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Neurology > Headache > Flashcards

Headache Flashcards

1
Q

What are the subclassifications of primary headache?

A

Migraine

Trigeminal autonomic cephalgias

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2
Q

What are the subclassifications of secondary headache?

A 
Thunderclap headaches
High pressure headaches
Low pressure
Headache
Neuralgias
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3
Q

For each headache type which a patient presents with, what questions are important to ask in the history?

A 
Age of onset
Chronic headache or episodic
Premonitory symptoms
Onset - time to peak of headache
Progression
Location
Character
Intensity
Precipitating factors
Exacerbating or relieving factors
Associated symptoms
How the patient behaves during an attack
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4
Q

What factors are important to ask about when taking a social history from a patient presenting with headache?

A 
Sleep pattern/disturbance
Meals
Exercise
Caffeine
Illicit drugs
Alcohol
Gas appliances
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5
Q

What examinations/investigations should always be done for a patient presenting with headache?

A

Blood pressure
Fundi examination and assessment for papilloedema
Facial sensation
Cranial and routine neurological examination

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6
Q

In addition to standard examinations and investigations, what further examinations should be conducted when the cause of headache is uncertain or a secondary headache is suspected?

A

Urine dipstick, pregnancy test, temperature, weight, GCS, mental status examination
Palpation of skull, neck, greater occipital nerves, temporal. arteries and nuchal rigidity
Examination of skin, cervical lymph nodes and tympanic membrane
Examination of visual acuity, visual fields and spontaneous venous pulsation

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7
Q

In addition to standard examinations and investigations, what further investigations should be conducted when the cause of headache is uncertain or a secondary headache is suspected?

A 
ECG
Urinalysis
Bloods - ESR, CRO, FBC, U&Es, TFTs
CT/MRU brain
Lumbar puncture
CT/ MRI angio/veno gram
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8
Q

Which patients presenting with headache should undergo further investigation?

A 
Systemic symptoms
Secondary risk factors
Seizures
Neurological symptoms
Older patients
Papilloedema
Precipitated by cough, exertion, sleep and valsalva
Change in nature of headache
Systemic symptoms of signs
Focal neurological deficit
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9
Q

What are the diagnostic criteria for a tension type headache?

A

At least 10 episodes occurring on <1 day a month
Lasts 30mins to 7 days
No nausea or vomiting
No more than one of photophobia or phonophobia
At least two of: bilateral location, pressing or tightening quality, mild or moderate intensity, not aggravated by routine physical activity

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10
Q

Which gene is associated with migraines?

A

Calcitonin gene related peptide

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11
Q

What is the cause of migraines?

A

Interaction between primary afferent nociceptive neurone, trigemiovascular system, brainstem, thalamus, hypothalamus and cortex

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12
Q

What are the diagnostic criteria for migraines?

A

At least 5 attacks which fulfilled other criteria
Headache attacks lasting 4-72 hours
Headache results in at least on of nausea/vomtiing or photobobia/phonophobia
Headache has at least two of: unilateral location, pulsating quality, moderate or severe pain and aggravation by causing avoidance of routine physical activity

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13
Q

Aura are usually visual. T/F?

A

True

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14
Q

What symptoms might a patient experience in the prodrome phase of a migraine?

A 
Yawning
Polyuria
Depression
Irritability
Food cravings
Poor concentration
Sensitivity to light and sound
Poor sleep
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15
Q

How long do aura last for in migraine?

A

5-60 minutes

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16
Q

What symptoms might a patient experience in the postdrome phase of a migraine?

A

Depression
Euphoria
Poor concentration
Fatigue

17
Q

What analgesics should never be used in migraines?

A

Opiates

18
Q

When should prophylaxis be used for patients with migraine?

A

If they are >4 disabling headaches per month

19
Q

What analgesics can be used to treat migraine?

A

Ibuprofen and paracetamol

Triptans

20
Q

What medications can be used as prophylaxis in migraine?

A 
Propranolol 
Topiramate
Amitriptyline
Candesartan
Flunarazine
21
Q

What dose of propranolol can be given as prophylaxis in migraine?

A

start 20mg bd, target 80mg bd

22
Q

What dose of topiramate can be given as prophylaxis in migraine?

A

Start 15 or 25 mg daily, target 50mg bd

23
Q

What dose of amitriptyline can be given as prophylaxis in migraine?

A

Start 10mg, target 50mg

24
Q

What dose of candesartan can be given as prophylaxis in migraine?

A

Start 4mg, target 16mg

25
Q

What dose of flunarazine can be given as prophylaxis in migraine?

A

10mg

26
Q

If prophylaxis is not effective in migraine, what other drugs can be used?

A 
Onabotulinumtoxin A
CGRP inhibitors (erenumab)
27
Q

What are the diagnostic criteria for cluster headache?

A

At least five attacks which fulfilled other criteroa
Severe or very severe unilateral. orbital, supraorbital and/or temporal pain lasting 15-180 mins
Either of both of a sense of restlessness or agitation and one of the following signs, ipsilateral to the headache: conjunctival injection/lacrimation, nasal congestion/lacrimation, eyelid oedema, forehead and facial sweating/fludhing, sensation of fullness in ear, mitosis, ptosis
Occurring with a frequency between one every other day and 8 a day.

28
Q

What will exacerbate and alleviate a raised pressure headahce?

A

Worse when lying flat, in the morning, with physical exertion, with valsalva
Improve on standing or sitting

29
Q

What associated symptoms are there is raised pressure headaches?

A

Nausea and vomiting

Transient visual obscurations with a change in posture

30
Q

What examination findings will be present in a raised pressure headache?

A 
Papilloedema (optic disc swelling)
Impaired visual acuity / colour vision
restricted visual. fields / enlarged blind spot
3rd nerve palsy
7th nerve palsy
Focal neurological signs
31
Q

Describe the presentation of a thunderclap headache?

A

‘First and worst’ headache
Severe headache with sudden onset
Typically peaks within one minute but can peak around 5 minutes. Duration greater than one hour

32
Q

How should a thunderclap headache be investigated?

A

CT
Lumbar puncture
If both are negative then an MRI, MRI/CT angio/venogram

33
Q

What are the possible causes of thunderclap headache?

A 
Subarachnoid haemorrhage
Intracerebral haemorrhage
Arterial dissection
Cerebral venous sinus thrombosis
Ischaemic stroke
Bacterial meningitis
Spontaneous intracranial hypotension
Pituitary apoplexy
34
Q

What causes low pressure headache?

A

CSF leakage causing traction on the meninges, cerebral/cerebellar veins and CN V/IV/X as a result of lumbar puncture or intracranial hypotension

35
Q

What will exacerbate and alleviate low pressure headaches?

A

Worse on sitting/standing

Relieved by lying down

Neurology (10 decks)

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