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Neurology Year 3 > Headaches > Flashcards

Headaches Flashcards

1
Q

Pyramidal distribution

A

A two-neuron system consisting of upper motor neurons in the Primary Motor Cortex and lower motor neurons in the anterior horn of the spinal cord. Each of these neurons have extremely long axons.

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2
Q

Functional weakness

A

No wasting, normal tone, normal reflexes, erratic power, non-anatomical loss

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3
Q

Neuromuscular junction symptoms

A

Fatigable weakness, normal or decreased tone, normal tendon reflexes. No sensory symptoms!

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4
Q

Motor symptoms of median nerve neuropathy

A

Unable to abduct thumb

Thenar atrophy

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5
Q

Sensory symptoms of median nerve neuropathy

A

Thumb, 2nd, third and lateral one half of 4th finger

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6
Q

Motor symptoms of ulnar nerve neuropathy

A

Unable to adduct finger and thumb

claw hand

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7
Q

Sensory symptoms of ulnar nerve neuropathy

A

Fifth and medial one half of fourth finger

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8
Q

Motor symptoms of radial nerve neuropathy

A

Unable to extend wrist, thumb and fingers (wrist drop)

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9
Q

Sensory symptoms of radial nerve neuropathy

A

Sensory loss in dorsum of hand

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10
Q

Motor symptoms of sciatic nerve neuropathy

A

Ankle doriflexors and plantar flexors (flail ankle)

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11
Q

Sensory symptoms of sciatic nerve neuropathy

A

Buttocks, lateral calf and most of foot

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12
Q

Motor symptoms of femoral nerve neuropathy

A

Paralysis of knee extensors

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13
Q

Sensory symptoms of femoral nerve neuropathy

A

Anterior thigh and medial calf

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14
Q

Motor symptoms of fibular nerve neuropathy

A

Paralysis of ankle dorisflexors &foot evertors

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15
Q

Sensory symptoms of fibular nerve neuropathy

A

Dorsum of foot and lateral calf

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16
Q

An example of a median nerve neuropathy

A

Carpal tunnel syndrome

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17
Q

An example of a radial nerve neuropathy

A

Saturday night palsy

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18
Q

An example of a fibular nerve neuropathy

A

Foot drop

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19
Q

Myoclonus

A

sudden, brief involuntary twitching or jerking movements

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20
Q

Chorea

A

rapid jerky involuntary movements

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21
Q

Dystonia

A

Unintentional sustained muscle contractions leading to abnormal postures e.g., clenching teeth

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22
Q

Hypomimia

A

Is a reduced degree of facial expression

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23
Q

Hypophonia

A

Weak voice due to incoordination of the vocal muscles.

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24
Q

Ataxia

A

Lack of muscle control & coordination of voluntary movements.

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25
Q

Dysdiadochokinesis

A

Clumsy fast alternating movements

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26
Q

Cerebellar signs

A 
Cerebellar gait is broad-based & unsteady
Intention tremor 
Dysdiadochokinesis
Nystagmus
Dysarthria
27
Q

Paratonia

A

Inability to relax muscles

28
Q

Paraparesis

A

Partial paralysis of lower limbs

29
Q

Exacerbating features to ask about in headache history taking.

A

Posture, Valsalva (sneezing, coughing, straining etc). Diurnal variation.

30
Q

Valsalva manoeuvre

A

A breathing method that may slow your heart when it’s beating too fast. To do it, you breathe out strongly through your mouth while holding your nose tightly closed.

31
Q

Phonophobia

A

Called ligyrophobia or sonophobia, is a fear of or aversion to loud sounds

32
Q

Miosis

A

Excessive constriction of the pupil of the eye

33
Q

Red flag symptoms in headache history taking

A
  1. New onset headache >55
  2. Known/previous malignancy
  3. Immuno-suppressed
  4. Early morning headache
  5. Exacerbation by Valsalva
34
Q

Migraine symptoms

A

Recurrent, severe headache which is usually unilateral and throbbing in nature

May be associated with aura, nausea and photosensitivity

Aggravated by, or causes avoidance of, routine activities of daily living. Patients often describe ‘going to bed’.

35
Q

Tension headache

A

Recurrent, non-disabling, bilateral headache, often described as a ‘tight-band’
Not aggravated by routine activities of daily living

36
Q

Cluster headache symptoms

A

Pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours with clusters typically lasting 4-12 weeks

Intense pain around one eye (recurrent attacks ‘always’ affect same side)
Patient is restless during an attack

Accompanied by redness, lacrimation, lid swelling
More common in men and smokers

37
Q

Cluster headaches are more common in what people?

