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Neurology- Clinical > Headache > Flashcards

Headache Flashcards

1
Q

What is the typical presentation of a headache caused by raised ICP?

A

Gradual onset, dull, generalised headache

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2
Q

Idiopathic intracranial hypertension is most common in which sex? It is almost always associated with which other factor?

A

Females - almost always associated with obesity (especially recent weight gain)

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3
Q

Headaches as a result of raised ICP often have diurnal variation. Describe the pattern?

A

These headaches are usually worse in the morning after wakening

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4
Q

What can make headaches as a result of raised ICP worse?

A

Lying down, coughing, straining, sneezing, bending forwards

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5
Q

What are two other symptoms which are often associated with headaches as a result of raised ICP?

A

Nausea and vomiting, visual field defects

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6
Q

Relating to vision, what signs may be seen on examination of a patient presenting with a headache as a result of raised ICP?

A

Papilloedema (bilateral enlarged blind spots and swollen discs) and a reduced visual field

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7
Q

What is a visual sign which is not commonly seen in a case of headache as a result of raised ICP but may be seen late on?

A

Decreased visual acuity

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8
Q

What investigations are used for a patient presenting with a headache as a result of raised ICP?

A

MRI head and MR venography, CSF sample from LP

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9
Q

When investigating a patient with a headache with signs of raised ICP, an MRI head and MR venography are used to rule out what?

A

Space occupying lesions and venous sinus thrombosis respectively

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10
Q

When investigating a patient with a headache with signs of raised ICP, what would normally be the result of their LP? Having an LP can have what effect on the patient’s symptoms?

A

Elevated pressure and normal constituents. Having an LP can often make the patient feel much better - the headache and visual field assessment will both improve

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11
Q

What are some medications which increase the risk of idiopathic intracranial hypertension and what are they used for?

A

Isotretinoin and tetracycline for acne, prednisolone for many conditions, tamoxifen for breast cancer and beclomethasone for acne

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12
Q

What are the long term outcomes of idiopathic intracranial hypertension if not managed well?

A

Not life-threatening but vision is under threat (i.e. can lead to blindness) if not controlled

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13
Q

What are the management options for a headache as a result of raised ICP?

A

Treat underlying cause (if there is one), weight loss, acetazolamide, CSF shunts

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14
Q

What type of drug is acetazolamide and what is its function? What are some side effects that it may cause?

A

A carbonic anhydrase inhibitor - may make people confused or cause tingling

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15
Q

What should be monitored in a patient with idiopathic intracranial hypertension?

A

Visual fields and CSF pressure

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16
Q

What is the typical presentation of a tension headache?

A

A band of pain or pressure around the forehead with no other neurological features. These are mild-moderate in severity and are bilateral.

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17
Q

Who are typically affected by tension headaches?

A

Women and the young

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18
Q

Patients with persistent tension headaches are screened for what?

A

Anxiety and depression

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19
Q

What is the most likely cause for a tension headache?

A

Stress

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20
Q

What is the investigation for a person presenting with a tension headache?

A

Usually no investigation is required

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21
Q

What are some treatment options for tension headaches?

A

Simple analgesia, reassurance, relaxation physiotherapy

22
Q

If the first line treatments for tension headache are not working, what medication can be tried and how long for?

A

An anti-depressant e.g. dothiepin or amitriptylline for 3 months

23
Q

What are the trigeminal autonomic cephalgias?

A

A group of primary headache disorders characterised by a unilateral trigeminal distribution pain that occurs with prominent ipsilateral cranial autonomic features

24
Q

What are some autonomic features which may occur in an autonomic trigeminal cephalgia?

A

Facial sweating, ptosis, miosis, nasal stuffiness, N+V, tearing, eyelid oedema

25
Q

Describe the classic presentation of a cluster headache?

A

A one-sided, retro-orbital stabbing pain with ipsilateral cranial autonomic features

26
Q

Who is cluster headache most likely to occur in?

A

Those aged 30-40, four times more common in men

27
Q

When is a cluster headache most likely to occur? During a bout, what can trigger a headache?

A

At night, during a bout headaches can be triggered by alcohol

28
Q

What is the average duration of a cluster headache? How often do they occur in a day during a cluster?

A

45-90 minutes, occurring 1-8 times a day

29
Q

How long can a bout of cluster headaches last for?

A

A few weeks - months (followed by a prolonged period of remission)

30
Q

How will patients with a cluster headache act?

A

Agitated and restless

31
Q

The facial pain in a cluster headache is caused by the activation of which nerve? The autonomic features of cluster headache are caused by activation of which nerve?

A

CNV1 / Parasympathetics of CNVII

32
Q

What investigations should all patients with a new trigeminal autonomic cephalgia undergo?

A

MRI brain and MR angiogram

33
Q

Why should all patients with a new trigeminal autonomic cephalgia have an MRI scan?

A

It can rarely be caused by a lesion in the hypothalamus

34
Q

How are cluster headaches treated in the acute phase?

A

100% high flow oxygen for 20 minutes and 6mg S/C sumatriptan

35
Q

How are cluster headaches prevented?

A

A reducing course of steroids for 2 weeks and then verapamil for prophylaxis

36
Q

What is the outcome of cluster headaches?

A

Can go on for life or can go into remission, even after many years of headaches

37
Q

Who is paroxysmal hemicrania most likely to occur in?

A

Older adults aged 50-60, more common in females

38
Q

What is the difference between paroxysmal hemicrania and cluster headache?

A

Paroxysmal hemicrania causes more frequent headaches but with a shorter duration

39
Q

How is paroxysmal hemicrania treated? What is important to know about this?

A

Indomethacin 50mg tds - this is an absolute response

40
Q

What is SUNCT?

A

Short lived, unilateral, neuralgiform headache with conjunctival injection and tearing (a TAC)

41
Q

What can be used to treat SUNCT?

A

Lamotrigine or gabapentin

42
Q

Who is trigeminal neuralgia most common in?

A

Elderly (> 60), more common in females

43
Q

What triggers trigeminal nerualgia?

A

Touch, usually of the V2/V3 area of the face

44
Q

What type of pain will trigeminal neuralgia cause?

A

Severe unilateral stabbing/shooting pain

45
Q

How long will an episode of trigeminal neuralgia last for? How often does this occur in a day?

A

1-90 seconds / 10-100 times a day (this can last for weeks-months before remission)

46
Q

What is the most common cause of trigeminal neuralgia?

A

An abnormal blood vessel (superior cerebellar artery) touching the trigeminal nerve which irritates and demyelinates it, causing abnormal neuronal discharges in response to normal stimulation

47
Q

What investigation is used for trigeminal neuralgia and why?

A

MRI brain - to check for a lesion of the trigeminal nucleus or nerve root e.g. MS, stroke, tumour

48
Q

How can trigeminal neuralgia be treated?

A

Carbamazepine or gabapentin - can also be treated surgically with ablation or decompression

49
Q

What is a thunderclap headache?

A

A headache which has a near immediate onset and reaches peak severity in seconds

50
Q

What are some associated features of a thunderclap headache?

A

Nausea or vomiting and phono/photophobia

51
Q

Thunderclap headache is treated as potential what until proven otherwise?

A

Subarachnoid haemorrhage

52
Q

What is the management of a thunderclap headache?

A

Immediate clinical assessment and imaging, most likely a plain CT

Neurology- Clinical (31 decks)

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