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Neuro > Headache > Flashcards

Headache Flashcards

1
Q

Most headaches are primary headaches. Name 3 types

A

Tension type
Migraine
Cluster

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2
Q

Define secondary headache

A

Identifiable structural or biochemical cause of headache

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3
Q

Six examples of seconday headache

A 
Tumour
Meningitis
Vascualr disorders
Systemic infection
Head injury
Drug-induced
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4
Q

Most frequent type of primary headache

A

Tension Type Headache

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5
Q

What type of headache is the 3rd most disabling condition in women under 50 according to WHO

A

Tension Type headache

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6
Q

Why are tension type headaches common to women in their reproductive years?

A

Drop in oestrogen can trigger

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7
Q

Describe the severity and spread of tension type headaches

A

Mild

Bilateral

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8
Q

Symptoms of tension headache that may be described

A

Pressing
Tightening
No other associated features
Not aggravated by phyical activity

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9
Q

3 categories of Tension type headache

A

Infrequent Episodic TTH
Frequent ETTH
Chronic TTH

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10
Q

How many days of TTH constitute an infrequent episodic TTH?

A

1 day per month

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11
Q

How many days of TTH constitute an frequent episodic TTH?

A

1-14 days per month

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12
Q

How many days of TTH constitute chronic TTH?

A

More than 15 days in one month`

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13
Q

Two classes of treatment in headache

A

Abortive

Prophylactic

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14
Q

Abortive treatment for Tension type headache

A

Aspirin, paracetamol

NSAIDS

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15
Q

What is the limit on abortive treatment for TTH to avoid overuse headache?

A

10 days per month

2 days in week

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16
Q

Preventative treatment of tension type headache?

A

Tricyclic antidepressants

- Amitriptyline, dothiepine, nortriptyline

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17
Q

What is the most frequent disabling type of headache?

A

Migraine

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18
Q

What is the typical age range for migraine sufferers?

A

20-50

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19
Q

How do migraine attacks present?

A 
Episodic
4-72 hours of headache
Unilateral location
Pulsating
Moderate to severe pain
Aggravated by/avoidance of physical activity
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20
Q

What symptoms may be experienced during a migrainous attack?

A 
Headache
Nausea
Photophobia
Phonophobia
Functional disability
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21
Q

What symptoms may be experienced between migrainous attacks?

A

Enduring predisposition to future attacks

Anticipatory anxiety

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22
Q

7 triggers of migraine

A 
Dehydration
Diet
Sleep disturbance
Hunger
Environmental stimuli
Stress
Oestrogen level change in women
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23
Q

5 phases of migraine

A 
Premonitory
Aura
Early headache
Advanced headache
Postdrome
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24
Q

Describe features of the premonitory phase in migraine

A 
Mood changes
Fatigue
Cognitive change
Muscle pain
Food craving
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25
Q

Describe features of the aura phase of migraine

A

Mild to moderate headache
Fully reversible, neurological changes, visual somatosensory
Not always followed by headache

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26
Q

What word describes an aura that is not followed by headache?

A

Acephalgic

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27
Q

Describe features of the early headache phase in migraine

A

Dull, mild pain
Nasal congestion
Muscle pain

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28
Q

Describe features of the advanced headache pahse in migraine

A 
Moderate to severe pain
Unilateral throbbing
Nausea
Photophobia
Phonophobia
Osmophobia (smells)
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29
Q

Describe features of the postdrome phase of migraine

A

Fatigue
Cognitive changes
Muscle pain

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30
Q

What percentage of migraine sufferers experience AURA?

A

33%

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31
Q

Define aura

A

Transient neurological symptoms resulting from cortical or brainstem dysfunction
May involve sensory, visual, motor or speech systems

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32
Q

How do symptoms evolve in aura?

A

Slowly
Vison precedes sensory, then speech
Wave from occipital lobe

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33
Q

How long may aura last?

A

15=60 minutes

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34
Q

What condition can aura be mistaken for?

A

TIA

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35
Q

How to differentiate aura from stroke?

A

Stroke is sudden
Symptoms will start at once in stroke - localised to specific vascular area
Aura follows wave, occipital forward

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36
Q

How is chronic migraine defined?

A

Migraine experience for more than 15 days in one month. Migraine can last longer than 8 days
Longer than 3 month history

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37
Q

How else is chronic migraine described?

