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Y3/ Neurology > Headache: A Clinical Approach > Flashcards

Headache: A Clinical Approach Flashcards

1
Q

What are the commenest headache conditions

A

migraine, tension headache, medication overuse headache

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2
Q

What are the more serious conditions that cause headache?

A

cluster headache, tumour, CNS infection

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3
Q

What is the commonest theory for the pathogenesis of migraine?

A
  • neuro-vasuclar theory, activation of trigeminovascular system
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4
Q

How can an aura present in a migraine?

A
  • visual auras are the most common, flashing lights, zizzag lines, certification spectre, paracentral scotoma
  • hemianopia
  • sensory parasthesia
  • hemiparesis
  • ompthalmoparesis
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5
Q

What are the features of migraine without aura?

A
  • headaches are often longer and more frequent, with the pain typically spreading bilaterally
  • more common in females from 30-50 who have generally experienced aura through their teens and twenties
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6
Q

What are the associated symptoms during the headache phase of migraine?

A

nausea, vomiting, photophobia, phonophobia

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7
Q

What is migraine pain like?

A
  • the headache is usually severe enough to put people to bed and typically is a throbbing, unilateral pain that become worse on activity
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8
Q

What is the first treatment of migraine?

A
  • removal of any triggers such as chocolate, cheese, alcohol, dehydration, fasting
  • also menstruation, exercise, travelling, stres
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9
Q

What is the acute treatment for mirgraine

A
  • analgesics (NSAIDs, paracetamol)

- anti-emetics (domperidone or metoclopramide), and triptans (5-HT antagonists e.g. sumitriptan)

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10
Q

What are prophylactic drugs for migraine?

A
  • beta blockers e.g. propanolol
  • antiepileptics e.g. topiramate
  • TCA’s, but sedative effects
  • acupuncture and botox
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11
Q

When are prophylactic treatments used?

A
  • only in severe ceases where there are >4 migraines a month
  • the does are built up to avoid side effects and then titrated up until symptoms are controlled
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12
Q

How do tension headaches present?

A
  • bilateral pressure, band like
  • can be episodic or continuous
  • may go along features of anxiety, such as panic attacks
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13
Q

How are tension headaches managed?-

A

stress management and reassurance

  • lifestyle changes
  • analgesia (never codeine!)
  • psych referral
  • prophylaxis, TCAs and SSRIs
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14
Q

How can a diagnosis of a medication overuse headache be made?

A
  • the headaches attenuate after 3 months of drug withdrawal
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15
Q

which drugs cause medication overuse headache

A

codeine
ergotaline
triptans

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16
Q

What is the presentation of cluster headache?-

A

cluster of headaches which only last 30-60 minutes around 4-5 times a day, more often at night.

  • typically they cause incredibly severe unilateral pain in the ocular or frontal regions, the patient will be incredibly agitated, and it is coupled with autonomic syndrome
  • typically one eye will water, and the conjunctiva will go red
  • there will be unilateral nasal discharge
17
Q

How can cluster headaches be investigated?

A

MRI , as there may be evidence of pituitary lesion that can irritate the trigeminal nerve

18
Q

How are cluster headaches managed?

A
  • acute treatment, subcutaneous or nasal sumatriptan alongside oxygen
  • prophylaxis includes verapamil, lithium and prednisone
19
Q

Cluster headaches are a form of ……….

A

Terminal autonomic cephalgias (TACs)

20
Q

What does temporal arteritis affect?

A

0 the branches of the external carotid arteries

21
Q

What are they features of temporal arteritis?

A

headache, scalp tenderness, jaw claudication, fever, weight loss, anaemia, increased ALP, proximal muscle weakness (polymyalgia rheumatica)

22
Q

What is the age group affected by temporal arteritis?

A
  • over 50
23
Q

What are the investigations for temporal arteritis?

A
  • blood tests, particularly ESR, which will be raised

- temporal artery biopsy can be performed under local but has poor sensitivity

24
Q

What are the complications of temporal arteritis?

A
  • blindness, if the internal carotid arteries are affected

- TIA or stroke

25
Q

What is the treatment for temporal arteritis?

A
  • treatment takes 2-3 years before symptoms are eradicated

- involves high does (60mg daily) of prednisolone to give an immediate response, and then dose is titrated down

26
Q

How does idiopathic intracranial hypertension present?

A
  • non-specific featureless chronic headache

- visual obscurations can occur leading to temporary blinding and there may be VI nerve palsies

27
Q

What is the main clinical sign in IIH?

A

papilloedema

28
Q

What are the precipitating factors for IIH?

A
  • hormonal: obesity, OCP, pregnancy, steroid therapies

- some antibiotic treatments

29
Q

How is IIH diagnosed?

A
  • lumbar puncture, demonstrating raised pressure of >40

- CT and MRI should be used to exclude venous sinus thrombosis and tumour

30
Q

How IIH managed?

A
  • neuro-opthalmology
  • closely monitoring visual fields to ensure vision is not impaired
  • remove any precipitating agents
  • weight loss encouraged
  • acetazolamide and other diuretics can be useful
  • surgical therapy includes limbo-peritoneal shouting or optic nerve sheath re-fenestration to permanently relieve pressure
31
Q

How does trigeminal neuralgia present?

A
  • sever stabbing pain triggered by factors such as touch and chewing
  • most commonly felt in the maxillary division of the trigeminal nerve unilaterally
32
Q

How is TN managed?

A
  • oral pregabaline or gabapentin

- can be treated with the injection of alcohol at the foramen rotundum, however this runs the risk of nerve damage

33
Q

How does headache associated with tumours present?

A
  • meningiomas will cause constant headache, usually in the right fronto-temporal region, and other symptoms such as slurred speech, arm weakness, and facial spasm
  • if there are focal symptoms and signs on one sign of the body, this is a red flag for a tumour

Y3/ Neurology (11 decks)

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