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Y3 Neurology > Headache Syndromes > Flashcards

Headache Syndromes Flashcards

1
Q

what are the red flag symptoms when a patient presents with headache (5)?

A 
new onset headache >55
known/previous malignancy
immunosuppression
early morning headache
exacerbated by valsalva
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2
Q

who is migraine more common in - males or females?

A

females

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3
Q

what is the average number of attacks in a month for patients with migraine?

A

one a month usually

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4
Q

what is the criteria for diagnosing migraine without aura?

A

> 5 attacks lasting 4-72 hours

two of = moderate/severe, unilateral, throbbing pain, worse on movement

one of = autonomic features, photophobia, nausea etc.

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5
Q

what is aura?

A

fully reversible visual, sensory, motor or language symptoms

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6
Q

how does migraine with aura present?

A

aura lasting 20-60 minutes, followed by migraine <1 hour later

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7
Q

state some examples of things that could trigger migraine

A 
sleep
diet
stress
hormones
physical exertion
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8
Q

what drugs can be used as acute abortive agents in migraine?

A

NSAIDs

triptans

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9
Q

name some NSAIDs that can abort a migraine and the dose that should be given

A

aspirin 900mg
naproxen 250mg
ibuprofen 400mg

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10
Q

what are triptans?

A

5-HT agonists

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11
Q

what routes can triptans be administered by?

A

oral
sublingual
subcutaneous

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12
Q

name three triptans that can be used to abort a migraine

A

razatriptan
eletriptan
frovatriptan - for sustained relief

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13
Q

when should migraine prophylaxis be considered?

A

more than three attacks per month OR very severe attacks

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14
Q

what are the three options for migraine prophylaxis?

A

amitriptyline
propranolol
topiramate

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15
Q

what dose of amitriptyline should be given for migraine prophylaxis?

A

10-25mg

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16
Q

what are some possible adverse effects of amitriptyline?

A

dry mouth
postural hypotension
sedation

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17
Q

what dose of propranolol should be given for migraine prophylaxis?

A

80-240mg daily

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18
Q

what conditions are contraindications to propranolol?

A

asthma

PVD

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19
Q

what type of drug is topiramate?

A

carbonic anhydrase inhibitor

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20
Q

what dose of topiramate should be given as migraine prophylaxis?

A

25-100mg daily

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21
Q

what are possible side effects of topiramate?

A

weight loss
paraesthesia
impaired concentration
enzyme inducer

22
Q

how do tension type headaches present?

A

pressing, tingling pain
bilateral
no N+V

23
Q

what medication can be prescribed if needed for tension type headaches and for how long?

A

antidepressants - dothiepin or amitryptiline

for three months

24
Q

what characterises the trigeminal autonomic cephalalgias (TACs)?

A

unilateral trigeminal distribution pain

occurs in association with prominent ipsilateral cranial autonomic features

25
Q

name some examples of ipsilateral cranial autonomic features

A 
ptosis
miosis
nasal stuffiness
N+V
tearing
eye lid oedema
26
Q

what are the four types of trigeminal autonomic cephalalgias?

A

cluster headaches
paroxysmal hemicrania
hemicrania continua
SUNCT

27
Q

what investigations are done for suspected trigeminal autonomic cephalalgias?

A

MRI brain

MR angiogram

28
Q

who gets cluster headaches?

A

young people

more common in males

29
Q

how do cluster headaches present?

A

severe unilateral headache, lasting 45-90 minutes

30
Q

how many headaches a day does someone with cluster headaches usually get?

A

1-8

31
Q

how are cluster headaches managed?

A

high flow oxygen 20 mins
SCUT sumitriptan 6mg
steroids

32
Q

what can be given for prophylaxis for cluster headaches?

A

verapamil

33
Q

who most commonly gets paroxysmal hemicrania?

A

elderly patients

more common in females

34
Q

how does paroxysmal hemicrania present?

A

severe unilateral headache lasting 10-30 mins

35
Q

how many headaches do patients with paroxysmal hemicrania get each day?

A

1-40

36
Q

how is paroxysmal hemicrania managed?

A

absolute response to indomethacin

37
Q

who most commonly gets hemicrania continua?

A

50-60s

more common in females

38
Q

how does hemicrania continua present?

A

constant severe unilateral headaches with unilateral autonomic features

39
Q

how is hemicrania continua managed?

A

absolute response to indomethacin

40
Q

what does SUNCT stand for?

A 
short lived 
unilateral
neuralgiform headache
conjunctival injections
tearing
41
Q

how is SUNCT managed?

A

lamotrigine

gabapentin

42
Q

what is a key risk factor for idiopathic intracranial hypertension?

A

obesity

43
Q

how does idiopathic intracranial hypertension present?

A

diurnal variation
morning N+V
visual loss

44
Q

what does CSF show in idiopathic intracranial hypertension?

A

elevated pressure

normal constituents

45
Q

what assessments should be done in idiopathic intracranial hypertension?

A

visual fields

CSF pressure

46
Q

what are the management options for idiopathic intracranial hypertension?

A

weight loss
acetazolamide
ventricular atrial/lumbar peritoneal shunt

47
Q

what triggers trigeminal neuralgia?

A

touch

usually in the area supplied by V2 + V3

48
Q

how does trigeminal neuralgia present?

A

severe stabbing unilateral pain, lasting 1-90 seconds

49
Q

what medications can be used to manage trigeminal neuralgia?

A

carbamazepine
gabapentin
phenytoin
baclofen

50
Q

what are the surgical management options for trigeminal neuralgia?

A

ablation

decompression

51
Q

what investigation is done for trigeminal neuralgia?

A

MRI brain

Y3 Neurology (31 decks)

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