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Finals: Medicine > Headaches > Flashcards

Headaches Flashcards

1
Q

Headache is a common symptom, and it is associated with many conditions.

Name the two types of headaches

A

Primary headaches

Secondary headaches

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2
Q

What is the difference between primary and secondary headaches

A

Primary headaches – those that are not associated with an underlying condition e.g., migraine, tension headache, cluster headache

Secondary headaches – those that are associated with an underlying pathology e.g., trauma, intracerebral infection, vascular disorders, medication overuse, neoplasm

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3
Q

Name some of the red flag symptoms that may be associated with headaches if the patient had meningitis

A

Fever, photophobia or neck stiffness

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4
Q

Name the red flag symptom that may be associated with headaches if the patient had temporal arteritis or glaucoma

A

Visual disturbance

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5
Q

Why is fundoscopy examination important in patients presenting with a headache

A
  • Checking for papilloedema (oedema of the optic disc)
  • Papilloedema indicates raised intracranial pressure, which may be due to a brain tumour, benign intracranial hypertension or an intracranial bleed
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6
Q

Papilloedema, seen of fundoscopy, indicates?

A

Indicates raised intracranial pressure

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7
Q

What are the characteristic features of a migraine

A

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

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8
Q

Name some of the associated symptoms for a migraine

A

Aura, nausea and photosensitivity

The aura may be visual e.g., zigzags, sensory e.g., paraesthesia spreading from fingers to face

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9
Q

Name some of the triggers that can bring about a migraine

A

Aggravated by, or causes avoidance of, routine activities of daily living

In women may be associated with menstruation

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10
Q

How long can a migraine last?

A

4-72 hours

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11
Q

How do you diagnose a migraine

A

Clinical diagnosis i.e. history

Presence of aura confirms diagnosis

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12
Q

How do you manage an acute migraine attack

A

Oral triptan e.g., Sumatriptan

AND

Paracetamol and/or NSAID

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13
Q

Triptan e.g., Sumatriptan is contraindicated in what patient group

A

Those with ischaemic heart disease

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14
Q

What are the characteristic features of a tension headache

A

Chronic recurring, bilateral headache, often described as a “tight-band” around the head

Non-pulsatile

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16
Q

In what gender is tension headaches most common in?

A

Females

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17
Q

Name some of the associated symptoms that may accompany a tension headache

A

Tenderness of the scalp muscles

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18
Q

Name some of the triggers that can bring about a tension headache

A

Stress

Not aggravated by routine activities of daily living

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19
Q

How long can a tension headache last?

A

30mins to 7 days

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20
Q

How do you diagnosis a tension headache

A

Clinical diagnosis i.e. history

21
Q

What is the long term mangement of migraines

A

Avoid triggers

Prophylaxis with Propranolol (beta blocker) or Topiramate

22
Q

What is the management of tension headaches

A

Symptomatic relief

Analgesia e.g, paracetamol or NSAIDS

Lifestyle e.g, sources of stress

23
Q

What are the characteristic features of a cluster headache

A

Recurrent attacks of sudden-onset unilateral periorbital pain i.e. pain around one eye, which is affect the same.

24
Q

In what gender is cluster headaches most common in?

A

Males

25
Q

What is the typical age of onset of a cluster headache

A

Age of onset is usually between 20 and 40 years

26
Q

Name some of the associated symptoms that can accompany a cluster headache

A

Redness, lacrimation, lid swelling

27
Q

Name some of the triggers that can bring about a cluster headache

A

Alcohol

Smoking

28
Q

Describe the duration pattern of a cluster headache

A

Each episode lasting 15 minutes to 3 hours, occurring once or twice a day, over a period of 4-12 weeks

Followed by a pain-free period of months before the next cluster begins

29
Q

How is cluster headaches diagnosed

A

Clinical diagnosis i.e. history

30
Q

How do you manage an acute attack of a cluster headache

A

Triptan e.g. Sumatriptan

AND
100% oxygen via non-rebreathable mask

31
Q

What drug can be used as a prophylaxis for cluster headaches

A

Verapamil (Calcium channel blocker)

32
Q

What are the characteristic features of a Trigeminal neuralgia

A

Recurrent short episodes of severe stabbing pain, affecting one side of the face, in the trigeminal nerve distribution.

33
Q

Name some of the triggers that can cause Trigeminal neuralgia

A

Triggered by touching the face, eating, or talking.

34
Q

What is the typical age of onset of a Trigeminal neuralgia

A

typically over the age of 50

35
Q

How is Trigeminal neuralgia diagnosed

A

Clinical diagnosis

36
Q

What imaging modality is used to exclude secondary causes of the Trigeminal neuralgia

A

MRI

Secondary causes e.g., tumours and aneurysms

37
Q

What is the 1st line therapy to manage Trigeminal neuralgia

A

Carbamazepine

38
Q

Name a surgical option to manage Trigeminal neuralgia

A

Microvascular decompression

39
Q

What are the features of the headaches associated with a raised intracranial pressure

A

Headaches are worse in the morning and upon bending over. Improves after vomiting and lying down

40
Q

Name some of the associated symptoms of a raised intracranial pressure

A

Neurological deficits due to compression of cranial structures by a space-occupying lesion.

Reduced level of consciousness.

Papilledema - oedema of the optic disc

41
Q

How is raised intracranial pressure diagnosed

A

CT scan

42
Q

How do we manage a raised intracranial pressure

A

ABCDE assessment

Treat the underlying cause

43
Q

What are the features of the headaches associated with a temporal arteritis

A

Rapid onset unilateral headache

44
Q

Name some of the associated symptoms that may accompany a headache in a patient with temporal arteritis

A

Jaw claudication i.e. fatigue of jaw muscles during chewing

Visual disturbance

45
Q

On examination, how would the temporal artery feel in a patient with temporal arteritis

A

Tender, palpable temporal artery

46
Q

What blood test will be raised in temporal arteritis

A

ESR

47
Q

What is the management options for temporal arteritis

A

High dose glucocorticoid and urgent ophthalmology referral

Finals: Medicine (91 decks)

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