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Year 2 - Nervous > Headache > Flashcards

Headache Flashcards

1
Q

2 broad categories of headaches

A

Primary

Secondary

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2
Q

What is a primary headache/ cause

A

Headache that is due to the headache condition itself and not due to another cause

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3
Q

What is a secondary headache

A

Headache that is present because of another condition, i.e. a structural or biochemical cause

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4
Q

Name 3 primary headaches

A

Tension type headache
Migraine
Trigeminal autonomic cephalalgias, e.g. cluster headache

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5
Q

Name examples of trigeminal autonomic cephalagias (4) + name the most common one

A

Cluster headache - most common

Paroxysmal hemicranias

SUNCT (Short lasting unilateral headache with conjunctival injection & tearing)

SUNA (Short lasting unilateral headache with autonomic symptoms)

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6
Q

Name causes of secondary headaches (6) + name the secondary headaches that they cause

A

Brain tumour
Meningitis
Cerebrovascular disorders, e.g. aneurysm/haemorrhage
Systemic infection, e.g. sinus headache
Head injury, e.g. post-traumatic headache
Drug-induced, e.g. medication overuse headache, spinal headache (after epidural)

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7
Q

Name conditions that cause secondary headaches (7)

A 
Trigeminal neuralgia
Subarachnoid haemorrhage
Meningitis
Encephalitis
Space occupying lesions/raised ICP
Intracranial hypotension
Giant cell arteritis
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8
Q

What headache does subarachnoid haemorrhage cause

A

Thunderclap headache (secondary)

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9
Q

What is the most frequent non-disabling/ disabling primary headache +

A

Tension type headache

Migraine - disabling

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10
Q

What is a migraine

A

Chronic, genetically determined, episodic neurological disorder that usually presents in early-to-mid life

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11
Q

What is the headache from a migraine thought to be caused by

A

Activation and sensitisation of the trigeminal sensory neurons

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12
Q

Triggers of migraine (4)

RF of migraine (4)

(slightly different things)

A

Stress
Lack of sleep
High caffeine intake
Changes in oestrogen level

Female
FH
Obesity
Overuse of headache medication

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13
Q

People with migraine are … to normal stimuli due to what

A

Hyper-responsive

Enhanced cortical responsiveness

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14
Q

Causes of enhanced cortical responsiveness in people with migraine (2)

A

Insufficient cortical inhibition

Reduced pre-activation of sensory cortices

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15
Q

Name the 4 phases of a migraine + label which 2 of these are pre-headache phases

A

Premonitory phase (pre-headache phase)
Aura phase (also pre-headahce)
Headache phase
Postdrome ( post-headache)

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16
Q

List some pre-monitory symptoms that may be predictors of a migraine attack (4)

A

Mood alteration
Food cravings
Fatigue
Increased irritability to light/sound

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17
Q

Does the aura phase occur in every migraine attack

A

No

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18
Q

What is aura

A

Term used to describe focal reversible neurological symptoms of a migraine that precedes the headache, e.g. visual, sensory, motor or speech symptoms

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19
Q

Name 3 types of aura (focal reversible neurological symptoms of a migraine that precedes the headache) + list symptoms that can occur during the aura phase of a migraine (5)

A

Visual - vision loss, blind spots, hemianopia - VISUAL IS MOST COMMON AURA
Sensory - paraesthesia
Motor - weakness on one side

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20
Q

An aura is not always followed by a headache - name this type of migraine

A

Acephalic migraine (migraine aura without headache)

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21
Q

What can the aura phase of a migraine often be confused with

A

TIAs

because also sudden onset, loss of function

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22
Q

What is the headache phase of a migraine attack subdivided into + describe the clinical features of each (2) (4)

A

Early phase - mild pain, no other symptoms

Advanced phase - moderate to severe pain + other symptoms (nausea, photophobia, functional disability)

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23
Q

Describe the postdrome phase of migraine attack (2)

A

Migraine associated symptoms may still be occurring after headache has resolved

Involves functional disability for 1 or 2 days

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24
Q

Clinical features of a migraine

  • characteristics of the pain (4)
  • migraine associated symptoms (3)

Headache of a migraine must have at least 2 of the pain characteristics and at least 1 of the migraine associated symptoms

A

Unilateral
Pulsating
Moderate or severe pain
Aggravated by routine/simple physical activity

Nausea
Photophobia
Phonophobia

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25
Q

Define criteria of a chronic migraine (3)

A

Headache for ≥ 15 days per month, of which ≥ 8 days have to be migraine, for more than 3 months

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26
Q

Do associated migraine symptoms improve/worsen in people with chronic migraine (2)

A

Improve

Become less frequent and less severe

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27
Q

Symptoms (3) /signs (3) of a migraine in adults

A

Prolonged headache - UNILATERAL PULSATILE PAIN
Nausea
Functional disability

Photophobia
Photophobia
Headache worse with activity

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28
Q

Signs of migraine in children (3)

