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Neurology > Headache DDx > Flashcards

Headache DDx Flashcards

1
Q

What are considered ‘red flags’ when a patient presents with a headache?

A

Headache waking them from sleep
Known/previous malignancy
Immunosuppressed
Exacerbated by Valsalva (coughing/sneezing)

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2
Q

Define a tension headache:

A

Bilateral non-pulsatile headache potentially with scalp tenderness.
Not associated N&V, photophobia or phonophobia

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3
Q

What medication has be shown to have a positive effect on tension headaches?

A

Anti-depressants

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4
Q

What is the management for tension headache?

A

Physiotherapy

Massage

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5
Q

Define a cluster headache:

A

Severe unilateral headache lasting 15mins - 3 hours with pain often around the eye
Can have up to 1 or 2 a day
Chronic or episodic

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6
Q

What are some symptoms of a cluster headache

A 
Watery bloodshot eye
Lid swelling
Lacrimation
Flushing
rhinorrhoea
Miosis
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7
Q

What group tend to suffer from cluster headaches?

A

30-40y/o

M>F

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8
Q

What is the treatment options for an acute episode cluster headache?

A

Acutely:
High flow oxygen
Steroids
Sumatriptan sub cut 6mg

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9
Q

What prophylactic treatment can be given for a cluster headache?

A

Verapamil

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10
Q

What is SUNCT syndrome:

A 
Rare headache belonging to a group pf headaches known as trigeminal autonomic cephalagias (TAC)
Short lived
Unilateral
Neuralgic headache
Conjuctival injections
Tearing
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11
Q

What treatment can be given for SUNCT?

A

Lamotrigine

Gabapentin

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12
Q

What type of headache presents with severe unilateral pain lasting only seconds but occuring between 10-100 times a day?

A

Trigeminal Neuralgia

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13
Q

What can trigger trigeminal neuralgia?

A

Touch

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14
Q

What branches of CNV are involved in trigeminal neuralgia?

A

CNV 2 & 3

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15
Q

Males are more affected by trigeminal neuralgia. True or false

A

False.

F>M

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16
Q

What ethnicity is trigeminal neuralgia more common in?

A

Asians

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17
Q

What age group is trigeminal neuralgia more common in

A

> 60y/o

18
Q

List some medications which can be used to treat trigeminal neuralgia:

A 
Carmbamazipine
Lamotrigine
Phenytoin
Baclofen
Gabapentin
19
Q

Other than medication what else can be done to treat trigeminal neuralgia?

A

Surgical ablation or decompression

20
Q

What type of headache, affecting mainly 50s-60s, presents with severe unilateral pain lasting 10-30mins between 1 and 40 times a day?

A

Paroxysmal Hemicrania

21
Q

What other type of headache is paroxysmal similar to and how might they differ?

A

Cluster

A paroxysmal headache is shorter in duration but more frequent

22
Q

What drug has an absolute response in paroxysmal hemicrania?

A

Indomethicin

23
Q

What are the features of a headache associated with idiopathic intercranial hypertension?

A 
Worse on waking
Nausea and vomiting
Seizures and odd behaviors
May have vision loss
Worsened by lying flat, bending forward and coughing
24
Q

What must you exclude in idiopathic intercranial hypertension?

A

Space occupying lesion

25
Q

What investigation should you do for a headache assoc with idiopathic intercranial hypertension?
What should you avoid?

A

CT imaging

DO NOT lumbar puncture until after imaging - patient is at risk of coning

26
Q

What examinations should be done for idiopathic intercranial hypertension?

A

Fundoscopy

Visual field exam

27
Q

Are females or males more likely to suffer from headache of idiopathic intercranial hypertension?

A

Females

28
Q

What is another risk factor for idiopathic intercranial hypertension?

A

Obesity

29
Q

What is the management for headache associated with idiopathic intercranial hypertension?

A

WEight loss
Monitoring visual fields and CSF
Acetazolomide
Shunt if necessary

30
Q

List some differential diagnosis of headache?

A 
Space occupying lesion
Infection
Stroke
GCA
Acute glaucoma
Sinusitis
Medication overuse
31
Q

How many patients with migraine suffer from aura?

A

20%

32
Q

What is the criteria for a migraine IF no aura.

A

5 attacks of severe unilateral throbbing headache
Lasting 4-72 hours
N & V
May have photo or phono phobia

33
Q

What can trigger migraine?

A 
Diet
Stress
Sleep
Hormones (menstruation)
Exercise
34
Q

How does stress increase the risk of a migraine?

A

Stress leads to increased levels of serotonin, which causes blood vessels to constrict and dilate
Substance P is then released, stimulating pain receptors

35
Q

What risk factors are there for a migraine?

Use the anagram CHOCOLATE

A 
Chocolate
Hangovers
Orgasms
Cheese
OCP
Lie - ins
Tumult
Exercise 
Other risks include female, obesity and smoking
36
Q

What medication is used for prophylaxis of migraine?

A

1st line: Propranolol Amitriptyline and Topimirate

2nd Line: Valproate, Gabapentin, pregabalin

37
Q

What medications can be used to treat an acute migraine?

A

NSAIDS e.g. aspirin

oral 5-HT antagonists e.g. triptans and ergots

38
Q

When are triptans contraindicated?

A

In ischaemic heart disease, coronary spasm and uncontrolled hypertension

39
Q

What is a serious side effect of ergotamine that must be mentioned to the patient before it is prescribed for migraine?

A

Gangrene

Vascular damage

40
Q

How often do patients tend to suffer from migraines?

A

1 attack a month

Neurology (15 decks)

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