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Headache Flashcards

1
Q

what is the exam usually like in headache

A

normal

expect in tumours

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2
Q

name the ha:

visual disturbance, sub acute onset headache, dark rooms make it better

A

migraine

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3
Q

name the ha:

Headache every time you stood up and fine when you sat down

A

low ICP

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4
Q

name the ha:

Every time you lie down heachache and when stand up fine, wakes you up in morning

A

high ICP

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5
Q

name the ha:

Make, smoker, one sided headache v sore that lasts half an hour

A

cluster ha

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6
Q

name the ha:

non specific, pain 2 on scale

A

stress ha

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7
Q

what are the associated factors you should ask about

A

Autonomic features (N+V), photophobia, phonophobia, positive visual symptoms, ptosis, miosis, nasal stuffiness

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8
Q

what are the ha exacerbating factor you should ask about

A

Posture, valsalva (sneezing, coughing, straining etc). Diurnal variation.

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9
Q

who does a migraine most commonly affect

A

young females

worse in teenage years/ early 20s then worse again in 40s/50s

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10
Q

what are the red flags for headaches

A

new onset >55
known/ previous malignancy
immunosuppressed (worry about intracranial infection)
early morning ha
exacerbated by valsalva (coughing, sneezing= raised ICP)

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11
Q

what past medical history is important in has

A

previous cancer

predisposition to thrombosis

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12
Q

why is social history important in ha

A

as problems can manifest as pain

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13
Q

how often do people usually get migrinaes

A

once a month

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14
Q

what are the diagnostic (IHS criteria) features for a migraine without aura

A

at least 5 attacks
lasts 4-72 hours

2 of:
-moderate/ severe, unilateral, throbbing pain, worse on movement

1 of:
-autonomic features, photo/phono phobia

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15
Q

when is migraine pain worse

A

evolves from on set, not worse at start

reaches 6/7 out of 10 pain

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16
Q

what is the pathophysiology of a migraine

A

both vascular and neural influences
have to be susceptible patient
stress trigger changes in brain- release of serotonin
blood vessels constrict and dilate
chemical including substance P irritate nerves and blood vessels causing pain

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17
Q

what is the pathophysiology of a migraine with aura

A
  • cortical spreading depolarisation
  • activation trigeminal vascular system - dilation of cranial blood vessels
  • release of substance P, neurokinin A, CGRP
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18
Q

where is the migraine centre

A

dorsal raphe nucleus and the locus coeruleus

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19
Q

how many migraines have an aura

A

20%

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20
Q

what is an ‘aura’

A

fully reversible visual, sensory, motor or language symtoms

visual most common

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21
Q

what language symptoms can you get with migraine

A

speech problems

word finding difficulties

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22
Q

how long does an aura usually last

A

20-60 mins, headache follows < 1 hour later (but can occur simultaneously)

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23
Q

what types of visual aura can you get

A

central scotomata
central fortification
hemianopic loss

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24
Q

what are the migraine tiggers

A 
sleep 
dietary (chocolate, cheese, alcohol) 
stress 
hormonal (menstrual)
physical exertion

(ha diary helpful to identify)