A

Transformed migraine

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38
Q

How may chronic migraine evolve from other episodes

A

History of episodic migraines, increasing frequency of headaches
Migrainous symptoms become less frequent and less severe
Episodes of sever migraine on background of less severe featureless frequent/daily headache
Can occur with/without escalation in medication use

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39
Q

Define medication overuse headache

A

Headache on more than 15 days in one month
Taking regular symptomatic medication
Can occur from primary headache

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40
Q

Which medications are common to causing medication overuse headache?

A

Triptans
Ergots
Opioids
Combo analgesics for more than 10 dyas in month
Simple analgesics for over 15 days in month

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41
Q

What other substance can cause ‘medication’ overuse headache>

A

Caffeine

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42
Q

Abortive migraine treatment

A

Aspirin
NSIADs
Triptans (limit 10 days per month)

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43
Q

Prophylactic migraine treatment

A

Propanolol
Candesartan
Antiepileptics ; topiramate, valproate, gabapentin
Tricyclic antidepressants; Amitryptiline, Dothiepin, nortriptyline
Venlafaxine

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44
Q

How does migraine change in pregnancy?

A

Migraine without aura improves in pregnancy

Migraine with aura will not change

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45
Q

What medication is contraindicated in active migraine with aura?

A

Combined oral contraceptive pill

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46
Q

Which medication for treating migraine should be avoided in women of child-bearing age?

A

Anti-epileptics

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47
Q

What treatment can be used in women of child bearing age/pregnant for migraine?

A

Acute - paracetamol

Prophylactic - propanolol

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48
Q

Four types of headache categorised as Trigeminal Autonomic Cephalgias

A

Cluster
Paroxysmal hemicrania
SUNCT
SUNA

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49
Q

Features of a trigeminal autonomic cephagia

A

Unilateral head pain V1
Very sever, excruciating
Cranial autonomic symptoms

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50
Q

List 6 cranial autonomic syptoms

A 
Conjunctival injection/lacrimation
Nasal congestion.rhinorrhoea
Eyelid oedema
Forehead and facial swelling
Misosis/ptosis (Horner's)
51
Q

What region of the head is painful in cluster headaches

A

Orbital and temporal

52
Q

What is the distribution of pain in cluster headaches?

A

Unilateral

53
Q

How long do cluster headaches tend to last?

A

15 minutes to 30 minutes

Rapid cessation

54
Q

What term is given to the severe pain experienced in cluster headaches?

A

Suicide headache

55
Q

How do autonomic symptoms coincide with a cluster headache?

A

Ipsilateral autonomic symptoms

56
Q

What migrainous symptoms are experienced in cluster headache?

A

Premonitory - tiredness, yawning
Assoicated - nausea, vomiting, photophobia, phonophobia
Typical Aura

57
Q

What percentage of patients with cluster headache experience epsiodic attacks?

A

80-90%

58
Q

In episodic cluster headache, how long do bouts and remission tend to last?

A

1-3 months

1 month remission

59
Q

How often can attacks occur in cluster headache?

A

Varies 1 every other day up to 8 attacks in a day

Continuous background of pain may be experienced

60
Q

What substance can trigger an attack during a bout of cluster headache, but typically has no effect in remission?

A

Alcohol

61
Q

Is there a pattern of timing in cluster headache?

A

Yes

Striking circadian rhythmicity - same time each day, same time of year

62
Q

How many people with cluster headache suffer chronically?

A

10-20%

63
Q

How long does chronic cluster headache last?

A

Bouts must last longer than 1 year without remission or with remission of less than a month

64
Q

Which region of the head is painful in paroxysmal hemicrania?

A

Orbital, temporal

65
Q

Distribution of pain in paroxysmal hemicrania

A

Unilateral

66
Q

Describe severity and time period of headache in paroxxysmal hemicrani

A

Rapid onset, rapid cessation - 2 to 30 minutes

Excruciatingly severe - 50% restless, agitated

67
Q

How do autonomic symptoms coincide with pain in paroxysmal hemicrania?

A

Ipsilateral autonomic symptoms

68
Q

10% of attacks in paroxysmal hemicrania are precipitated by…

A

bending/rotation of head

69
Q

What percentage of sufferers of paroxysmal hemicrania are chronic and episodic?

A

80% chronic

20% episodic

70
Q

How many attacks can occur daily in paroxysmal hemicrania?

A

2-40 attacks

71
Q

Paroxysmal hemicrania has an absolute repsonse to what drug?

