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Y4: Neurology > Headache > Flashcards

Headache Flashcards

1
Q

important points to explore in a history?

A

SOCRATES
triggers
auras, visual disturbances
red flags

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2
Q

red flags for headache?

A 
new onset HA >55
new/ previous Hx of malignancy
immunosuppressed
early morning HA which wakes you up
exacerbated by valsalva manouvre 
persistent severe headache, worse at night
associated weight loss
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3
Q

what ees dees?

a common cause of headache which occurs intermittently characterised by recurrent
episodes of headache lasting a few hours to a few days.

A

migraine

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4
Q

attacks of migraine can usually be associated with known triggers e.g.

A 
stress
skipping meals
binge eating
menstruation or ovulation
oral contraceptive
bright sunshine
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5
Q

clinical features of migraine?

A

at least 5 attacks in 5-72hrs:

  • unilateral throbbing headache
  • worse on movement
  • photo/phonophobia (require dark room)
  • N&V
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6
Q

how may migraine present differently in children?

A

shorter, may be bilateral, more prominent GI symptoms

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7
Q

T/F: most migraines occur with aura

A

false - 20%

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8
Q

what is an aura? (with migraine)

A

reversible visual, auditory, motor or language symptoms inc zigzag lines, central or hemianopic scotoma, aphasia and muscle weakness occurring before or at the start of the headache

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9
Q

which medication is completed contraindicated in pts with migraine with aura and why?

A

COCP- significantly increased risk of ischaemic stroke

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10
Q

diagnosis of migraine?

A

no other physical symptoms: clinical

weakness, aphasia, other Sx: CT scan (rule out stroke)

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11
Q

treatment of migraine?

A

trigger avoidance

mild: high dose NSAID +/- antiemetic
severe: oral triptan (rizatriptan, sumatriptan) +/- NSAID +/- antiemetic (even w/o N&V)

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12
Q

SEs of triptans?

A

dizzy, drowsy, altered temperature sensation, tingling sensations, chest/ throat tightness or heaviness

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13
Q

contraindications of triptans?

A

coronary vasospasm
ischaemic heart disease
previous cerebrovascular accident

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14
Q

what can be used as migraine prophylaxis? indications for this?

A

> 3 attacks/ month or severe

- propranolol or topiramate

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15
Q

how is a tension type headache often described?

A

tight band around head often radiating to neck

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16
Q

triggers of tension type headache?

A

stress, depression, anxiety

believed to be caused by stiffening of muscles of face and neck

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17
Q

clinical features of tension type headache?

A

band like pressure around head radiating to neck

tingling sensation in head

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18
Q

absence of what clinical features is important for a diagnosis of tension headache?

A

N&V or photo/phonophobia

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19
Q

treatment of tension type headache?

A

reassurance
relaxation
amitriptyline in chronic refractory tension type HA

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20
Q

what are Trigeminal autonomic cephalgias?

A

a group of HA disorders categorised by unilateral pain (often severe) in distribution of trigeminal nerve. Often associated with autonomic symptoms on ipsilateral side

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21
Q

3 types of TAC?

A

cluster HA
trigeminal neuralgia
paroxysmal hemicrania

22
Q

where did cluster headache get its name?

A

tends to occur in clusters during the day (1-8 times) and for a certain period of the year (weeks-months) before ceasing for a long period of time

23
Q

demographic for cluster HA?

A

men 20-55

24
Q

clinical features of cluster HA?

1) symptoms
2) timing
3) how often/ day

A

severe unilateral stabbing retro-orbital, supra-orbital or temporal region pain

ipsilateral autonomic features: ptosis, miosis lacrimation, nasal stuffiness, chemosis

cicardian rhythm of onset (often night or early morning)

last 10 minutes - 3 hours, 1-8 times/ day

25
Q

diagnosis of cluster HA?

A

usually clinical

MRI + MR angiogram to rule out secondary cause

26
Q

treatment of cluster HA?

1) acute
2) prophylaxis

A

1) high flow oxygen + SC sumatriptan

2) verapamil

27
Q

how to differentiate paroxysmal hemicrania from a cluster HA?

