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CU Child Neuro Potpourri > Headache Syndromes > Flashcards

Headache Syndromes Flashcards

1
Q

What are the red flags in a headache history?

A
  • New onset headache >55 years old
  • Known/previous malignancy
  • Immuno-suppressed
  • Early morning headache
  • Exacerbation by coughing/sneezing (increased ICP)
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2
Q

A patient who has a headache which is worse upon lying down is likely to have what condition?

A

Intracranial hypertension

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3
Q

Autonomic symptoms (photo/phonophobia) usually occur with what type of headache?

A

Primary headaches - e.g. Migraine

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4
Q

What type of headache should be considered if the patient who is presenting is immunosuppressed?

A

intracranial infection

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5
Q

What visual sign is often present previous to a migraine?

A

“aura”

  • disturbance of vision
  • may also cause speech/word-finding difficulty
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6
Q

Social and lifestyle problems can aggravate chronic headaches. TRUE/FALSE?

A

TRUE

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7
Q

What gender is more likely to get migraines, and how often are attacks per month on average?

A

Females>males

usually around 1 attack per month

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8
Q

Most migraine sufferers experience an aura prior to their migraine. TRUE/FALSE?

A

FALSE

80% - no aura

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9
Q

What features are needed to be diagnostic of migraine?

A

At least 5 attacks (lasting between 4-72 hours)

2 of : Moderate/ severe, unilateral, throbbing pain, worse during movement.

1 of : Autonomic features, photophobia/ phonophobia

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10
Q

In females, migraines can be hormonally driven. At what ages do you think the incidence of migraine in females peaks?

A

early teenage years (due to puberty)

Menopausal age

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11
Q

Describe the pathological events that lead to the pain felt during a migraine.

A
  • Stress triggers in the brain cause serotonin to be released
  • Blood vessels constrict and dilate
  • Chemicals including substance P are released causing sensation of pain
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12
Q

What structures are found in the migraine centre of the brain?

A

Dorsal Raphe Nucleus

Locus Coeruleus

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13
Q

How long does a pre-migraine aura usually last for?

A

around 20-60 minutes

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14
Q

What visual symptoms can be present during an aura?

A

Central scotomata
Central fortification
Hemianopic loss

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15
Q

What are the potential triggers of a migraine?

A 
Sleep 
Dietary
Stress
Hormonal
Physical exertion
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16
Q

What can help to identify specific migraine triggers?

A

Headache diary

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17
Q

What pharmacological therapies can be given acutely in migraine?

A

NSAID => Aspirin 900mg/Naproxen/Ibuprofen
+/- anti-emetic

Triptan (serotonin agonist)
- Rizatriptan, sumatriptan

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18
Q

What different formulations of triptans are made?

A

Oral tablets
sub-lingual wafers (no water required)
subcutaneous - consider in those with N+V

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19
Q

When is migraine prophylaxis considered?

A

If > 3 attacks per month OR very SEVERE

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20
Q

What non-pharmacological methods are used for migraine prophylaxis?

A

acupuncture

relaxation exercises

21
Q

What pharmacological treatments can be given for migraine prophylaxis?

A

Amitriptyline => 10 - 25mg (max 75mg)
Propranolol => 80-240mg daily
Topiramate => 25mg-100mg daily

Sometimes: gabapentin, pizotifen, Sodium valproate, Botulinum toxin

22
Q

What are the adverse effects of amitriptyline?

A

Dry mouth
Postural hypotension
sedation

23
Q

Who should NOT be given a beta-blocker?

A

asthma

Peripheral vascular disease

24
Q

What are the adverse effects of Topiramate?

A
  • weight loss
  • paraesthesia
  • impaired concentration
25
Q

How should migraine patients modify their diet?

A
  • Keep hydration up (drink 2litres /day)

- Avoid triggers e.g. chocolate and cheese

26
Q

What are the different classifications of migraine?

A

Acephalgic - no headache, but aura + N+V
Basilar - in brainstem => vertigo
Retinal migraine - flashes at back of eye
Hemiplegic - stroke-like symptoms

27
Q

What symptoms indicate a tension type headache?

A
  • tingling
  • mild to moderate pain
  • bilateral
  • absence of N and V
  • absence of autonomic symptoms
28
Q

How are tension type headaches treated?

A
  • relaxation physiotherapy

- amitriptyline if required

29
Q

What are trigeminal autonomic cephalgias (TACs)?

A
  • primary headache disorders
  • unilateral trigeminal distribution pain
  • ipsilateral cranial autonomic features.
30
Q

What cranial autonomic features present with a TAC?

A
  • Ptosis
  • Miosis
  • Nasal Stuffiness
  • Nausea/ vomiting
  • Tearing
  • Eye lid oedema
31
Q

What are the four main types of TAC?

A

Cluster headache
Paroxsymal hemicrania
Hemicrania continua
SUNCT

32
Q

Who usually gets a cluster headache?

A

Young (30s-40s)

Men> women

33
Q

How long do cluster headaches normally last?

A

Individual headache duration = 45- 90mins

Patients can have between 1 to 8 day, which continues for a few weeks -> months.

34
Q

How are cluster headaches treated?

A
  • High flow O2 => 100% for 20 mins
  • S/C sumatriptan 6mg
  • Steroids- reducing course over 2 weeks
  • Verapamil for prophylaxis
35
Q

Who usually develops a paroxysmal hemicrania?

A

Elderly (50s-60s)

women> men

36
Q

How long does a a paroxysmal hemicrania usually last for?

A

Duration: 10- 30mins
Frequency: 1 to 40 day

37
Q

How is a paroxysmal hemicrania treated?

A

indomethicin

38
Q

What is a SUNCT headache?

A 
S= Short lived (15-120 secs)
U=unilateral 
N= neuralgiaform headache
C= conjunctival injections
T= Tearing
39
Q

What is used to treat SUNCT headaches?

A

Lamotrigine

Gabapentin

40
Q

Patients with new onset cranial autonomic features require what investigations?

A

MRI brain

MR angiogram

41
Q

What patient group usually get idiopathic intracranial hypertension?

A

F > M

obese

42
Q

What symptoms are usually present in idiopathic intracranial hypertension?

A
  • headache worse in the morning
  • morning N + V
  • enlarged blind spot
  • visual loss on standing
43
Q

Why is an MRI completed to investigate idiopathic intracranial hypertension?

A

To rule out tumour or hydrocephalus

44
Q

How is idiopathic intracranial hypertension treated?

A
  • weight loss
  • acetazolamide
  • shunt (only if no weight loss OR acetazolamide untolerated and worried vision will be compromised)
  • monitor visual fields
45
Q

Who usually gets trigeminal neuralgia?

A

Elderly (>60)

women>men

46
Q

How is trigeminal neuralgia usually triggered?

A

Triggered by touch, usually V2/3

47
Q

How long do trigeminal neuralgia attacks last?

A

Duration: 1 sec to 90 secs
Frequency: 10 to 100 day
Lasts few weeks to months before remission

48
Q

How can trigeminal neuralgia be investigated?

A

MRI brain

49
Q

How is trigeminal neuralgia treated?

A

Carbamazepine
Gabapentin
phenytoin
baclofen

Surgical decompression if CN V squished

CU Child Neuro Potpourri (17 decks)

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