A

More common in men and smokers

38
Q

Temporal arteritis

A 
Typically patient > 60 years old
Usually rapid onset (e.g. < 1 month) of unilateral headache
Jaw claudication (65%)
Tender, palpable temporal artery
Raised ESR
39
Q

Medication overuse headache

A

Present for 15 days or more per month
Developed or worsened whilst taking regular symptomatic medication

Patients using opioids and triptans are at most risk

May be psychiatric co-morbidity

40
Q

What drugs are associated with medication overuse headache?

A

Opioids and triptans

41
Q

Epidemiology of migraine

A

3 times more common in women

Prevalence in men is around 6%, in women 18%

42
Q

Common triggers for a migraine attack

A
  1. tiredness, stress, alcohol
  2. combined oral contraceptive pill,
  3. lack of food or dehydration
  4. cheese, chocolate, red wines, citrus
  5. menstruation, bright lights
43
Q

Non-pharmacological treatment for migraines

A

1, Education- avoid triggers

  1. Headache diary
  2. Diet- regular intake, avoid triggers
  3. healthy balanced diet
  4. Hydration- at least 2 litres day,
  5. decrease caffeine
  6. Stress- decrease
  7. Regular exercise
44
Q

Acute pharmacological treatment for migraines

A

Combination therapy of NSAIDs and Triptans

NSAIDs

  1. Aspirin 900mg,
  2. Naproxen 250mg
  3. Ibuprofen 400mg

Triptans

  1. Rizatriptan= eletriptan > sumatriptan
  2. Frovatriptan for sustained relief
45
Q

Prophylactic treatment for migraines

A

More than 3 attacks month or very severe consider prophylaxis

  1. Amitriptyline
  2. Beta blockers – propranolol
  3. Topiramate
46
Q

Side effects of Amitriptyline

A

Dry mouth, postural hypotension, sedation

47
Q

Topiramate mechanism of action

A

Carbonic anhydrase inhibitor (Na/ GABA)

48
Q

Topiramate side effects

A

Poor side effect profile- start slowly

Weight loss, paraesthesia, impaired concentration, enzyme inducer

49
Q

NSAIDs used in migraines

A
  1. Aspirin 900mg,
  2. Naproxen 250mg
  3. Ibuprofen 400mg
50
Q

Triptans used in acute management of migraines

A
  1. Rizatriptan= eletriptan > sumatriptan

2. Frovatriptan for sustained relief

51
Q

Management of tension-type headache

A

Acute treatment: aspirin, paracetamol or an NSAID are first line

Prophylaxis: NICE recommend ‘up to 10 sessions of acupuncture over 5-8 weeks’

52
Q

Management of Cluster headaches

A

Acute: 100% oxygen (80% response rate within 15 minutes), subcutaneous triptan (75% response rate within 15 minutes)

Prophylaxis: verapamil is the drug of choice.

53
Q

Paroxysmal hemicrania (PH)

A

Defined by attacks of severe, unilateral headache, usually in the orbital, supraorbital or temporal region.

These attacks are often associated with autonomic features, usually last less than 30 minutes and can occur multiple times a day.

54
Q

Hemicrania continua

A

A chronic and persistent form of headache marked by continuous pain that varies in severity, always occurs on the same side of the face and head and is superimposed with additional debilitating symptoms. on the continuous but fluctuating pain are occasional attacks of more severe pain.

55
Q

Treatment of Hemicrania continua

A

indomethacin (Only NSAID that works)

56
Q

SUNCT Headaches

A
  • S= Short lived (15-120 secs)
  • U=unilateral
  • N= neuralgiform headache
  • C= conjunctival injections
  • T= Tearing
57
Q

Treatment for SUNCT Headaches

A

Lamotrigine, Gabapentin

58
Q

Drugs that cause Idiopathic intracranial hypertension

A 
>	combined oral contraceptive pill
>	steroids
>	tetracyclines
>	vitamin A
>	lithium
59
Q

Risk factors for Idiopathic intracranial hypertension

A

o obesity
o female sex
o pregnancy
o drugs*

60
Q

Features for Idiopathic intracranial hypertension

A 
o	headache
o	blurred vision
o	papilledema (usually present)
o	enlarged blind spot
o	sixth nerve palsy may be present
61
Q

Management of Idiopathic intracranial hypertension

A 
o	weight loss
o	diuretics e.g. acetazolamide
o	topiramate is also used, 
o	repeated lumbar puncture
o	Optic nerve sheath decompression 
o	Lumboperitoneal or ventriculoperitoneal shunt may also be performed to reduce intracranial pressure
62
Q

What diuretic is used in Idiopathic intracranial hypertension

A

acetozolamide

63
Q

What are ways to reduce intracranial pressure?

A

Lumboperitoneal or ventriculoperitoneal shunt, repeated lumbar puncture

Neurology Year 3 (22 decks)

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