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systems- neuro- oc > headache > Flashcards

headache Flashcards

1
Q

are most headaches primary or secondary?

A

primary

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2
Q

what would be types of secondary headaches?

A 
Tumour
Meningitis
Vascular disorders
Systemic infection
Head injury
Drug-induced
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3
Q

what would be types of primary headaches?

A

Tension Type Headache
Migraine
Cluster Headache

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4
Q

what is tension type headache?

A

Mild, bilateral headache which is often pressing or tightening in quality, has no significant associated features and is not aggravated by routine physical activity

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5
Q

what are tension type headache treatments?

A

Aspirin or paracetamol
NSAIDs
Limit to 10 days per month (~2 days per week) to avoid the development of medication overuse headache

Preventative treatment
Rarely required
Tricyclic antidepressants
amitriptyline, dothiepin, nortriptyline

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6
Q

what is the most frequent dsiabling primary headache?

A

migraine

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7
Q

what is a migraine?

A

A chronic disorder with episodic attacks

Complex changes in the brain

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8
Q

what happens during migraine attacks?

A

Headache
Nausea, photophobia, phonophobia
Functional disability

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9
Q

what happens in between migraine attacks?

A

Enduring predisposition to future attacks

Anticipatory anxiety

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10
Q

what are migraine triggers?

A 
dehydration
diet
environmental stimuli
changes in oestrogen level in women
sleep disturbance
hunger
stress
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11
Q

what percentage of people does aura affect?

A

33%

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12
Q

what is aura?

A

Transient neurological symptoms resulting from cortical or brainstem dysfunction

May involve visual, sensory, motor or speech systems

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13
Q

how long does aura occur for?

A

15-60 minutes

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14
Q

how would you define a chronic migraine?

A

Headache on ≥ 15 days per month, of which ≥ 8 days have to be migraine, for more than 3 months

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15
Q

how does medication overuse in headaches occur?

A

Headache present on ≥15 days / month which has developed or worsened whilst taking regular symptomatic medication

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16
Q

what is the treatment for migraines?

A

Abortive treatment
Aspirin or NSAIDs
Triptans
Limit to 10 days per month (~2 days per week) to avoid the development of medication overuse headache

Prophylactic treatment
Propranolol, Candesartan
Anti-epileptics
Topiramate, Valproate, Gabapentin
Tricyclic antidepressants
amitriptyline, dothiepin, nortriptyline 
Venlafaxine
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17
Q

when are you likely to get your first migraine as a woman?

A

during pregnancy

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18
Q

what treatment would you use for someone that is haveing an acute attack of migraines but is pregnant?

A

paraceamol

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19
Q

what preventatives would you give a pregnant person with migraines

A

Propranolol or Amitriptyline

20
Q

what are Trigeminal Autonomic Cephalalgias

A

group of headache disorders characterised by attacks of moderate to severe unilateral pain in the head or face, with associated ipsilateral cranial autonomic features such as lacrimation, conjunctival injection, rhinorrhoea, nasal congestion, eyelid oedema and ptosis.

21
Q

where would the pain most likely be due to a cluster headache?

A

mainly orbital and temporal

22
Q

how long would a cluster headache be?

A

15 mins to 3 hours

23
Q

what are the different types of Trigeminal Autonomic Cephalalgias

A

Paroxysmal Hemicrania
SUNCT
cluster headache

24
Q

which of the TAC’s attack the most frequent

A

Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing
(SUNCT)

25
Q

which os the TAC’s last the longest?

A

cluster headache

26
Q

which of the TAC’s have a burning sensation?

A

SUNCT

27
Q

where would the pain be due to paroxysmal hemicrania?

A

mainly orbital and temporal

28
Q

how long would a paroxysmal hemicrania attack last?

A

2-30 mins

29
Q

what are cutaneous triggers for SUNCT?

A

Wind , cold
Touch
Chewing

30
Q

what type of a pain is trigeminal neuralgia?

A

stabbing

31
Q

how long does trigeminal neuralgia last?

A

5-10 seconds

32
Q

what are the treatments for cluster headache?

A

Abortive (Headache)
Subcutaneous sumatriptan 6mg or nasal zolmatriptan 5mg
100% oxygen 7-12 l/min via a tight fitting non-rebreathing max is effective and safe

Abortive (Headache bout)
Occipital depomedrone injection (same side as the headache)
Or tapering course of oral prednisone

Preventative
Verapamil (high doses may be required)
Lithium
Methysergide (risk of retroperitoneal fibrosis)
Topiramate
33
Q

what are the treatments for paroxysmal hemicrania?

A

No abortive treatment

Prophylaxis with indometacin
Alternatives – COX-II inhibitors, Topiramate

34
Q

what are the treatments for SUNCT?

A

No abortive treatment

Prophylaxis:
Lamotrigine
Topiramate
Gabapentin
Carbamazepine / Oxcarbazepine
35
Q

what are the treatments for trigeminal neuralgia?

A

No abortive treatment

Prophylaxis:
Carbamazepine
Oxcarbazepine

Surgical intervention:
Glycerol ganglion injection
Steriotactic radiosurgery
Decompressive surgery

36
Q

what are presentations of a secondary headache?

A 
Associated head trauma
First or worst
Sudden (thunderclap) onset
New daily persistent headache
Change in headache pattern or type
Returning patient
37
Q

what are red flags for a secondary headache?

A

new onset headache

new or change in headache
aged over 50
Immunosupression or cancer

change in headache frequency, characteristics or associated symptoms

focal neurological symptoms
non-focal neurological symptoms
abnormal neurological examination

38
Q

what is a thunderclap headache?

A

A high intensity headache reaching maximum intensity in less than 1 minute
Majority peak instantaneously

39
Q

what are differential diagnosis for thunderclap headaches?

A 
Primary (migraine, primary thunderclap headache, primary exertional headache, primary headache associated with sexual activity)
Subarachnoid haemorrhage
Intracerebral haemorrhage
TIA / stroke
Carotid / vertebral dissection
Cerebral venous sinus thrombosis
Meningitis / encephalitis
Pituitary apoplexy
Spontaneous intracranial hypotension
40
Q

who is likely to get a subarachnoid haemorrhage?

A 
All patients presenting with a sudden 
	severe headache that peaks within a 
	few minutes and lasts for at least 1 hour  
Examination is often normal!
Never consider a patient ‘too well’ 
	for SAH
41
Q

what are features suggestive of a space occupying lesion or raised intracranial pressure?

A

Progressive headache with associated symptoms and signs

Headache worse in morning or wakes patient from sleep
Headache worse lying flat or brought on by valsalva (cough, stooping, straining)
Focal symptoms or signs
Non-focal symptoms e.g. cognitive or personality change, drowsiness
Seizures
Visual obscurations and pulsatile tinnitus

42
Q

what is intracranial hypotension

A

a condition in which there is negative pressure within the brain cavity

43
Q

causes of intracranial hypotension?

A

Dural CSF leak

44
Q

investigations for intracranial hypotension

A

MRI brain and spine

45
Q

treatment of intracranial hypotension

A

Bed rest, fluids, analgesia, caffeine (e.g. 1 can red bull qds)
i.v. caffeine
Epidural blood patch

46
Q

when would you consider someone with arteritis of large arteries?

A

in any patient over the age of 50 years presenting with new headache

47
Q

what are specific features of giant cell arteritis?

A

include scalp tenderness, jaw claudication and visual disturbance
Prominent, beaded or enlarged temporal arteries may be present

An elevated ESR supports the diagnosis
(usually >50, often much higher, rarely normal)
Raised CRP and platelet count are other useful markers

systems- neuro- oc (51 decks)

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