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Neurology Clinical > Headache Assessment > Flashcards

Headache Assessment Flashcards

1
Q

Migraines are more common in which gender

A

Women

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2
Q

Which headaches symptoms are classified as dangerous

A 
1- Thunderclap 
2- Focal symptoms 
3- fever 
4- persisting / progressive / provoked 
5- new onset headaches
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3
Q

What are the 4 types of new onset dangerous headaches

A

1- Thunderclap headache
2- Fever
3- Focal symptoms
4- persisted-provoked

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4
Q

What are Thunderclap headaches and what needs to be done if patient comes in with one

A

MAXIMAL at ONSET
Go from no headache to severe within seconds. Lasts for 20-30 minutes and then disappears completely or lingers for a while. Symptom of SAH, necessary to further investigate must do CT Brian.

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5
Q

What do you think when a patient presents with headache and fever

A

1- Systemic or viral illness.
2- Sinusitis
3- Meningitis ( viral or bacterial )
4- Encephalitis

Need to exclude bacterial meningitis: progressive, painkillers do not work, getting worse and it’s been 6-12+ hrs.

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6
Q

What do you think when a patient presents with headache and focal symptoms

A

Most will have migraine with aura , evolving sensory disturbances. Usually due to migraines.

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7
Q

What could be the reason for persistent headaches

A

1- CO poising : can tell by work or home environment
2- Temporal arteritis
3- Intracranial Hypertension : High BMI and pulsatile tinnitus
4- Cervicogenic / hemicrania : NSAID responsive
6- Paranasal Sinusitis : dental pain
7- Migraine chronic onset

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8
Q

What is temporal arteritis / giant cell arteritis

A

Patient usually 50+ and ESR is over 50.

Arteries at the side of the head become inflamed , can cause blindness since it can affect retina.

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9
Q

What could be the reasons for provoked headaches and how will they present

A

1- CSF leak : orthostatic 2- 2- Coital / Exertional : intense and severe , suspect SAH
3- Cluster Headache: nocturnal , autonomic activation, pain around one eye , runny nose , ptosis, goes away
4- Trigeminal neuralgia : electric shock sharp pain and triggered by something
5- Hypnic headache: awakens from sleep ( due to caffeine )

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10
Q

What are orthostatic headaches

A

when lying down patient is fine but when standing up there’s pressure in head ,and really bad headache that is resolved when lying down again

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11
Q

How can you relieve orthostatic headaches

A

Epidural Patch in lumbar canal

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12
Q

Will CT brain in orthostatic headache detect the problem

A

Usually not, usually requires MRI

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13
Q

What are the treatments for cluster headaches

A

High flow oxygen and Imigran injections. Plus verapamil

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14
Q

How is trigeminal neuralgia treated

A

Tegretol medication.

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15
Q

Why is trigeminal neuralgia important to diagnose

A

In younger people could be the first presentation fo MS

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16
Q

What is the classical presentation of Brian tumours

A

1- Tension type headaches
2- focal neurology / epileptic seizures
3- papilloedema

raised ICP headache in 20%.

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17
Q

What is the presentation of ICP headache

A

Patient wakes up with headache, vomits and then in a few hours pain goes away

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18
Q

How are recurrent headaches diagnosed

A

Headache type through History + Normal Neurological exam. Scans are generally not required

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19
Q

What are the symptoms of Migraines

A

Sickening headaches that make patient what to lie down. Normal neurological exam

1- Disabling level of pain
2- recurrent headaches
3- sensory sensitivity features : usually nausea / light
4- prodromal symptoms ( psychotic )
5- Transient vertigo , brain fog , tingling , heaviness, visual loss, flash , difficulty finding words or concentrating
6- Aura
7- unilateral ( but not always the case )

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20
Q

What are risk factors for migraines

A 
1- Neck stiffness/ injury/ tightness 
2- temporal mandibular joint disfunction 
3- short sighted ( myopia ) 
4- family history of headache 
5- female predominant
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21
Q

What senses become sensitive with migraines

A

Light, noise, smell, movement, touch , nausea

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22
Q

What are possible prodromal symptoms of migraines

A 
1- Depression / anxiety 
2- hungry / thirsty / cravings 
3- elation/energy 
4- diarrhoea/ pleura 
5- drowsy / lack of interest
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23
Q

Explain what is the migraine aura symptoms

A

Depending on the cortical area it is affecting. Visual , hearing, balance, motor , sensory or consciousness

24
Q

Is a persistent aura due to migraines

A

no migraine auras go away

25
Q

What are the symptoms of tension type headaches

A

1- Tightness/ weight/ pressure / band feeling
2- lasts for hrs, days, weeks
3- nothing makes it worse or better
4- any location on head

26
Q

What are the symptoms for Ice-Pick Headache

A 
1- Brief neuralgic pain 
2- lasts for seconds disappears 
3- may increase to migraine 
4- may linger like tension-type 
5- often around the ye
27
Q