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25
what are the non pharmological treatments for migraines
``` education- avoid triggers ha diary relaxation/ stress management healthy diet hydration reduce caffeine exercise ```
26
what are the acute/ abortive pharmalogical treatments for migraines
``` NSAID: -aspirin 900mg, -naproxen 250mg, -ibruprofen +/- anti emetic if gastroparesis take asap ``` Triptans -5HT agonist (Rizatriptan= eletriptan > sumatriptan) Oral, sub-lingual, subcutaneous- consider method of administration in those with N+V treat at start of headache similar efficacy to NSAIDS
27
what are the prophylaxic treatments for migraines
amitriptyline (10-25mg) propanalol (80-240mg) topiramate (25-100mg) titrate drug as tolerated to achieve efficacy at the lowest dose possible Must trial each for minimum of 3 months Consider non-pharmacological methods such as acupuncture, relaxation exercises others inc- gabapentin, pizotifen, Na valporate, botox (given if 3 failed medicines), monoclonal antibodies
28
when do you gove migraine prophylaxs
3 attacks per month or if very severe
29
what are the side effecrts of amitriptyline
dry mouth postural hypotension sedation light headedness
30
who do you not give a beta blocker to
asthmatics, PVD, heart failure
31
what is topiramate and what are its side effects
carbonic anhydrase inhibitor nasty drug weight loss, paraesthesia, impaired concentration, enzyme inducer, probably teratogenic
32
what are the rarer types of migraine
``` acephalgic- aura basilar- vertigo,, get unsteady retinal ophthalmic hemiplegic (familial/ sporadic)- get symptoms similar to stroke, encephalopathic abdominal- children, recurrent abdo pain ```
33
is migraine unilateral or bilateral
unilateral
34
what are the features of a tension headache
``` can be episodic or chronic pressing tingling sensation bilateral mild to moderate pain absence of N&V absence of photophobia or phonophobia ```
35
what is the treatment for tension type headaches
relaxation physio antidepressant -dothiepin or amitriptyline -3 month review reassure
36
what causes tension headaches
often stressors
37
what are the trigeminal autonomic cephalgias (TACs)
a group of primary headache disorders characterised by unilateral trigeminal distribution pain that occurs in association with prominent ipsilateral cranial autonomic features (is a primary headache complex)
38
what is a primary headache
one not caused by a tumour
39
what are the ispilateral autonomic features seen in trigeminal autonomic cephalgias
``` ptosis miosis nasal stuffiness N/V tearing eye lid oedema ```
40
what are the four main types of trigeminal autonomic cephalgias
cluster paroxsymal hemicrania hemicrania continua SUNCT (short lived unilateral neuralgiaform headache, conjunctival injections, tearing)
41
who gets cluster has
young (30-40s) | men> women
42
what are the features of a cluster ha
circadian (around sleep) and seasonal variation severe unilateral headache lasts 45-90 mins get 1-8 a day cluster bout may last few weeks to months severe pain, dont like to lie still
43
what is the treatment for a cluster ha
high for oxygen 100% for 20 mins (home canisters) sub cut sumatriptan 6mg steriods (reducing course over 2 weeks) verapamil for prophylaxis (all have MRI to make sure nothing there)
44
who gets paroxysmal hemicrania
older (50s-60s) | women> m3n
45
what are the features of paroxysmal hemicrania
severe unilateral headache unilateral autonomic features lasts 10-30 mins 1-40 a day (shorter duration and more frequent than cluster has)
46
what is the treatment for paroxysmal hemicrania
responds v well to indomethicin (used to diagnose)
47
what is SUNCT
``` short lived (15-120 seconds) unilateral neuralgiaform headache conjunctival injections tearing ```
48
what is the treatment for SUNCT
lamotrigine | gabapentin
49
what investigations for those with new onset unilateral cranial autonomic features
always do MRI brain and MR angiogram
50
who gets idiopathic intracranial hypertension
F>m | obese
51
what are the symptoms of idiopathic intracranial hypertension
headache (diurnal variation, worse when they wake up, morning N&V) visual loss- enlarged blind spot
52
what investigations do you do into idiopathic intracranial hypertension
MRI with MRV sequence (should be normal) cerebrol spinal fluid (elevated pressure, normal constituents) visual fields
53
when is the only time you do a lumbar puncture in raised ICP
IIH- do scan of brain first to make sure its normal
54
what is the treatment for IIH
``` weight loss acetazolamide ventricular atrial/ lumbar peritoneal shunt (only if patient going blind as problematic) monitor visual fields and CSF pressure ```
55
who gets trigeminal neuralgia
elderly (>60) | women> men
56
what are the features of trigeminal neuralgia
``` triggered by touch, usually V2/3 severe stabbing unilateral pain duration 1-90 seconds 10 to 100 times a day bouts of pain may last weeks to months before remission chewing makes it worse ```
57
what is the treatment for trigeminal neuralgia
carbamazepine gabapentin phenytoin baclofen surgically: - abalation - decompression
58
what investigations in trigeminal neuralgia
MRI brain
59
what other than trigeminal neuralgia should you consider in facial pain
eyes, ears, sinuses, teeth, TMJ etc
60
what is the 1st line for uncomplicated migraines
symptomatic NSAIDs

Neurology (35 decks)

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