Headache Assessment Flashcards by Joyce Beshara

Migraines are more common in which gender

Women

How well did you know this?

Not at all

Perfectly

Which headaches symptoms are classified as dangerous

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

How well did you know this?

Not at all

Perfectly

What are the 4 types of new onset dangerous headaches

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

How well did you know this?

Not at all

Perfectly

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

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.

How well did you know this?

Not at all

Perfectly

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

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.

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

What could be the reason for persistent headaches

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

How well did you know this?

Not at all

Perfectly

What is temporal arteritis / giant cell arteritis

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.

How well did you know this?

Not at all

Perfectly

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

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 )

How well did you know this?

Not at all

Perfectly

What are orthostatic headaches

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

How well did you know this?

Not at all

Perfectly

How can you relieve orthostatic headaches

Epidural Patch in lumbar canal

How well did you know this?

Not at all

Perfectly

Will CT brain in orthostatic headache detect the problem

Usually not, usually requires MRI

How well did you know this?

Not at all

Perfectly

What are the treatments for cluster headaches

High flow oxygen and Imigran injections. Plus verapamil

How well did you know this?

Not at all

Perfectly

How is trigeminal neuralgia treated

Tegretol medication.

How well did you know this?

Not at all

Perfectly

Why is trigeminal neuralgia important to diagnose

In younger people could be the first presentation fo MS

How well did you know this?

Not at all

Perfectly

What is the classical presentation of Brian tumours

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

raised ICP headache in 20%.

How well did you know this?

Not at all

Perfectly

What is the presentation of ICP headache

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

How well did you know this?

Not at all

Perfectly

How are recurrent headaches diagnosed

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

How well did you know this?

Not at all

Perfectly

What are the symptoms of Migraines

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 )

How well did you know this?

Not at all

Perfectly

What are risk factors for migraines

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

How well did you know this?

Not at all

Perfectly

What senses become sensitive with migraines

Light, noise, smell, movement, touch , nausea

How well did you know this?

Not at all

Perfectly

What are possible prodromal symptoms of migraines

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

How well did you know this?

Not at all

Perfectly

Explain what is the migraine aura symptoms

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

Is a persistent aura due to migraines

no migraine auras go away

What are the symptoms of tension type headaches

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

What are the symptoms for Ice-Pick Headache

``` 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 ```

What is possible treatment for Ice-Pick Headache

NSAIDS , Neck physiotherapy

Can people with migraines get other types of headaches

Yes they usually do

How to tell difference between focal seizure and migraine aura

Focal seizure : maximal at onset | migraine aura: maximal over minutes

What are the risk factors of a very one sided headache

1- TMJ joint dysfunction on that side | 2- cervical spine abnormality on that Side

Does a one sided headache automatically mean migraine

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

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

What is Horner's syndrome and how does it present

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

Horner's syndrome could be a sign of what

ipsilateral internal carotid artery dissection which could give thunderclap heading

What are the differential diagnosis for thunderclap headache

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

What investigations could be done for thunderclap headaches

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

When are angiograms done with thunderclap headache presentations

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

When are Venography's does for thunderclap headache presentation

Suspected Cerebral Venous Sinus Thrombosis

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

contrast : Suspected spontaneous intracranial hypotension normal : suspected stroke , infarction

Stimulation or pain in the neck causes referred pain in what

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

What examinations are done if migraine is suspected

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 )

How to manage Migraines

``` 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 ```

What is the Acute management of migraine

``` 1- NSAIDS/ paracetamol - aspirin / ibuprofen 2- Anti-emetics - buccastem / metoclopramide 3- Triptans - sumatriptan / injection ``` NICE recommend early triptan and combinations with others

What is the window of treatment for migraines

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

What is the prophylaxis treatment for migraines

1- Beta-blockers - propranolol 2- Anti-convulsants - topiramate 3- Anti-depressants - amitriptyline/ Give for 3 months to see if they work

What are the types of constant headaches

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

What is a sign of idiopathic intracranial hypertension

Papillodema

How to diagnose Chronic migraine

``` 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 ```

What investigations are done for chronic migraines

1- FBP / TSH/ cortisol / LFT 2- ask about sleep apnoea no need for scans

What is the prophylaxis treatment for chronic migraines

Medications with randomized trial evidence 1- Topiramate 2- Botulinum Toxin A 3- Anti-CGRP Abs

When are you able to get botox for chronic migraines

if any of the 3 prophylactic drugs fail

How does Botox work for migraines

31 different injection points, botox works to desensitize C fibres

When migraines are building , level of what antibodies rises

CGRP, driving inflammatory process that gives pain

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

Monoclonal Ab which block CGRP pathways. | Have minimal side effects but very expensive

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

Prescribe the Monoclonal Ab

What is new daily persistent headache s

Headaches post vaccines

What is Hemicrania Continua and what medication is prescribed

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