A
  • shorter (10-30 mins)
  • more frequent (1-40/ day)
  • more common in females, older age of onset (50-60)
28
Q

treatment of paroxysmal hemicrania?

A

indomethicin (complete response)

29
Q

what does SUNCT stand for? (a type of TAC)

A

short-lived
unilateral (temporal, retroorbital and supraorbital regions)
neuralgiaform (single stabs, series of stabs or saw-tooth pattern)
conjunctival injection
tearing

30
Q

treatment of SUNCT?

A

lamotrigine, gabapentin

31
Q

what causes trigeminal neuralgia?

A

disorder of the trigeminal nerve, most commonly due to compression of vascular origin. Can also be demyelinating disease/ neoplastic compression

32
Q

Trigeminal neuralgia

The __ and __ divisions of the nerve are most commonly affected and symptoms tend to be UNILATERAL/ BILATERAL

A

maxillary and mandibular

unilateral

33
Q

clinical features of trigeminal neuralgia?

A

electric shock-like pain usually around the nose or mouth
pain lasts up to 90 seconds and can go on for weeks-months
exacerbated by touching, cold wing, shaving/ brushing teeth, talking, eating, drinking

34
Q

Ix in trigeminal neuralgia?

A

MRI brain

35
Q

Rx of trigeminal neuralgia?

A

1) carbamazepine

2) neurosurgical debulking or radiofrequency ablation

36
Q

HAs caused by increased intracranial pressure may be due to benign causes e.g. … or ore sinister aetiologies e.g. …

A

IIH

brain tumours

37
Q

what is a medication HA?

A

headache lasting 15 days which started/ got worse while the patient was on regular medication and improved within 2 months of discontinuation

38
Q

name 3 types of activity-related HA?

A

primary cough HA
primary exertional HA
primary sexual HA

39
Q

describe the HA in the following vascular disorders

1) subarachnoid haemorrhage
2) carotid dissection
3) giant cell arteritis

A

1) sudden onset occipital thunderclap, signs of meningism
2) spontaneous or due to hyperextension neck injury. Pain in head/ neck and symptoms of ischaemia distal to the dissection with horner syndrome
3) scalp tenderness, jaw claudication

40
Q

HAs caused by increased intracranial pressure may be due to benign causes e.g. … or ore sinister aetiologies e.g. …

A

IIH

intracranial neoplasm, abscess

41
Q

what is idiopathic intracranial hypertension? (IIH)

A

idiopathic process of chronically raised CSF pressures in the brain occurring w/o any discernible SOL

42
Q

who does IIH tend to occur in?

A

young obese females

43
Q

clinical features of IIH?

A

HA: throbbing type, worse in morning, relieved
on standing.
Bilateral papilloedema.
N&V
Less commonly, CNVI palsy due to increased ICP

44
Q

Ix in IIH

  • MRI/ CT
  • visual field testing
  • LP
A

MRI/CT: slit like ventricles
VF: papillodeoma > enlarged blind spot
LP: high opening pressure

45
Q

treatment of IIH?

A

1) weight loss (usually sufficient)
2) acetazolamide (decreases CSF production)
3) lumboperitoneal shunt

46
Q

what Ix must be carried out in all patients with TACs?

A

MRI and MR angiogram to rule out secondary causes

47
Q

describe the features of primary cough HA. Cause?

A

occurs on coughing
sharp, bilateral pain lasting short duration

most have underlying cause (Chiari malformation, aneurysm)

48
Q

describe the features of primary exertional HA.

A

occurs with exercise

bilateral, pulsating

49
Q

describe the features of primary sexual HA.

A

early coital cephalgia: dull occipital aching, worsens with sexual excitement
post-coital cephalgia: severe and maximal during orgasm

50
Q

Migraine triggers?

A 
CHOCOLATE:
chocolate
hangovers
orgasms
cheese/caffeine
oral contraceptives
lie-ins
alcohol
travel
exercise
51
Q

Migraine triggers?

A 
CHOCOLATE:
chocolate
hangovers
orgasms
cheese/caffeine
oral contraceptives
lie-ins
alcohol
travel
exercise

Y4: Neurology (13 decks)

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