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Neurology > Headache > Flashcards

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
Q

what are the non pharmological treatments for migraines

A 
education- avoid triggers 
ha diary 
relaxation/ stress management 
healthy diet 
hydration 
reduce caffeine 
exercise
26
Q

what are the acute/ abortive pharmalogical treatments for migraines

A 
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
Q

what are the prophylaxic treatments for migraines

A

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
Q

when do you gove migraine prophylaxs

A

3 attacks per month or if very severe

29
Q

what are the side effecrts of amitriptyline

A

dry mouth
postural hypotension
sedation
light headedness

30
Q

who do you not give a beta blocker to

A

asthmatics, PVD, heart failure

31
Q

what is topiramate and what are its side effects

A

carbonic anhydrase inhibitor

nasty drug
weight loss, paraesthesia, impaired concentration, enzyme inducer, probably teratogenic

32
Q

what are the rarer types of migraine

A 
acephalgic- aura
basilar- vertigo,, get unsteady 
retinal 
ophthalmic 
hemiplegic (familial/ sporadic)- get symptoms similar to stroke, encephalopathic 
abdominal- children, recurrent abdo pain
33
Q

is migraine unilateral or bilateral

A

unilateral

34
Q

what are the features of a tension headache

A 
can be episodic or chronic
pressing tingling sensation 
bilateral 
mild to moderate pain 
absence of N&amp;V
absence of photophobia or phonophobia
35
Q

what is the treatment for tension type headaches

A

relaxation physio
antidepressant
-dothiepin or amitriptyline
-3 month review

reassure

36
Q

what causes tension headaches

A

often stressors

37
Q

what are the trigeminal autonomic cephalgias (TACs)

A

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
Q

what is a primary headache

A

one not caused by a tumour

39
Q

what are the ispilateral autonomic features seen in trigeminal autonomic cephalgias

A 
ptosis 
miosis 
nasal stuffiness
N/V
tearing 
eye lid oedema
40
Q

what are the four main types of trigeminal autonomic cephalgias

A

cluster
paroxsymal hemicrania
hemicrania continua
SUNCT (short lived unilateral neuralgiaform headache, conjunctival injections, tearing)

41
Q

who gets cluster has

A

young (30-40s)

men> women

42
Q

what are the features of a cluster ha

A

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
Q

what is the treatment for a cluster ha

A

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
Q

who gets paroxysmal hemicrania

A

older (50s-60s)

women> m3n

45
Q

what are the features of paroxysmal hemicrania

A

severe unilateral headache
unilateral autonomic features
lasts 10-30 mins
1-40 a day

(shorter duration and more frequent than cluster has)

46
Q

what is the treatment for paroxysmal hemicrania

A

responds v well to indomethicin (used to diagnose)

47
Q

what is SUNCT

A 
short lived (15-120 seconds)
unilateral 
neuralgiaform headache
conjunctival injections 
tearing
48
Q

what is the treatment for SUNCT

A

lamotrigine

gabapentin

49
Q

what investigations for those with new onset unilateral cranial autonomic features

A

always do MRI brain and MR angiogram

50
Q

who gets idiopathic intracranial hypertension

A

F>m

obese

51
Q

what are the symptoms of idiopathic intracranial hypertension

A

headache (diurnal variation, worse when they wake up, morning N&V)
visual loss- enlarged blind spot

52
Q

what investigations do you do into idiopathic intracranial hypertension

A

MRI with MRV sequence (should be normal)
cerebrol spinal fluid (elevated pressure, normal constituents)
visual fields

53
Q

when is the only time you do a lumbar puncture in raised ICP

A

IIH- do scan of brain first to make sure its normal

54
Q

what is the treatment for IIH

A 
weight loss 
acetazolamide 
ventricular atrial/ lumbar peritoneal shunt  (only if patient going blind as 
problematic)
monitor visual fields and CSF pressure
55
Q

who gets trigeminal neuralgia

A

elderly (>60)

women> men

56
Q

what are the features of trigeminal neuralgia

A 
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
Q

what is the treatment for trigeminal neuralgia

A

carbamazepine
gabapentin
phenytoin
baclofen

surgically:

  • abalation
  • decompression
58
Q

what investigations in trigeminal neuralgia

A

MRI brain

59
Q

what other than trigeminal neuralgia should you consider in facial pain

A

eyes, ears, sinuses, teeth, TMJ etc

60
Q

what is the 1st line for uncomplicated migraines

A

symptomatic NSAIDs

Neurology (35 decks)

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