A

Confusion
Ataxia
Aphasia

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29
Q

What does chronic migraine often cause and ultimately what other type of headache does this lead to

A

Medication overuse

Leads to medication overuse headache (secondary headache)

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30
Q

Are migraines unilateral or bilateral

Are tension type headaches unilateral or bilateral

A

Unilateral

Bilateral

31
Q

Clinical features of a tension type headache (5)

  • pain characteristics (4)
  • other symptoms
A

Bilateral
Generalised head pain, but often frontal or occipital
Non-pulsatile
Constricting pain - feels like a tight band

Tenderness of head, neck and muscles of mastication

32
Q

Abortive (acute attack) (3)
+
preventative (ongoing chronic*) (2)

treatment of tension type headaches (TTH)

*chronic tension headache = >7 a month

A

Abortive treatment:
Aspirin or paracetamol or NSAIDs

Preventative: (rarely used)
Tricyclic antidepressants
-Amitryptiline
-Doxepin

33
Q

Abortive (acute attack) (3)
+
preventative (ongoing) (4)

treatment of migraines

A

Abortive:

  • Aspirin or NSAIDs - for mild acute attack
  • Triptans - for severe acute attack

Preventative (ongoing):

  • propanolol - beta blocker
  • anti-convulsants - topiramate
  • tricyclic antidepressants - amitryptiline
  • antidepressant - venlafaxine (if have co-existing depression)
34
Q

How long is abortive treatment for headaches used

A

10 days a month to prevent medication overuse headache

35
Q

Treatment of migraine in pregnant people (2)

A

Paracetamol only

Avoid triggers

36
Q

Anti-epileptics (e.g. sodium valproate, lamotrigine, topiramate, carbamazepine, levetericetam) shouldn’t be given to what people

A

Women of child bearing age

37
Q

What are trigeminal autonomic cephalalgias

A

A group of headache disorders characterised by attacks of unilateral pain in the head or face
+ associated IPSILATERAL cranial AUTONOMIC features such as eye watering, redness, rhinorrhoea, nasal congestion, and ptosis

38
Q

Cranial autonomic signs (7) of trigeminal autonomic cephalalgias

A 
Conjunctival injection
Lacrimation
Nasal congestion/rhinorrhoea
Eyelid oedema
Forehead + facial sweating
Miosis (constriction of pupil)
ptosis
39
Q

What division of CN V is involved in trigeminal autonomic cephalalgias

A

CN V1 - ophthalmic

40
Q

Cluster headaches

  • duration
  • frequency
  • pattern throughout year
A

Longest and least frequent of all the TACs

Last 15 mins - 3 hours
Up to 8 attacks a day
Last average 3 months then remission of up to a year; could be just a month

41
Q

What do cluster headache attacks correlate with physiologically

A

Circadian rhythm - attacks usually occur same time each day and the bout occurs same time each year

42
Q

Symptoms /signs of cluster headaches

  • pain (characteristic, location)
  • other symptoms (4)
  • autonomic signs (6)
A

Excruciating (sharp stabbing, burning) UNILATERAL pain localised to the orbital, supra-orbital, and/or temporal areas

Associated symptoms - nausea, vomiting, photophobia, agitation/restless

Ipsilateral autonomic signs:
•	conjunctival injection 
•	Lacrimation
•	Rhinorrhoea
•	eyelid oedema/swelling
•	facial sweating
•	ptosis
43
Q

Treatment of cluster headaches

  • abortive treatment of an acute attack (2)
  • acute attack suppression (2)
  • preventative treatment/ongoing treatment (3)
A

Abortive treatment of acute attack:
• Subcutaneous sumatriptan (triptan)
• Supplemental oxygen

Acute attack suppression:
• Greater occipital nerve (GON) block - mixture of steroid + LA injected into GON on symptomatic side
• Prednisolone

Preventative:
• Verapamil - CCB - 1ST LINE, OR
• Lithium OR
• Topiramate - anticonvulsant

44
Q

Pain character of:

  • Cluster headache
  • Paroxysmal hemicrania
  • SUNCT
A

Sharp throbbing
Sharp throbbing
Stabbing burning, pulsating

45
Q

Symptoms (1) /signs (7) of paroxysmal hemicranias

-pain (characteristic, location)

A

Excruciating unilateral pain localised to orbital and temporal areas

Ipsilateral cranial autonomic signs (7) - see other flashcard

46
Q

Duration/frequency of paroxysmal hemicranias (PH)

A

2-30 mins - shorter than cluster

1-40 attacks a day - more frequent than cluster (up to 8)

47
Q

Paroxysmal hemicranias are more often chronic or episodic

A

Chronic

48
Q

Treatment of paroxysmal hemicranias (2) + what drug does PH respond to very well*

