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MD4001 Pathology > Headache > Flashcards

Headache Flashcards

1
Q

What percentage of primary care symptoms involve headache?

A

> 4% GP consultations

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2
Q

What percentage of neurology referals involve headache?

A

30%

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3
Q

What percentage of headache in primary care are not given a diagnostic label?

A

70%

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4
Q

WHat percentage of the population have a tension headache at any time?

A

40%

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5
Q

What are common headache types?

A
  • Tension / muscular
  • Migraine
  • Analgesia overuse
  • Systemic illness
  • Cervicogenic
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6
Q

What are the different types of serious headaches?

A
  • Subarachnoid haemorrhage
  • Meningitis
  • Tumours
  • Other SOL
  • Temporal arterititis
  • Stroke (including CV sinus thrombosis)
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7
Q

What should be included in a history headache history?

A

SOCRATES as aide memoire

  • How long?
  • Position on head?
  • Character (not intensity)?
  • Frequency When?
  • Diurnal variation?
  • Change in character
  • Nausea / vomitting
  • Radiation
  • Other neurological symtpms
  • PMH, FH
  • Medicines
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8
Q

What does a tension headache history usually present with?

A
  • Over weeks, months, years
  • Tightness, pressure
  • Constant, or worse towards evening
  • Rarely with nausea
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9
Q

What are the treatments for tension headaches?

A
  • Reassurance
  • Explain the muscles around the head
  • Reduce analgesia
  • Use relaxation exercises
  • Low dose amitriptyline
  • Won’t go away overnight
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10
Q

How many people in the UK are off work every day due to a migraine?

A

> 100,000

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11
Q

What are the symptoms of a migraine?

A
  • Headache with nausea
  • With or without aura, spreads over minutes
  • Unilateral or bilateral, usually hours-days
  • Photophobia, phonophobia, gut symptoms
  • Pulsating, sharp
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12
Q

What gender are migrains more common in?

A

Women - especially mid-cycle, at period and menopause (oestrogen)

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13
Q

What is thought to cause migraines?

A
  • Mechanism unclear, vascular and neural theories
  • Certain triggers (take diary) - foods, alcohol, beginning or end of working week, periods
  • May be exacerbated by physical activity
  • Often family history
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14
Q

What are the acute migraine treatments?

A
  • Triptans - agonsists at 5HT- 1b and 5HT-1d receptors (sumatriptan, rizatriptan, naratriptan, zolmitriptan etc)
  • Aspirin, paracetamol
  • Anti-nausea (prochlorperazine, metoclopramide)
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15
Q

What are the prophylactic treatments of migraines?

A
  • Beta blockers (propranolol)
  • Amitriptyline (low dose)
  • Pizotifen (5HT-2a and 2c antagonist, antihistamine, anticholenergic)
  • Topiramate
  • Sodium valproate
  • Candesartan
  • Flunarazine
  • Lisinopril
  • Methysergide (retroperitoneal fibrosis)
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16
Q

What are other migraine treatments that are not usually prescribed in primary care?

A
  • Botulinum toxin injection (usually every 90 days)
  • Anti-CGRP monoclonal antibodies, erenumab, liscensed in 2018 for >4 migraines / month UK, subcutaneous monthly injection, must have tried at least 3 other prophylactics
  • Acupuncture
17
Q

What category of people should not be prescribed the combined oral contraceptive pill?

A

Women with migraine and aura due to increased risk of stroke

18
Q

What are the symptoms of trigeminal neuralgia?

A
  • Shooting pain in one or more division of V

- Extremely painful, maybe triggered by cold or eating

19
Q

What is considered the cause of trigeminal neuralgia?

A
  • Young people consider demyelination

- Older people, often abberant blood vessel touching V

20
Q

What are the treatments for trigeminal neuralgia?

A
  • Carbamazepine
  • Gabapentin
  • Injection
  • Surgery
21
Q

What is trigeminal autonomic cephalagia (TAC)?

A
  • Recurrent pain in trigeminal distribution with autonomic features (eye watering, nasal congestion, redness eye)
  • Commonest of these is cluster headache: unilateral (striking circadian rhythm, dame time of day, clustering in periods usually few weeks, around one eye, runny)
  • Paroxysmal hemicranias (women>men), shorter, more frequent attacks, response to indomethacin
22
Q

What is the treatment of Trigeminal Autonomic cephalgia?

A
  • Triptans
  • Oxygen
  • High dose verapamil (up to 960 mg/day)
  • Indomethacin for P Hemicrania
23
Q

What is a medication overuse headache?

A
  • Present for > 15 days / month
  • Worsened while analgesia has been used
  • If using simple analgesia > 15 days/month, or > 10 days for other acute e.g. triptans
  • No evidence of another type of headache
  • Uncertain whether abrupt cessation of gradual stopping is better for treatment
24
Q

What is a thunderclap headache? How is it treated?

A
  • Instant or rapidly appearing (< 60 seconds)
  • Must consider SAH, but can be exertional (coital cephalgia)
  • Requires urgent investigation, CT head, LP after 12 hours, look for bilirubin and oxyhaemaglobin
25
Q

What is associated with raised intracranial pressure?

A
  • Headache usually mild
  • Diurnal variation - worse in morning, often gone by lunchtime
  • “headache wakes me up in morning”
  • May be worse with cough, straining
  • Often mild nausea
  • Neurological features
  • look for papilloedema
  • Tumours, absess, CSF blockage
  • Urgent referral and scan
26
Q

What are the classic clinical signs of meningitis?

A
  • Fever
  • Photohobia
  • Neck stiffness
  • Altered conscioussness
  • Petechial rash
  • Most meningitis is viral, but cannot distinguish clinically, so treat with ceftriaxone/cefotaxime or benzyl penicillin
27
Q

What are the symptoms / signs of temporal arteritis?

A
  • Never < 50 years of age
  • May be features of polymyalgia (proximal myopathy)
  • Jaw claudication
  • Tendor temporal arteries
  • Raised ESR (strong marker of inflammation)
28
Q

How is temporal arterietis diagnosed / treated?

A
  • Ultrasound or temporal artery biopsy (sample error)

- Danger of blindness, use steroids early - Prednisolone

29
Q

What group is most likely affected by cerebral venous sinus thrombosis?

A

Female - oral contraceptive pill

30
Q

What is associated with cerebral venous sinus thrombosis?

A
  • Headaches, often severe

- May be bilateral, haem

31
Q

What is used to investigate / diagnose cerebral venous sinus thrombosis?

A

MRI/MRV

32
Q

What is a low ICP caused by and what does it involve?

A
  • After lumbar puncture
  • Headache on standing, eased with lying
  • Can occur spontaneously
33
Q

How can low ICP be treated?

A
  • May resolve spontaneously

- Blood patch for post lumbar puncture headache

34
Q

What can cause early morning headaches?

A
  • Raised ICP
  • Obesity
  • History snoring
  • COPD
  • Sleep apnoea
35
Q

What is Transient Global Amnesia?

A
  • Variant of migraine
  • Often during stress/exposure to cold
  • Period of amnesia, unable to lay down any new memory, keep repeating the same question
  • Few minutes to hours
  • Usually solitary event that does not reoccur, can be similar to stroke
  • Clinical diagnosis

MD4001 Pathology (18 decks)

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