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MD4001 Neuro and Endocrine > Headaches > Flashcards

Headaches Flashcards

1
Q

Describe the common components of a history of a patient with tension headache

A
  • can last weeks/months/years
  • characterised by a tightness or pressure around the head
  • constant or worse towards the evening
  • overused analgesia
  • rarely prevents with nausea
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2
Q

How would you treat a tension headache

A
  • relaxation exercises
  • reduce analgesia
  • low dose amitriptyline (10-20mg)
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3
Q

Describe the symptoms of a migraine

A
  • one side at a time with nausea
  • unilatera/bilateral for hours/days
  • photophobia, phonophobia, gut symptoms
    pulsating, sharp character
  • more common in women mid-cyle/newly menopausal (linked to oestrogen)
  • can be with an aura (visual, weakness or sensory deficit that spreads over minutes)
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4
Q

Describe the relevance of a scotoma

A

Flashing light around visual field

  • grey-scale represents migraine
  • coloured is associated with epilepsy
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5
Q

How can you try and figure out the cause of a patient’s headache?

A
  • look for triggers (eg. food/alcohol/beginning or end of working week)
  • is it exacerbated by physical activity or bang to the head
  • family history?
  • suggest diary to note patterns and help decide treatments
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6
Q

What is the treatments of acute migraines?

A

Low frequency migraines

  • aspirin, paracetamol
  • anti-nausea meds (prochlorperazine, metoclopramide)
  • triptans (5-HT receptor agonists)
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7
Q

How would you treat frequent migraines?

A

Prophylactic treatment:

  • B-blockers
  • low dose amitriptyline
  • pizotifen (5-HT antagonist, antihistamine, anticholinergic)
  • topiramate
  • sodium valporate
  • candesartan
  • flunarazine
  • lisinopril
  • methysergide
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8
Q

What are the non-pharma treatments of migraines?

A
  • botulinum toxin injection every 90 days
  • anti-CGRP monoclonal antibodies (erenumab) for patients getting over 4 migraines a month and tried other prophylactics
  • acupuncture
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9
Q

What is trigeminal autonomic cephalagia and its presentation?

A

Cluster headache - unilateral usually around the eye occuring at the same time everyday. Occurs for a few weeks then goes and then returns after a period.

Presentation:

  • recurrent pain in trigeminal distribution
  • autonomic features (eye watering, nasal congestion, eye redness)
  • more common in males
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10
Q

What is paroxysmal hemicrania?

A
  • similar condition to TAC
  • more common in women
  • shorter, more frequent attacks
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11
Q

How can you differentiate between TAC and paroxysmal hemicrania?

A

paroxysmal hemicrania responds to indomethacin and TAC does not

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12
Q

How would you treat TACs?

A
  • triptans
  • high dose O2
  • high dose verapamil (Ca2+ channel blocker)
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13
Q

What are the signs of a medication overuse headache?

A
  • occurs for over half the month and is worse with analgesic use
  • common if patient is using analgesia for the majority of days in a month
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14
Q

Describe thunderclap headaches

A
  • rapidly appearing, very severe pain
  • consider SAH
  • urgent investigation needed (CT looking for blood in the brain and 12 hr CSF)
  • can be due to exertion due to vasospasm
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15
Q

What characterises early morning headaches?

A
  • cervicogenic due to poor posture in bed, over exertion, spinal degeneration etc.
  • sleep apneoa with CO2 retention due to obesity and snoring, can be associated with alcohol
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16
Q

Describe the presentation and treatment of raised ICP

A
  • mild headache
  • diurnal variation (worse in morning before getting better)
  • mild nausea
  • neuro features - bilaterall papilloedema (sign of abscess or CSF blockage)

Treatment: scan and urgent referral

17
Q

What characterises temporal arteritis, and how would you test and treat it?

A
  • jaw claudication (pain on chewing)
  • features of polymyalgia (tired and stiff in morning)
  • onset of temporal headache
  • can cause blindness through embolism in eye

Test:

  • palpate temporal arteries for tenderness
  • check for raised erythrocyte sedimentation rate (sign of inflammation)
  • use ultrasound or temporal body biopsy to look for inflammation

Treated with high dose steroids

18
Q

What is the presentation of cerebral venous sinus thrombosis?

A
  • common in females on OCP
  • severe headache
  • raised ICP
  • papillodema and seizures
  • MR shows bilateral haem (diagnostic of CVST)
  • empty delta sign on imaging also associated with it
19
Q

What is the presentation of low ICP headache?

A
  • headache when standing, eased when lying down
  • can develop into fits (due to decreased support to brain)
  • untreated can cause death
20
Q

How is low ICP headaches treated?

A
  • blood patch

* patient’s own blood used to clot the hole to stop the leak of CSF

MD4001 Neuro and Endocrine (70 decks)

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