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Neurology > Headache > Flashcards

Headache Flashcards

1
Q

State the difference between a primary and a secondary headache and give some examples of each

A

Primary headache- no underlying medical cause-tension type headache, migraine, cluster headache
Secondary headache- has an identifiable structural or biochemical cause- tumour, meningitis, head injury

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2
Q

Describe the characteristics of a tension-type headache

A

Mild, bilateral headache which is often pressing or tightening in quality and has no significant associated features and is not aggravated by routine physical activity

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3
Q

How are tension-type headaches treated?

A

Abortive treatment- aspirin/paracetamol or NSAIDS (Limit to 10 days per month to avoid medication overuse headache)
Preventative treatment- tricyclic antidepressants (rarely required)

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4
Q

What are the common triggers of migraines?

A 
Stress
Hunger
Sleep disturbance
Dehydration
Diet
Environmental stimuli
Changes in oestrogen level in women
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5
Q

What are the symptoms of migraine?

A

During attacks- headache, nausea, photophobia, phonophobia, functional disability
In-between attacks- Anticipatory anxiety

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6
Q

What are the different stages of a migraine?

A 
Premonitory
Aura
Early headache
Advanced headache
Postdrome
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7
Q

What are the characteristics of the premonitory phase of a migraine?

A 
Mood changes
Fatigue
Cognitive changes
Muscle pain
Food craving
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8
Q

What are the characteristics of the aura phase of a migraine?

A

Fully reversible
Neruological changes
Visual somatosensory

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9
Q

What are the characteristics of the early headache phase of a migraine?

A

Dull headache
Nasal congestion
Muscle pain

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10
Q

What are the characteristics of the advanced headache phase of a migraine?

A 
Unilateral
Throbbing
Nausea
Photophobia
Phonophobia
Osmophobia
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11
Q

What are the characteristics of the postdrome phase of a migraine?

A

Fatigue
Cognitive changes
Muscle pain

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12
Q

How long does aura tend to last and what are its symptoms?

A

15-60 minutes

Sudden onset loss of function affecting visual, sensory motor or speech systems

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13
Q

How is chronic migraine defined?

A

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

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14
Q

What are the characteristics of a transformed migraine?

A

History of episodic migraine
Increasing frequency of headaches over time
Migrainous symptoms become less frequent and more severe

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15
Q

What are the causes of medication overuse headache?

A

Use of triptans, ergots, opioids and combination analgesics >10 days/month
Use of simple analgesics >15 days/month
Caffeine overuse

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16
Q

What are the characteristics of medication overuse headache?

A

Headache present on at least 15 days/month which has developed or worsened whilst taking regular symptomatic medication

17
Q

What is the abortive treatment for migraines?

A

Aspirin or NSAIDs
Triptans
Limit to 10 days per month

18
Q

What is the prophylactic treatment for migraines?

A

Propanolol, candesartan
Anti-epileptics
Tricyclic antidepressants
Venlafaxine

19
Q

How is migraine treated in pregnancy?

A

Acute attack- paracetamol

Preventative- propanolol or amitriptyline

20
Q

What are the characteristics of cluster headaches?

A

Excruciating pain that is mainly orbital and temporal, and is strictly unilateral
Rapid onset
Lasts 15 mins to 3 hours
Patients are restless and agitated during attack
Prominent ipsilateral autonomic symptoms

21
Q

How are episodic cluster headaches characterised?

A

Attacks cluster into bouts lasting 1-3 months with periods of remission lasting at least a month
Attack frequency ranges from 1 every other day to 8 per day
May be continuous pain between attacks
Attacks occur at the same time each day and bouts occur at the same time each year

22
Q

How are chronic cluster headaches characterised?

A

Bouts last longer than a year without remission
OR
Remissions last less than a month

23
Q

What are the characteristics of paroxysmal hemicrania?

A

Excruciating pain that is mainly orbital and temporal and strictly unilateral
Rapid onset and last 2-30mins
~50% patients are restless and agitated during an attack
Prominent ipsilateral symptoms
2-40 attacks per day with no circadian rhythm

24
Q

What are the characteristics of SUNCT?

A

Short-acting unilateral nerualgiform headache with conjunctival injection and tearing (SUNCT)
Unilateral orbital, supraorbital or temporal pain
Stabbing or pulsating pain
10-240 second duration
Cutaneous triggers- wind, cold, touch, chewing
Attack frequency ranges from 3-200/day with no refractory period
Pain accompanied by conjunctival injection and lacrimation

25
Q

What are the characteristics of trigeminal neuralgia?

A

Unilateral maxillary or mandibular division pain
Stabbing pain
5-10 second duration
Cutaneous triggers- wind, cold, touch, chewing
Attack frequency ranges from 3-200/day with a refractory period

26
Q

How can cluster headaches be managed?

A 
Abortive (headache)- subcutaneous sumatriptan or nasal zolmatriptan
100% oxygen at 7-12L/min
Abortive (headache bout)- Occipital depomedrone injection (same side as headache)
Tapering course of prednisone
Preventative- 
Verapamil
Lithium
Methysergide
Topiramate
27
Q

How can paroxysmal hemicrania be managed?

A

No abortive treatment

Prophylaxis with indometacin, COX-II inhibitors or topiramate

28
Q

How can SUNCT be managed?

A 
No abortive treatment
Prophylaxis-
Lamotrigine
Topiramate
Gabapentin
Carbamazepine/oxcarbazepine
29
Q

How can trigeminal neuralgia be treated?

A 
No abortive treatment
Prophylaxis- carbamazepine or oxcarbazepine
Surgical intervention:
-Glycerol ganglion injection
-Steriostatic radiosurgery
-Decompressive surgery
30
Q

What presentations of a secondary headache indicate a sinister cause?

A 
Associated head trauma
First or worst
Sudden/thunderclap onset
New daily persistent headache
Change in headache pattern or type
Returning patient
31
Q

How is a thunderclap headache characterised?

A

A high intensity headache reaching maximum intensity in under a minute

32
Q

What are the warning features of a headache caused by a space occupying lesion or raised intracranial pressure?

A

Headache worse when the patient wakens from sleep
Headache worse lying flat
Headache brought on by valsalva (cough, straining etc)
Focal symptoms or signs
Seizures
Visual obscurations and pulsatile tinnitus

33
Q

What are the characteristics of intracranial hypotension?

A

Clear postural component to the headache that may be lost when headache becomes chronic

34
Q

How is intracranial hypotension investigated and managed?

A

Investigation- MRI brain and spine
Treatment- Bed rest, fluids, analgesia
IV caffeine
Epidural blood patch

35
Q

When should giant cell arteritis be considered?

A

In any patient over 50 presenting with new headache

36
Q

What are the characteristics of giant cell arteritis?

A 
Diffuse, persitent and sometimes severe headache
Patient systemically unwell
Scalp tenderness
Jaw claudication
Visual disturbance
37
Q

How should giant cell arteritis be investigated and managed?

A

Elevated ESR supports diagnosis
Raised CRP and platelet count also useful markers
High dose prednisolone started and take a temporal artery biopsy

Neurology (29 decks)

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