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2ND YEAR SYSTEMS: Neuro > Headache > Flashcards

Headache Flashcards

1
Q

What is a primary headache? Give the 3 examples

A

Not the result of another medical condition / no underlying medical cause.

Can be:-
Tension type headache
Migraine
Cluster headache

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2
Q

What is a secondary headache?

A

Has an identifiable structural or biochemical cause ie

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3
Q

Causes of secondary headaches?

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

however not all secondary headache is sinister

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4
Q

Tension type headache

A

Most frequent primary headache but is not disabling and rarely presents to doctors

Mild, bilateral headache
often pressing or tightening in quality

no significant associated features and is not aggravated by routine physical activity

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5
Q

Treatment for tension type headache: abortive and preventative

A

Abortive treatment:-
Aspirin or paracetamol
NSAIDs

Preventative treatment:-
Rarely acquired
Tricyclic antidepressants

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6
Q

Migraine: general info

A

most frequent disabling primary headache

affects 6 million in UK, aged 20-50

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7
Q

What is a migraine?

A

A chronic disorder with episodic attacks

Complex changes in the brain. Origin of which cannot be pinpointed to a single brain site or mechanism.

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8
Q

Symptoms associated with migraines (5)

A

Headache
Nausea
photophobia phonophobia
Functional disability

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9
Q

What can trigger a migraine (7)

A 
Sleep disturbance
Dehydration
Diet
Environmental stimuli
Changes in oestrogen level in women
Hunger
Stress
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10
Q

Clinical phases of migraine

A

A migraine attack can take days to develop and resolve; headache is only 1 of several symptoms associated with migraine

Although the symptoms of migraine often overlap, the classic view is to separate an attack into phases.

  1. The Premonitory Phase
  2. Aura phase
  3. Headache phase - early and advanced
  4. Postdrome - symptoms beyond the resolution of the headache (1-2 days)
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11
Q

What is the Aura phase

A

Affects 33% of migraineurs

Transient neurological symptoms resulting from cortical or brainstem dysfunction

May involve visual, sensory, motor or speech systems

slow evolution of symptoms. Symptoms last 15-60 mins

can be confused with TIA

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12
Q

Define 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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13
Q

Medication overuse headache

A

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

Can occur in any primary headache

Migraineurs taking pain medication for another reason can develop chronic headache

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14
Q

Abortive treatment for migraines (2)

A

Aspirin or NSAIDs
Triptans

Limit to 10 days per month to avoid the development of medication overuse headache

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15
Q

Prophylactic treatment for migraines (4)

A

Propranolol, Candesartan

Anti-epileptics - Topiramate, Valproate, Gabapentin

Tricyclic antidepressants - amitriptyline, dothiepin, nortriptyline

Venlafaxine

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16
Q

Specific issues in women

A

Migraine without aura gets better in pregnancy

First migraine can occur
during pregnancy

The combined OCP is contraindicated in active migraine with aura

Avoid anti-epileptics in women of child bearing age

Treatment is more difficult in pregnancy
Acute attack: Paracetamol
Preventative: Propranolol or Amitriptyline

17
Q

What does the group of headache disorders known as Trigeminal Autonomic Cephalalgias comprise of? (4)

A

cluster headache - most frequent attacks and longest duration
Paroxysmal Hemicrania
SUNCT
SUNA

18
Q

What does SUNCT stand for? and what is it?

A

Short-lasting Unilateral Neuralgiform headache with Conjunctival injection and Tearing

strictly unilateral, generally orbital, supraorbital or temporal pain

stabbing or pulsating pain

cutaneous triggers - wind, cold, touch, chewing

19
Q

What does SUNA stand for?

A

Short-lasting Unilateral Neuralgiform headache with Autonomic Symptoms

20
Q

What are the shared symptoms of trigeminal autonomic cephalagias

A

Unilateral head pain

Very severe / Excruciating

Cranial autonomic symptoms include:-
Conjunctival injection / lacrimation

Nasal congestion / rhinorrhoea

Eyelid oedema

Forehead & facial sweating

Miosis / ptosis (Horner’s syndrome)

Attack frequency and duration differs

Treatment responses differ

21
Q

Cluster headache

A

Pain: mainly orbital and temporal

Excruciatingly severe (“suicide headache”)
Patients are restless and agitated during an attack

Attacks are strictly unilateral

Rapid onset (max within 9 mins in 86%)

Duration: 15 mins to 3 hours

Rapid cessation of pain

22
Q

Cluster headache: re-occurrence

A

Attacks “cluster” into bouts typically lasting 1-3 months with periods of remission lasting at least 1 month

Attack frequency: 1 every other day to 8 per day
May be continuous background pain between attacks

alcohol is a trigger during a bout but not in remission

attacks occur at same time each day and bouts at same time each year

23
Q

Paroxysmal Hemicrania

A

Pain: mainly orbital and temporal
Attacks are strictly unilateral

rapid onset - duration = 2-30 minutes

80% have chronic PH, 20% have episodic PH

Frequency: 2-40 attacks per day (no circadian rhythm)

Absolute response to indometacin

24
Q

Trigeminal neuralgia

A

unilateral maxillary or mandibular division pain

stabbing pain

cutaneous triggers - wind, cold, touch, chewing

25
Q

What would you be concerned about in a patient presenting with a headache? ie what would be more sinister

A

Associated head trauma

First headache or worst

Sudden (thunderclap) onset

New daily persistent headache

Change in headache pattern or type

Returning patient

26
Q

Red flags for secondary headache (9)

A

new onset headache

new or change in headache especially if aged over 50 or have Immunosupression or cancer

change in headache frequency, characteristics or associated symptoms

focal neurological symptoms (one region of the brain)

non-focal neurological symptoms

abnormal neurological examination

neck stiffness/fever

low pressure - headache comes on by sitting/standing up

Giant cell arteritis - visual disturbance, pain in jaw when chewing

27
Q

Thunderclap headache

A

A high intensity headache reaching maximum intensity in less than 1 minute

may be primary or secondary - no reliable differentiating features

28
Q

Subarachnoid haemorrhage

A

1 in 10 patients with thunderclap headache will have a SAH

Examination is often normal

Need a CT brain
lumbar puncture - within 12 hrs after headache onset

after 2 weeks, CT +/- LP is unreliable - angiography is required

29
Q

What features suggest a space ocupying lesion and/or raised intracranial pressure

A

Progressive headache with associated symptoms and signs - headache is common 1st presenting feature

warning features:-

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

30
Q

Intracranial hypotension: what is it? investigation? treatment?

A

Dural CSF leak

Can be spontaneous or iatrogenic (post LP)

Headache develops or worsens soon after assuming an upright posture and lessens or resolves shortly after lying down

Once the headache becomes chronic it often loses its postural component

Investigation: MRI brain and spine

Treatment: bed rest, fluids, analgesia, caffeine, i.v caffeine, epidural blood patch (autologous (patient’s own) blood used to close holes in the dura mater)

31
Q

What is Giant cell arteritis?

A

Arteritis of large arteries

Headache is usually diffuse, persistent and may be severe
The patient may be systemically unwell

Specific features include scalp tenderness, jaw claudication and visual disturbance

Prominent, beaded or enlarged temporal arteries may be present

high ESR (erythrocyte sedimentation rate) supports diagnosis - high in inflammation/infection

Raised CRP and platelet count also useful markers

2ND YEAR SYSTEMS: Neuro (32 decks)

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