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Neurology > Headache > Flashcards

Headache Flashcards

1
Q

what aspects of headache should be covered in a history

A 
SOCRATES 
unilateral/bilateral 
timing - morning 
duration 
associated with autonomic symptoms, N+V, photophobia
worsens with valsalva manoeuvres 
PMH of cancer
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2
Q

what are red flags to look out for in someone with a headache

A 
>55 yo
immunosuppressed 
previous/current known malignancy 
worse in the morning 
associated with N+V, worsens with valsalva
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3
Q

what can headaches be categorised as

A

primary and secondary headache complexes

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4
Q

list the primary headache complexes

A

migraine
tension type headache
autonomic cephalgias: cluster headache, paroxysmal hemicrania, SUNCT

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5
Q

list the secondary headache complexes

A

idiopathic intracranial hypertension

trigeminal neuralgia

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6
Q

sore head upon standing is intracranial hypo/hyper tension

A

HYPO tension

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7
Q

sore head upon lying down is intracranial hypo/hyper tension

A

HYPER tension

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8
Q

migraine with/without aura is more common

A

without aura is more common

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9
Q

IHS criteria is for defining migraine with/without aura

A

without aura

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10
Q

what is the criteria for defining migraine without aura

A

at least 5 attacks
each lasting 4-72 hours
2 of: mod/severe, unilateral, throbbing pain, worse with movement
1 of: autonomic features, photo/phonophobia

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11
Q

who gets migraines

A

females
teens / 40-50s menopausal
menstrually related

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12
Q

what is the pathophysiology of migraines

A

neurovascular problem in susceptible individuals
serotonin release causes vasoconstriction and dilatation
substance P irritates nerves and vessels causing pain

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13
Q

describe aura associated with migraines

A

fully reversible symptoms - visual, sensory, motor or language
lasts 20-60 minutes

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14
Q

triggers of migraine

A 
stress 
sleep 
diet - dark chocolate, cheese, alcohol
hormonal 
physical exertion
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15
Q

what can be used to help identify triggers of migraine

A

headache diary

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16
Q

what are the main groups of management in migraine

A

pharmacological and non-pharmacological

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17
Q

list non-pharmacological Mx of migraine

A 
avoid triggers 
stress avoidance 
headache diary 
hydration - 2L water daily 
reduce caffiene 
regular exercise
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18
Q

what is acute management of migraine

A

NSAIDs +- anti emetic

Triptans

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19
Q

why would you give an anti-emetic with NSAID in acute migraine

A

if there is gastroparesis

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20
Q

what are triptans and how do they work

A

serotonin (5HT) agonists

cause vasoconstriction of dilated vessels

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21
Q

how can triptans be administered

A

PO
SC
sublingual

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22
Q

when would you give someone migraine prophylaxis

A

if they have had more than 3 attacks per month

or very severe migraines

23
Q

what prophylaxis can be given for migraines

A

amitriptyline (tricyclic antidepressant)
propranolol (B blocker)
topiramate (anti-convulsant/carbonic anhydrase inhibitor)

24
Q

side effects of amitriptyline

A

postural hypotension
dizziness
sleepiness
dry mouth

25
Q

side effects of propranolol

A 
bronchoconstriction 
cold peripheries 
bradycardia 
sleep disturbance
GI upset 
tiredness
26
Q

when is propranolol contraindicated

A

asthma/COPD
heart failure
peripheral vascular disease

27
Q

topiramate is teratogenic, true or false

A

TRUE

28
Q

side effects of topiramate

A

weight loss
parasthesia
poor cognition
enzyme inducer

29
Q

other treatments of migraine

A 
gabapentin
pizotifen 
sodium valproate (teratogenic)
botox scalp injection 
anti CGRP Ab
30
Q

list some “fancy” types of migraine

A 
acephalgic
basilar 
retinal 
ophthalmic 
hemiplegic (familial)
abdominal (children)
31
Q

describe symptoms of tension type headache

A

bilateral
pressing/tingling pain
absence of autonomic features

32
Q

management of tension type headache

A

relaxation physiotherapy
anti-depressants: dothiepin, amitriptyline
reassurance

33
Q

what are trigeminal autonomic cephalgias (TACs)

A

group of primary headache complexes with unilateral trigeminal distribution pain along with ipsilateral cranial autonomic features

34
Q

list cranial autonomic features

A 
nasal stuffiness 
eye tearing 
ptosis 
miosis 
N+V 
eyelid oedema
35
Q

what are the 4 main types of autonomic cephalgias

A

cluster headache
paroxysmal hemicrania
hemicrania continuum
SUNCT

36
Q

who gets cluster headaches

A

men

30-40s

37
Q

symptoms of cluster headahces

A

severe unilateral pain
45-90 min
cluster bout
moving makes it better

38
Q

management of cluster headaches

A

high flow oxygen 100% for 2 min
SC sumitriptan
steroids reduced over 2 weeks

39
Q

prophylaxis for cluster headaches

A

verapamil

40
Q

who gets paroxysmal hemicrania

A

females

50-60s

41
Q

symptoms of paroxysmal hemicrania

A

severe unilateral headache
10-30 min
more frequent episodes

42
Q

management of paroxysmal hemicrania

A

very sensitive to indomethicin

43
Q

what is SUNCT

A 
Short lived 15-120 sec
Unilateral 
Neuralgiaform headache 
Conjuctival injections 
Tearing
44
Q

management of SUNCT

A

lamotrigine, gabapentin

45
Q

what investigations do those with new onset unilateral cranial autonomic features get

A

MRI brain

MR angiogram

46
Q

what is idiopathic intracranial hypertension IIH and who gets it

A

^ICP
females
obese BMI>30

47
Q

symptoms of IIH

A

headaches worse in the morning
N+V
visual loss (papilloedema needs to be checked for)

48
Q

LP is indicated in all cases of IIH, true or false

A

FALSE
LP is only done if scan is normal
contraindicated in ^ICP

49
Q

management of IIH

A

MRI, CSF, visual fields
Weight loss!!!
acetazolamide (carbonic anhydrase inhibitor)
ventricular-peritoneal shunt

50
Q

who gets trigeminal neuralgia

A

females

>60 yo

51
Q

triggers of trigeminal neuralgia

A 
touch
chewing 
swallowing 
talking
eating
52
Q

symptoms of trigeminal neuralgia

A

sharp stabbing unilateral pain lasting 1-90 seconds

53
Q

management of trigeminal neuralgia

A

MRI - rules out compression
carbamazepine, gabapentin, phenytoin, baclofen
surgery - ablation, decompression

Neurology (25 decks)

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