmal hemicrania

48
Q

what is the average duration of trigeminla neuralgia?

A

5-10 seconds

49
Q

what are the pre monitory symptoms of a migraine?

A

fatigue
muscle pain
mood changes
food cravings

50
Q

what are the postdrome symptoms of a migraine?

A

fatigue

muscle pain

51
Q

what prophylaxis drug can be used for all primary headaches?

A

topiramate

Neurology Clinical (21 decks)

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