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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
How should migraine patients modify their diet?
- Keep hydration up (drink 2litres /day) | - Avoid triggers e.g. chocolate and cheese
26
What are the different classifications of migraine?
Acephalgic - no headache, but aura + N+V Basilar - in brainstem => vertigo Retinal migraine - flashes at back of eye Hemiplegic - stroke-like symptoms
27
What symptoms indicate a tension type headache?
- tingling - mild to moderate pain - bilateral - absence of N and V - absence of autonomic symptoms
28
How are tension type headaches treated?
- relaxation physiotherapy | - amitriptyline if required
29
What are trigeminal autonomic cephalgias (TACs)?
- primary headache disorders - unilateral trigeminal distribution pain - ipsilateral cranial autonomic features.
30
What cranial autonomic features present with a TAC?
- Ptosis - Miosis - Nasal Stuffiness - Nausea/ vomiting - Tearing - Eye lid oedema
31
What are the four main types of TAC?
Cluster headache Paroxsymal hemicrania Hemicrania continua SUNCT
32
Who usually gets a cluster headache?
Young (30s-40s) | Men> women
33
How long do cluster headaches normally last?
Individual headache duration = 45- 90mins | Patients can have between 1 to 8 day, which continues for a few weeks -> months.
34
How are cluster headaches treated?
- High flow O2 => 100% for 20 mins - S/C sumatriptan 6mg - Steroids- reducing course over 2 weeks - Verapamil for prophylaxis
35
Who usually develops a paroxysmal hemicrania?
Elderly (50s-60s) | women> men
36
How long does a a paroxysmal hemicrania usually last for?
Duration: 10- 30mins Frequency: 1 to 40 day
37
How is a paroxysmal hemicrania treated?
indomethicin
38
What is a SUNCT headache?
``` S= Short lived (15-120 secs) U=unilateral N= neuralgiaform headache C= conjunctival injections T= Tearing ```
39
What is used to treat SUNCT headaches?
Lamotrigine | Gabapentin
40
Patients with new onset cranial autonomic features require what investigations?
MRI brain | MR angiogram
41
What patient group usually get idiopathic intracranial hypertension?
F > M | obese
42
What symptoms are usually present in idiopathic intracranial hypertension?
- headache worse in the morning - morning N + V - enlarged blind spot - visual loss on standing
43
Why is an MRI completed to investigate idiopathic intracranial hypertension?
To rule out tumour or hydrocephalus
44
How is idiopathic intracranial hypertension treated?
- weight loss - acetazolamide - shunt (only if no weight loss OR acetazolamide untolerated and worried vision will be compromised) - monitor visual fields
45
Who usually gets trigeminal neuralgia?
Elderly (>60) | women>men
46
How is trigeminal neuralgia usually triggered?
Triggered by touch, usually V2/3
47
How long do trigeminal neuralgia attacks last?
Duration: 1 sec to 90 secs Frequency: 10 to 100 day Lasts few weeks to months before remission
48
How can trigeminal neuralgia be investigated?
MRI brain
49
How is trigeminal neuralgia treated?
Carbamazepine Gabapentin phenytoin baclofen Surgical decompression if CN V squished

CU Child Neuro Potpourri (17 decks)

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