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Neurology > Headache > Flashcards

Headache Flashcards

1
Q

What are the headache red flags?

A 
New onset headache > 55
Known/previous malignancy
Immunosuppression
Early morning headache
Exacerbated by valsalva (coughing, sneezing, straining)
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2
Q

What are the criteria for diagnosis of migraine without aura?

A
  • at least 5 attacks
  • duration 4-72 hours
    2 of:
  • moderate/severe
  • unilateral
  • throbbing
  • worse on movement
    1 of:
  • autonomic features (nausea and vomiting)
  • photophobia/phonophobia
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3
Q

Name some common migraine triggers

A 
Sleep
Dietary: chocolate, cheese
Stress
Hormones (natural or oral contraceptives)
Exercise
Alcohol
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4
Q

Which two classes of drug are used in the acute treatment of migraines?

A

NSAIDS

Triptans (5HT agonists)

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5
Q

Give some examples of NSAIDs which can be used to treat an acute migraine?

A

Aspirin
Naproxen
Ibuprofen

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6
Q

What are the contraindications for use of triptans?

A 
IHD
Coronary spasm
Uncontrolled hypertension
Recent lithium
SSRIs
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7
Q

What lifestyle advice should be given to patients diagnosed with migraines?

A 
Healthy diet, avoid triggers
Keep hydrated
Avoid caffeine
Reduce stress
Regular exercise
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8
Q

When should prophylactic migraine drugs be considered?

A

If > 3 attacks per month or very severe

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9
Q

How long should one prophylactic drug be tried for before switching to another?

A

3 months

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10
Q

Give some examples of drugs used for prophylaxis of migraines

A

Amitriptyline
Propranolol
Topiramate

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11
Q

What are the side effects of amitriptyline?

A

Dry mouth
Postural hypotension
Sedation

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12
Q

When should propranolol be avoided?

A

Asthma
Peripheral vascular disease
Heart failure

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13
Q

What are the side effects of topiramate?

A

Weight loss
Paraesthesia
Impaired concentration
Enzyme inducer

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14
Q

Describe the features of a tension headache?

A

Bilateral
Non-pulsating
Mild/moderate
Absence of N&V, photophobia or phonophobia

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15
Q

How is a tension headache managed?

A

Relaxation physiotherapy
Stress relief
Antidepressants e.g. dothiepin, amitriptyline

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16
Q

What are the trigeminal autonomic cephalgias?

A

Primary headache disorders characterised by

  • unilateral trigeminal distribution pain
  • in association with ipsilateral cranial autonomic features
17
Q

What are the cranial autonomic features?

A 
Ptosis
Miosis
Nasal stuffiness
Nausea and vomiting
Tearing
Eyelid oedema
18
Q

What are the 4 main types of trigeminal autonomic cephalgias?

A

Cluster
Paroxysmal hemicrania
Hemicrania continua
SUNCT

19
Q

Describe the features of a cluster headache

A

Rapid onset, unilateral pain around one eye

Eye may become watery, blood shot, with lid swelling, lacrimation, facial flushing, rhinorrhoea, miosis +/- ptosis

20
Q

How long do cluster headaches usually last?

A

45-90 minutes
1-8 attacks per day
clusters last 4-12 weeks

21
Q

What is the acute treatment for a cluster headache?

A

High flow oxygen 100% for 20 mins
SC sumatriptan
Steroids

22
Q

Which drug can be used for prophylaxis of cluster headaches?

A

Verapamil

23
Q

What is the difference between cluster headaches and paroxysmal hemicrania?

A

Paroxysmal hemicrania more common in older people (50-60) and women
Attacks shorter duration (10-30 mins) but more frequent (1-40 per day)

24
Q

What is the treatment for paroxysmal hemicrania?

A

Absolute response to Indomethicin

25
Q

What does SUNCT stand for?

A 
Short lived (15-120 seconds)
Unilateral
Neuralgiaform headache
Conjunctival injections
Tearing
26
Q

What is the treatment for SUNCT headaches?

A

Lamotrigine

Gabapentin

27
Q

How do you investigate suspected trigeminal autonomic cephalgias?

A

MRI brain + MR angiogram

28
Q

What is trigeminal neuralgia?

A

Intense stabbing pain
Lasting seconds
In trigeminal nerve distribution (usually V2/V3)

29
Q

What can trigger trigeminal neuralgia?

A

Triggered by touch e.g.

  • washing
  • shaving
  • eating
  • talking
  • dental prosthesis
30
Q

Which investigation should be done in trigeminal neuralgia?

A

MRI to look for secondary causes (compressing nerve)

31
Q

What are the treatment options for trigeminal neuralgia?

A

Medical:

  • carbamazepine
  • gabapentin
  • phenytoin
  • baclofen

Surgical:

  • ablation
  • decompression

Neurology (16 decks)

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