A

Indometacin

72
Q

What does SUNCT stand for?

A

Short-lasting Unilateral Neuralgiform headache with Conjunctival Injection and Tearing

73
Q

Describe the regions headache is present in SUNCT

A

Unilateral

Orbital, supraorbital, temporal

74
Q

Describe the character of the headache in SUNCT

A

Stabbing, pulsating at V1

75
Q

Name cutaneous triggers of SUNCT

A

Wind
Touch
Cold
Chewing

76
Q

How many headache attacks can be experienced daily with SUNCT

A

3-200, no refractory period

77
Q

Describe the region of pain in trigeminal neurallgia

A

Unilateral

MAXILLARY OR MANDIBULAR -moreso than opthalmic

78
Q

Describe the character of pain in trigeminal neuralgia

A

Stabbing pain - 5-10 seconds

Electric SHock

79
Q

What can trigger trigeminal neuralgia?

A

Cutaneous triggers - wind, cold, touch, chewing

80
Q

What is the attack frequency of Trigeminal neuralgia?

A

Similar to SUNCT 3-200

81
Q

How does trigeminal neuralgia differ from SUNCT?

A

Pain in maxillary, mandible region

Refractory period between attacks

82
Q

Autonomic features in trigeminal neuralgia

A

UNCOMMON

83
Q

Abortive treatment of cluster headache?

A

Subcutaneous sumatriptan 6mg
or
nasal zolmatriptan
100% oxygen

84
Q

Abortive treatment of bout of cluster headache?

A

Occipital injection

Oral prednisolone

85
Q

Prophylactic treatment of cluster headache

A

Verapimil
Lithium
Methysergide (ERGOMETRINE TARTRATE)
Topiramate

86
Q

Abortive treatment of paroxysmal hemicrania>

A

NO ABORTIVE TREATMENT

87
Q

Prophylactic treatment of paroxysmal hemicrania

A

Indometacin

88
Q

Alternatives to indometacin

A

COX II inhibitors

Topiramate

89
Q

Abortive treatment for SUNCT

A

NO ABORTIVE

90
Q

Prophylactic treatment for SUNCT

A

Lamotrigine
Topiramate
Gabapentin
Carbamazepine/Oxcarbazepine

91
Q

Abortive treatment of trigeminal neuralgia

A

NO ABORTIVE

92
Q

Prophylactic treatment of trigeminal neuralgia

A

Carbamazepine

Oxcarbazepine

93
Q

Surgical intervention for trigeminal neuralgia

A

Glycerol ganglion injection
Steriotactic radiosurgery
Decompressive surgery

94
Q

Likely presentations of secondary headache

A 
Assoicated head trauma
Sudden onset
New daily persistent headache
Change in pattern/type of headaches
Returning patient from primary
95
Q

Red Flag Headache symptoms

A

New onset
New/change in headache - over 50, immunosupressed, cancer
Focal neurological symptoms
Non-focal symptoms
Abnormal neurological examination
Neck stiffness
Fever
High pressure ; worsens lying down, on wakening, on exertion, valsalva (RF for cerebral venous sinus thrombosis)
Low pressure - headache precipitated by sitting/standing up
Giant cell arteritis - jaw claudication, visual disturbance, prominent/headed temporal arteries

96
Q

Describe onset of thunderclap headache

A

High intensity headache reaches max intensity in less than 1 minute.
Majority peak instantaneously
SUDDEN, SEVERE, INSTANTANEOUS

97
Q

Diferrentials for thunderclap headache

A 
Primary - migraine, exertional, sexual activity
Subarachnoid haemorrhage
Intracerebral haemorrhage
TIA/Stroke
Catorid/vertebral dissection
Cerebral venous sinus thrombosis
Meningitis/encephalitis
Pituitary apoplexy
Spontaneous intracranial hypotension
98
Q

How many people with thunderclap headache are diagnosed with subarachnoid haemorrhage?

A

1 in 10

99
Q

What percentage of SAH cases are aneurysmal?

A

85%

100
Q

Mortality of SAH

A

50%

101
Q

Risk of rebleed in SAH

A

4-6% in first 48 hours

40% in first month

102
Q

Treatment of SAH

A

Coiling

Clipping

103
Q

How does SAH present

A

Sudden headache, peaks within minutes, lasts at least 1 hour

Examination normal

104
Q

Investigations for SAH

A

CT brain
Lumbar puncture
Beyond 2 weeks - angiography

105
Q

In what time frame must a lumbar puncture be carried out in SAH?