What is possible treatment for Ice-Pick Headache

A

NSAIDS , Neck physiotherapy

28
Q

Can people with migraines get other types of headaches

A

Yes they usually do

29
Q

How to tell difference between focal seizure and migraine aura

A

Focal seizure : maximal at onset

migraine aura: maximal over minutes

30
Q

What are the risk factors of a very one sided headache

A

1- TMJ joint dysfunction on that side

2- cervical spine abnormality on that Side

31
Q

Does a one sided headache automatically mean migraine

A

No

32
Q

What are the risk factors for SAH ( 6 ) that would show that severe headache needs more investigations

A 
1- 40 + years 
2- neck pain / stiffness 
3- onset during exertion 
4- thunderclap onset 
5- neck stiffness on examination 
6- Loss of consciousness
33
Q

What is Horner’s syndrome and how does it present

A

Loss of sympathetic innervation to the eye , causing partial upper eye lid drooping ( ptosis) , pupil is constricted due to parasympathetic overactivity ( myosis )

34
Q

Horner’s syndrome could be a sign of what

A

ipsilateral internal carotid artery dissection which could give thunderclap heading

35
Q

What are the differential diagnosis for thunderclap headache

A 
1- SAH 
2- Meningitis 
3- Venous sinus thrombosis 
4- Pituitary apoplexy 
5- spontaneous intracranial hypotension
36
Q

What investigations could be done for thunderclap headaches

A

1- CT Brian
2- lumber puncture ( for bilirubin peak )
3- check CSF glucose & protein
4- CSF cultures for infection

37
Q

When are angiograms done with thunderclap headache presentations

A

If arterial dissection , vasoconstriction are suspected and if CT&LP are inconclusive for SAH

38
Q

When are Venography’s does for thunderclap headache presentation

A

Suspected Cerebral Venous Sinus Thrombosis

39
Q

When are MRI’s with contrast does for thunderclap headache presentation ? what about normal MRI

A

contrast : Suspected spontaneous intracranial hypotension

normal : suspected stroke , infarction

40
Q

Stimulation or pain in the neck causes referred pain in what

A

In the head. The higher up the neck the more forward the pain is referred in the head

41
Q

What examinations are done if migraine is suspected

A

1- Cervical flexion-rotation test
2- palpation of upper cervical muscles . sub occipital insertions
3- palpate ROM TMJIs
4- visual acuity
5- Neuro screening exam
6- BP, pulse, Heart sounds ( check atria )

42
Q

How to manage Migraines

A 
1- Lifestyle 
 - Hydration 
 - avoid hunger 
 - sleep well 
 - walk / exercise 
2-  modifiable Risk factors 
 - medication overuse 
 - neck/ posture 
 - jaw intervensions 
 - eye vision correction 
 - BMI , reduces overweight 
3- Psychology of pain 
  - explain to patient the pain  is normal 
4- Acute Medication 
5- Prophylaxis
43
Q

What is the Acute management of migraine

A 
1- NSAIDS/ paracetamol 
 - aspirin / ibuprofen 
2- Anti-emetics 
 - buccastem / metoclopramide
3- Triptans 
 - sumatriptan / injection

NICE recommend early triptan and combinations with others

44
Q

What is the window of treatment for migraines

A

Take medication before it is too severe. if head is too sore to touch then unlikely medication will treat the migraine

45
Q

What is the prophylaxis treatment for migraines

A

1- Beta-blockers - propranolol
2- Anti-convulsants - topiramate
3- Anti-depressants - amitriptyline/

Give for 3 months to see if they work

46
Q

What are the types of constant headaches

A

1- chronic migraine
2- chronic tension type headache
3- idiopathic intracranial hypertension
4- cervicogenic headache

47
Q

What is a sign of idiopathic intracranial hypertension

A

Papillodema

48
Q

How to diagnose Chronic migraine

A 
1- 6 months + 
2- more than 50% of days with headache 
3- 50% of headaches have migraine features 
4- no other reason 
5- normal examination
49
Q

What investigations are done for chronic migraines

A

1- FBP / TSH/ cortisol / LFT
2- ask about sleep apnoea

no need for scans

50
Q

What is the prophylaxis treatment for chronic migraines

A

Medications with randomized trial evidence

1- Topiramate
2- Botulinum Toxin A
3- Anti-CGRP Abs

51
Q

When are you able to get botox for chronic migraines

A

if any of the 3 prophylactic drugs fail

52
Q

How does Botox work for migraines

A

31 different injection points, botox works to desensitize C fibres

53
Q

When migraines are building , level of what antibodies rises

A

CGRP, driving inflammatory process that gives pain

54
Q

What medication was just approved in 2020/2021 for chronic migraines

A

Monoclonal Ab which block CGRP pathways.

Have minimal side effects but very expensive

55
Q

If the botox doesn’t work for chronic migraine what do you do next

A

Prescribe the Monoclonal Ab

56
Q

What is new daily persistent headache s

A

Headaches post vaccines

57
Q

What is Hemicrania Continua and what medication is prescribed

A

a headache causing constant pain on one side of the head, treated via NSAIDS

Neurology Clinical (14 decks)

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