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09- Neurology > Headache > Flashcards

Headache Flashcards

1
Q

what are red flags for headache?

A

new onset >55

known/previous malignancy

immune-suppressed

early mornign headache

exacerbation by valsalva

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2
Q

are migraines unilateral or bilateral?

A

unilateral

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3
Q

who is most commonly affected by migraines?

A

young women

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4
Q

what can trigger a migraine and what is a useful way to identify them?

A

triggers: sleep, diet, stress, hormones, exercise

headache diary

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5
Q

what is a migraine with aura?

A

sensory distrubance

lasts arounf 20-60mins

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6
Q

what are the three kinds of visual aura?

A

central scotomata

central fortification

hemianopic loss

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7
Q

describe central socotomata

A

area of depresed vision (blurring) on focus point of vision

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8
Q

describe central fortification

A

images floating (zig-zag pattern)

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9
Q

describe hemianopic loss

A

loss of vision on one side

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10
Q

what is an acephalgic migraine?

A

migraine aura without the headache

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11
Q

what is a basialr migraine?

A

vertigo, nausea

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12
Q

release of what substance is thought to cause migraines?

A

release of substance P, neurokinin A, CGRP → irritates blood vessels

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13
Q

how is migraine diagnosed?

A

at least 5 attacks

lasting 4-72 hours

mod/severe unilateral, throbbing pain

worse on movement

1 of photophobia/phonophobia

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14
Q

what are the non-pharmacological treatment options for migraine?

A

avoid triggers

headache diary

relaxtion

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15
Q

what are the pharmacoloigcal treatment options for migraine?

A

NSAID- take as early as possible to reduce headache

triptans- 5-HT agonist

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16
Q

what can be given as prophylaxis in migraines?

A

propanolol (avoif in asthma/HF)

topiramate carbonic anhydrase inhibitor

amitriptyline tricyclic antidepressant

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17
Q

how many migraine attacks warrant prophylactic treatment?

A

>3 attacks a month

(must trial each drug for minimum of 4 months)

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18
Q

describe tension headache

A

episodic

pressign tingling quality

mild-moderate

bilateral

no N&V

19
Q

is photophobia/phonophobia present in tension headaches?

A

NO

20
Q

what triggers tension headache?

A

usually environmental i.e. stress

21
Q

what is autonomic cephalgia?

A

group of primary headahce disorders characterised by unilateral trigeminal ditribution pain

22
Q

what investigation do people with suspected TCA require?

A

MRI of head and MR angiogram of the brain

23
Q

what are the different types of trigeminal autonomic cephalgias (TAC)?

A

cluster headaches

paroxysmal hemicrania

SUNCT

idiopathic intracranial hypertension

trigeminal neuralgia

24
Q

who is most commonyl affected by cluster headaches?

A

young males mostly 30/40s

25
Q

are cluster headaches bliateral/unilateral?

A

unilateral

26
Q

how often do cluster headaches occur and for how long do they last?

A

1-4 a day, for days to weeks

severe lasting 30mins -2 hrs

27
Q

what pattern can be seen in cluster headaches?

A

circadian

seasonal (spring and autumn)

28
Q

what is the treatment for cluster headaches?

A

sub cut triptan and oxygen in acute

steroids for 2 weeks

verapamil as prophylactic

29
Q

who is affected by paroxysmal hemicrania?

A

elderly 50/60s

women > men

30
Q

how would you describe a paroxysmal hemicrania?

A

severe unilateral headache

31
Q

what is the frequency of paroxysmal hemicrania?

A

1-40 day

lasts 10-30mins

32
Q

what is the treatment for paroxysmal hemicrania?

A

indomethacin

33
Q

hwo do you differentiate between cluster headaches and paroxysmal hemicrania both of which are severe unilateral headaches?

A

paroxysmal hemicrania has shorter duration and much more frequent than cluster

34
Q

how do you treat SUNCT?

A

lamotrigine

gabapentin

35
Q

what is SUNCT?

A

Short lived Unilateral Neuralgiform headache with Conjuctival infection and Tearing

36
Q

what is idiopathic intracranial hypertension?

A

increased intracranial pressure

37
Q

what variation is seen in intracranial hypertension?

A

headaches w diurnal variation

38
Q

how is intracranial hypertension investigated?

A

fundoscopy

visual field testing

LP

MRI head

39
Q

who suffers trigeminal neuralgia?

A

tends to be older females

40
Q

how would you describe the pain in trigeminal neuralgia?

A

severe stabbing pain

unilateral

41
Q

what triggers trigeminal neuralgia?

A

triggered by touch

42
Q

how long does trigeminal neuralgia last and how often does it occur?

A

lasts 1-90s occuring 10-100 times a day

43
Q

what is the treatment for trigeminal neuralgia?

A

carbamazepine, gabapentin

can surgically intervene with ablation or decompression

09- Neurology (16 decks)

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