A

within 12 hours of onset

106
Q

Symptoms of meningitis

A 
Nausea with or without vomiting
Photophobia
Phonophobia
Neck stiffness
RASH
107
Q

Symptoms of encephalitis

A

Altered mental state or consciousness
Focal symptoms and signs
Seizures

108
Q

Causes of raised intracranial pressure

A 
Glioblastoma multiforme
Cerebral abscess
Venous infarct with focal area of haemorrhage
Meningioma
Hydrocephalus
Papilloedema
109
Q

Symptom of gliobastoma multiforme

A

Weeks to months of high pressure headache

110
Q

Features suggesting space occupying lesion

A

Progressive headache with associated signs and symptoms
Warning - headache worse in morning/wakes patient from sleep
Worse lying flat or valsalva
Focal signs and symptoms
Seizures
Non-focal ; cognitive, personality change, drowsiness
Visual obscurations
Pulsatile tinnitus

111
Q

What causes intracranial hypotension?

A

Dural CSF leak - spontaneous or iatrogenic (post LP)

112
Q

What features of headache indicate intracranial hypotension?

A

Clear postural component - upright; lessens/resolves when lying down
When headache becomes chronic loses postural component

113
Q

Investigation of intracranial hypotension

A

MRI brain and spine

114
Q

Treatment for intracranial hypotension

A 
Bed rest
Fluid
Analgesia
Caffeine - IV
Epidural blood patch - injects blood into widened epidural space, seal to make space tighter
115
Q

Purpose of IV caffeine in treatment of intracranial hypotension?

A

Raise CSF pressure

116
Q

Describe the onset and character of the headache in Giant Cell Arteritis

A 
NEW
Diffuse
Persistent
May be severe
PATIENT MAY BE SYSTEMICALLY UNWELL
117
Q

Symptoms of giant cell arteritis

A

Scalp tenderness
Jaw claudication
Visual disturbance
Prominent, headed, enlarged temporal arteries

118
Q

Signs of giant cell arteritis

A

Prominent, headed, enlarged temporal arteries
Elevated ESR (>50 - much higher)
Raised CRP
Raised platelets

119
Q

Treatment of Giant Cell arteritis

A

High dose prednisolone

Temporal artery biopsy - behind eye, stroke, constricted RV

120
Q

Risk factors trigeminal neuralgia

A 
Multiple Sclerosis
Age - 50-60
Female
Family history
Stroke and hypertension
121
Q

Complications of trigeminal neuralgia

A

Impact on daily living
Depression/isolation
Weight loss - inability to eat; cutaneous triggers

122
Q

Red flag symptoms in trigeminal neuralgia - may suggest underlying cause

A

Sensory changes.
Deafness or other ear problems.
History of skin or oral lesions that could spread perineurally.
Pain only in the ophthalmic division of the trigeminal nerve (eye socket, forehead, and nose), or bilaterally.
Optic neuritis.
Family history of multiple sclerosis.
Age of onset before 40 years.

123
Q

TTH differentials

A

Headache not associated with an underlying condition – primary headache:
Migraine.
Trigeminal autonomic cephalgias for example cluster headache and paroxysmal hemicranias.
Other primary headache disorders such as primary cough headache and cold-stimulus headache.
Secondary headaches — headache attributed to an underlying condition including:
Trauma or injury to the head and/or neck.
Cranial or cervical vascular disorders for example intracerebral haemorrhage, central venous thrombosis or giant cell arteritis.
Non-vascular intracranial disorders for example idiopathic intracranial hypertension or neoplasm.
Exposure to, or withdrawal from, a substance such as carbon monoxide, cocaine or alcohol — medication over use headache (which can be due to ergotamines, triptans, simple analgesics and opioids) is included in this category.
Infection for example intracranial infection (including meningitis, encephalitis and cerebral abscess) or systemic infection.
Disorders of homeostasis for example hypoxia or hypertension including pre-eclampsia and eclampsia.
Disorders of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structure such as angle closure glaucoma, temporomandibular disorder, dental problems, otitis media or sinusitis.
Psychiatric disorders such as somatization disorder.
Painful cranial neuropathies and other facial pains such as trigeminal neuralgia, post-herpetic neuralgia and optic neuritis.

Neuro (9 decks)

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