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Clinical Neuroscience > Headache > Flashcards

Headache Flashcards

1
Q

Headaches can either be Primary due to a headache disorder OR Secondary to another condition.

List 3 types of Primary Headache Disorder

A
  • Tension headache
  • Migraine
  • Cluster headache
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2
Q

List 6 types of Secondary headache

A
  • Intracranial lesion (tumour, haemorrhage)
  • Meningitis/ infection
  • Temporal arteritis
  • Glaucoma
  • Medication overdose headache
  • Trigeminal neuralgia
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3
Q

What are the Red Flag features of headaches?

A

SNOOP

  • Systemic symptoms/ disorders (Infection, Pregnancy etc)
  • Neurological symptoms
  • Onset new/ changed and patient >50
  • Onset in Thunderclap presentation
  • Papilloedema, Positional Provocation, Precipitated by exercise (suggest raised ICP)
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4
Q

Describe the presentation of a headache caused by a Space Occupying Lesion

A
  • Gradual onset
  • Progressive
  • Associated neurological symptoms
  • Addition features of raised ICP (Nausea, Worse on coughing/bending, early morning headache)
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5
Q

What would you look at in a clinical examination in someone with a headache

A
  • Full neurological exam (Cranial + Peripheral)
  • Vital signs (BP, RR, Temp, Pulse etc)
  • Other relevant systems)
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6
Q

Describe the epidemiology of Tension headache

A
  • Most common
  • More common in females
  • More common in young people (teens & adults)
  • Unusual if first onset is > age of 50 (possible malignancy)
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7
Q

Describe the pathophysiology of Tension headache

A
  • Tension in Head+Neck muscles (E.g Occipitofrontalis)

- Usually no family history

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8
Q

Describe the Site, Quality, Intensity and Timing of Tension headache

A

Site: Bilateral frontal, can radiate to neck

Quality: Tight/ band-like, constricting, non pulsatile

Intensity: Mild to moderate

Timing;

  • Worse at end of day
  • Chronic if >15 times per month, otherwise Episodic
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9
Q

Describe the Aggravating, Relieving factors and Secondary Symptoms of Tension headache

A

Aggravating;

  • Stress
  • Poor posture
  • Lack of sleep

Relieving;
- Simple analgesics

Secondary symptoms;
- Sometimes mild nausea

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10
Q

Describe the epidemiology of Migraine

A
  • More common in females
  • Most had 1st attack before 30
  • Severity decreases as age increases
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11
Q

Describe the pathophysiology of Migraine

A

Unclear but possibly;

  • Inflammation of CN V sensory neurones innervating large vessels and meninges
  • Brain sensitised to otherwise ignored stimuli-> Pain
  • Clear family history
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12
Q

Describe the Site, Quality, Intensity and Timing of Migraine

A

Site: Unilateral, often frontal

Quality: Sudden/ gradual onset, Pulsatile

Intensity: Moderate-severe, often need to lie down

Timing;

  • Lasts 4-72 hours
  • Possibly cyclical (menstrual cycle)
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13
Q

Describe the Aggravating, Relieving factors, Secondary Symptoms and Triggers for Migraine

A

Aggravating;
- Photophobia or Phonophobia (loud sounds)

Relieving;

  • Sleep/ lying down
  • Simple analgesics (Triptans)

Secondary symptoms;

  • May have Aura
  • Nausea + Vomiting

Triggers;

  • Some foods (cheese, chocolate)
  • Lack of sleep
  • Stress
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14
Q

Describe the epidemiology of Medication Over-use Headache

Describe its Pathophysiology

A
  • 3rd most common
  • Often 30-40 years old
  • More common in Females
  • Upregulation of pain receptors in meninges
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15
Q

List clinical features of Medication Over-use headache

A
  • Present at least 15 days a month
  • No improvement after OTC medication
  • Using analgesics at least 10 days a month
  • Various symptoms (Dull/ tension type/ migraine type)
  • Often coexists with Depression and sleep disturbance
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16
Q

Describe the management of Medication Over-use headache

A

Discontinuing of medication, but will get worse before it gets better

17
Q

Describe the epidemiology of Cluster headache

A
  • More common in males
  • 1 in 1000 people
  • Smoking is a risk factor
  • Usually begins at 20-40
18
Q

Describe the Site, Quality, Intensity and Timing of Cluster headache

A

Site: Around/ behind one eye, no radiation

Quality: Sharp/ penetrating

Intensity: Very severe, constant intensity, makes it difficult to sit still

Timing;

  • Rapid onset
  • Attacks last 15 min-3 hours, 1-2 times a day
  • Usually at night
  • Remissions between attacks can be 3 months- 3 years
19
Q

Describe the Aggravating, Relieving factors and Secondary Symptoms for Cluster headache

A

Aggravating;

  • Head injury
  • Smoking
  • Alcohol

Relieving;
- Simple analgesics ineffective, use O2 and Triptans

Secondary Symptoms (decreased sympathetic activity);

  • Ptosis
  • Nasal congestion
  • Red, watery eye
20
Q

List 8 triggers for cluster headache

A
  • Alcohol
  • Heat
  • Exercise
  • Solvent inhalation
  • Lack of sleep
  • Smoking
  • Histamine (hayfever)
  • GTN
21
Q

Describe the epidemiology of Trigeminal Neuralgia

Describe its Pathophysiology

A
  • Peak incidence 50-60, increasing with age
  • More common in females
  • Most cases: Compression of CN V
  • Some cases: Due to Tumours/ MSK or Skull base abnormalities
  • More common in those with a history of chronic pain
22
Q

Describe the Site, Quality, Intensity and Timing of Trigeminal Neuralgia

A

Site: Unilateral often over one eye, Radiates to eyes, lips, nose, scalp

Quality: Sharp/ stabbing, Electric shock feeling

Intensity: Severe

Timing: Sudden onset, lasts from seconds-minutes

23
Q

Describe the Aggravating, Relieving factors and Secondary Symptoms for Trigeminal Neuralgia

A

Aggravating;

  • Light touch to face
  • Eating
  • Cold wind
  • Vibrations

Relieving;
- Difficult to alleviate, simple analgesics ineffective

Secondary Symptoms;
- Possible numbness and tingling before attack

24
Q

Describe the epidemiology of Temporal arteritis

Describe its Pathophysiology

A
  • More common in females
  • Often over 50 (usually over 75)
  • Vasculitis of large and medium sized arteries of head
25
Q

How may Temporal Arteritis present in addition to headache?

A
  • Visual disturbance
  • Jaw pain

(Many other possible symptoms)

(Risk of permanent vision loss due to involvement of vessels supplying CN II)

26
Q

Describe the investigation of headaches

A
  • Dependant on cause
  • Headache diary can be useful if chronic
  • May need imaging if red flags
27
Q

Describe the treatment of headaches

A
  • Treat underlying cause
  • Simple analgesics
  • Triptans for Migraine (with O2 for Cluster headaches)
28
Q

List 6 referral criteria for headaches

A
  • Suspected tumour
  • Suspected raised ICP
  • Recent onset of seizures
  • Previous cancer
  • Unexplained focal deficit
  • Unexplained cognitive/ personality changes

Clinical Neuroscience (19 decks)

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