A

*Indomethacin - eliminates symptoms

Anti-epileptic - topiramate

49
Q

Symptoms (1) /signs of short lasting unilateral headache with conjunctival injection + tearing (SUNCT) (8) + where is pain localised
-pain (characteristic, location)

A

Excruciating unilateral pain located in orbital, supraorbital and temporal area

Ipsilateral autonomic signs (8)

50
Q

Duration/frequency of SUNCT

A

5 secs - 3 mins

3 - 200 attacks a day

51
Q

Triggers of SUNCT/SUNA (4)

A

Wind
Cold
Touch
Chewing

52
Q

Name the 3 patterns of attacks in SUNCT

A

single stab attacks;

groups of stabs;

saw-tooth pattern - group of stabs occurring in quick succession such that the pain does not return to baseline between stabs

53
Q

Abortive/preventative (4) treatment of SUNCT/SUNA

A

No abortive treatment

Preventative with anti-convulsants/epileptics:
Lamotrigine, 
Topiramate
gabapentin
Carbamazepine
54
Q

What is trigeminal neuralgia

A

Facial pain syndrome of the areas innervated by the trigeminal nerve

55
Q

2 causes of trigeminal neuralgia

A

Compression of CN V often due nearby blood vessel

MS - loss of myelin of CN V

56
Q

What divisions of CN V are involved in trigeminal neuralgia

A

CN V2 & V3

57
Q

Symptoms of trigeminal neuralgia

-pain (characteristic + location)

A

Severe sharp stabbing FACIAL PAIN in the lower face - jaw, teeth and gums

NO AUTONOMIC SYMPTOMS/SIGNS

58
Q

Duration/frequency of trigeminal neuralgia

A

5 secs - 10 secs

3 - 200 attacks a day

59
Q

Treatment of trigeminal neuralgia

  • abortive treatment
  • preventative (ongoing) treatment (2)
  • surgical treatment if medication unresponsive (2)
A

No abortive treatment - just prescribed with anticonvulsants when diagnosed

Prophylaxis with anti-convulsants:
• carbamazepine OR oxcarbazepine

Surgical intervention:
• Microvascular decompression
• Ablative surgery - e.g. steriotactic radiosurgery

60
Q

Triggers of trigeminal neuralgia (4) - same as SUNCT triggers

A

Touching your face
Wind
Chewing
Cold

61
Q

List some red flags of secondary headaches (6)

A 
New onset headache
Change in headache frequency or character
Focal neurological symptoms
Neck stiffness/fever
Hypotension
Giant cell arteritis
62
Q

Symptoms/signs of a thunderclap headache caused by subarachnoid haemorrhage
+ duration of headache

A

High intensity headache reaching max intensity in less than a min and lasts for at least an hour

63
Q

Differentials of a thunderclap headache (subarachnoid haemorrhage isn’t the only cause) (4)

A

Primary headache - migraine, primary exertion headache
Subarachnoid haemorrhage
TIA/stroke
Carotid/vertebral dissection

64
Q

Treatment of thunderclap headache caused by subarachnoid haemorrhage (4)

A

Surgical clipping of aneurysm or endovascular coil embolisation
CCBs
Anticonvulsants

65
Q

Causes of a headache due to raised ICP/space occupying lesion (4)

A

Tumour - e.g. GBM, meningioma
Haemorrhage
Cerebral abscess
Hydrocephalus

66
Q

Clinical features of a headache caused by raised ICP/space occupying lesion (4)

A

Headache worse in morning
Headache worse lying flat or brought on by valsalva (cough, strain)
Focal symptoms/signs
Seizures

67
Q

Cause of intracranial hypotension

A

Dural CSF leak either spontaneous or iatrogenic (e..g post LP)

68
Q

What improves/worsens a low pressure headache (i.e. a headache caused by intracranial hypotension)

A

Improves when lying down

Worsens when upright

69
Q

Treatment of a headache caused by intracranial hypotension (5)

A 
Bed rest
IV fluids
Analgesia
IV caffeine - to raise CSF pressure
Epidural blood patch - injecting a sample of your own blood into the epidural space; clotting factors of the blood close the hole in the dura
70
Q

Where is the headache localised in giant cell arteritis

A

Temporal areas

71
Q

What condition is giant cell arteritis associated with

A

Polymyalgia rheumatica

72
Q

Symptoms of polymyalgia rheumatic (2)

A

Aching and stiffness in the neck, shoulders, hips, and proximal extremities

73
Q

Treatment of a headache caused by giant cell arteritis

A

High dose prednisolone

74
Q

Investigations of giant cell arteritis (4)

A

ESR - raised
CRP - raised
FBC
Temporal artery biopsy - definitive diagnosis

Year 2 - Nervous (39 decks)

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