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Y4: Neurology > Headache > Flashcards

Headache Flashcards

1
Q

Describe a Tension headache?

A
  • Tends to affect frontal and occipital regions
  • ‘Tight band around the head’
  • Does not worsen with routine physical activity
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2
Q

Cause of tension headaches?

A
  • Psychological stress
  • Disturbed sleep pattern
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3
Q

Case history of tension headaches

A
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4
Q

Clinical features of a tension headache?

A
  • Bilateral
  • Dull and non-pulsatile
  • Worsen as the day progresses
  • Mild nausea, photophobia, phonophobia can occur
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5
Q

Risk factors for a tension headache?

A
  • Mental tension
  • Stress
  • Missing meals
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6
Q

Differentials for tension headaches?

A
  • Chronic migraine
  • Medicine overuse headache
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7
Q

Management of acute tension headache?

A
  • Simple analgesics
    • Aspirin
    • Paracetamol
    • Ibuprofen
    • Naproxen
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8
Q

Management of persistent tension headache?

> 7-9 headache days/month

A
  • 1st:
    • Amitriptyline (antidepressant)
  • 2nd:
    • Mirtazipine
  • CBT may help
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9
Q

Complications of tension headache?

A

Peptic ulcer from NSAID use

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10
Q

Describe a migraine?

A
  • Chronic, genetically determined, episodic, neurological disorder
  • Nausea, photophobia and disability with the headache
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11
Q

Describe migraine aura?

A
  • Reversible visual, sensory or speech symptoms
  • Precedes the headache
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12
Q

Describe a screening method for migraine?

A
  • ID migraine
  • Has a headache limited your activities for a day or more in the last 3 months?
  • Do you feel nauseous or do you vomit when you have a headache?
  • Does light bother you when you have a headache?
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13
Q

Read the case histories for migraine

A
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14
Q

Risk factors for migraine?

A
  • Family history
  • High caffeine intake
  • Female sex
  • Obesity
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15
Q

Differentials for migraine?

A
  • Tension headache
  • Cluster headache
  • Medication overuse headache
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16
Q

Describe the management of a migraine patient with persistent symptoms?

A
  • Sumatriptan
  • Adjuvant high-flow oxygen
  • Adjuvant IV corticosteroid
17
Q

Management of mild-moderate migraine symptoms?

A
  • Aspirin (or Ibuprofen)
  • Adjunct anti-emetics
  • Adjunct hydration
18
Q

Management of severe migraine symptoms?

A
  • Triptan
  • Adjunct anti-emetics
  • Adjunct hydration
  • Adjunct NSAID
19
Q

Complications of migraines?

A
  • Status migrainosus
    • Migraine attack lasting >72 hours
    • Assess for medication overuse
  • Depression
20
Q

Describe a cluster headache?

A
  • Unilateral headache lasting 15-180 minutes
    • Orbital, supra-orbital or temporal
  • Associated with autonomic symptoms
    • Ptosis, rhinnorhoea
21
Q

What are the 3 cardinal features of cluster headaches?

A
  • Trigeminal distribution of pain
  • Ipsilateral cranial autonomic symptoms
  • Circadian pattern of attacks
22
Q

Case history of someone with a cluster headache

A
23
Q

Risk factors for cluster headaches?

A
  • Male sex
  • Family history
  • Head injury
  • Smoking
  • Heavy drinking
24
Q

Diagnostics tests which should be ordered for cluster headaches?

A
  • CT or MRI head
  • ESR (normal)
  • Pituitary function tests
    • Normal in primary cluster headache
    • Abnormal = secondary to pituitary adenoma
25
Q

Management of an Acute attack of cluster headache?

A
  • Subcutaneous sumatriptan
  • Oxygen
  • Adjunct Greater occipital nerve block
26
Q

Management of episodic/chronic cluster headaches?

A
  • Verapamil
    • 2nd: Lithium or gabapentin
    • 3rd: Valproate
    • 4th: Surgery
27
Q

Surgical options for cluster headaches?

A
  • Occipital nerve stimulation
  • Deep brain stimulation of posterior hypothalamic region
28
Q

Complication of cluster headache

A

Depression and anxiety

29
Q

Partial triggers for migraines?

A
  • CHOCOLATE
    • Chocolate
    • Hangovers
    • Orgasms
    • Cheese/caffeine
    • Oral contraceptives
    • Lie ins
    • Alcohol
    • Travel
    • Exercise
30
Q

Symptoms of trigeminal neuralgia?

A
  • Paroxysms of intense, stabbing pain
  • Lasting seconds in trigeminal distribution
  • Unilateral in mandibular or maxillary divisions
  • Face screws up with pain
31
Q

Triggers for Trigeminal neuralgia?

A
  • Washing affected area
  • Shaving
  • Eating
  • Talking
32
Q

Typical patients with trigeminal neuralgia?

A
  • Male >50
  • Female Asians
33
Q

Secondary causes of trigeminal neuralgia?

A
  • MS
  • Tumour
  • Chronic meningeal inflammation
34
Q

Investigations into trigeminal neuralgia?

A

MRI to exclude secondary causes

35
Q

Treatment for Trigeminal neuralgia?

A
  • Carbamazepine
  • Lamotrigine
  • Phenytoin
  • Gabapentin
  • Surgery
36
Q

Describe the surgical management of trigeminal neuralgia?

A
  • Microvascular decompression
    • Anomalous vessels are separated from the trigeminal root
37
Q
A

Y4: Neurology (11 decks)

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