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Neuro 2 > Headaches > Flashcards

Headaches Flashcards

1
Q

Most frequent headache? TreatmentAggregated by physical activity?

A

Tension headache

Treatment = NSAIDS/ paracetamol

Prevented by Tricyclic antidepressants eg amitriptyline

NOT aggrivated by physical activity

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2
Q

Most frequent disabling headache?

A

MIGRAINES!!

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3
Q

Ages for migrane?

A

20-50

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4
Q

Symptoms of migranes?

A

Different stages have differnt symptoms.

During attack:
-headache (duh)
-Nausea
_Photophobia, Phonophobia
-functional disability

In between attacks:
-Enduring predisposition to future attacks
-Anticipatory anxiety

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5
Q

What are the phases of Migraines?

A

Premonitory -> Aura -> Early headache -> Advanced headache -> Postdrome

Premoitory = mood changes, fatigue, cognitive changes, muscle pain,m food cravings (think stroppy teenager in bed eating ice cream)

Aura = Visual somatosensory reversiable changes

Early headache = dull. nasal congestion, muscle pain

Advanced= unilateral throbbing, nausea, photo, osmo (smell) and phono phobiasphobia,

Postdrome= fatigue, muscle pain, cognitive changes

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6
Q

What is an Aura What happen in an aura?Differences Aura vs TIA?

A

Fully reversible visual somatosensory changes, 1/3 migraine patients have them

Lasts 15-60 minutes

Chages and “sweeps” through, so visual, sensory and then speech. Can all start at the same time though.

TIA you get all the neurological deficit happening at once, compared to Aura where it transitions

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7
Q

What is Chronic migraine?What is it associated with?

A

Often almost like a baseline headache that is spiked with migraine attacks.

Associated with drug overuse

Criteria: at least 3 months, 15/month headaches, 8/month migraines

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8
Q

wHAT DRUGS CAN CAUSE MEDICATION OVERUSE HEADACHES?

A

Opiods, triptans (antimigaine), ergots (treatment for severe, throbbing headaches), combintion analgesics (>10 days per month, so should only be used twice a week maximum)

Simple analgesics also cause it, if used more than 15 days/month

CAFFINE!

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9
Q

whAT ARE TEH MODIFIABLE LIFESTYLE TRIGGERS IN mIGRAINE?

A

STRESS
hunger
sleep disturbance
dehydration
diet
environmental stimuli
changes in oestrogen levels in women

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10
Q

wHAT DO YOU TREAT MIGRAINES WITH?

A

Aspririn/NSAIDS
Triptans (limit 10 dyas/month - 2/week)

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11
Q

wHO HAS TO AVOID vALROATE?

A

Child bearing women

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12
Q

wHAT ARE THE PROHYLACTIC TREATMENTS OF MIGRAINES?

A

Propranolol (B blocker -> reduces the effet of the sympathetic system (nor adrenalin) on the heart) Candesartan (ARB - angiotensin receptor blocker - stops angiotensin II from its hypertensive effects)

Anti-epileptics:
Topiramate, Valproate (not childbearing women)

Tricyclic antidepressants
Amitriptyline, nortriptyline

Flunarizine

Botox

CGRP Monoclonal Antibodies

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13
Q

trEATMENT OF mEDICAITON OVERUSE HEADACHE

A

Prevention based! Limit treatment to 2 days per week.

If suddenly stopped, then headaches can be worse for 2-4 weeks, nad have to wait for 2 months to know if it has been effective or not.

^ better for triptans than opiods/combinaiton painkillers

not clear which is the best strategy.

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14
Q

cOMBINED ocp CONTRAINDICATED IN AVCTIVE MIGRAINE. wHY?

A

Increased risk of stroke

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15
Q

antiepileptics IN WOMEN OF CHILD BEARING AGE?

A

No, please avoid!! Tetratogenic so need to make sure they are on enough conrtaceptives!

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16
Q

hOW DO WE TREAT MIGRAINES ION PREGNANT WOMEN?

A

Acute = paracetamol, NSAIDS (ONLY FIRST 2 trimesters!!) Then can cause the patent ductus arteriosus to close.

Triptans

17
Q

wHAT IS pRIMARY NEW DAILY PERSISTANT HEADACHE?

A

Distinct and clearly remembered onset, with pain becoming continuous
and unremitting within 24 hours.

Need to actively exclude secondary causes.

18
Q

What is Neuralgia?

A

Intense nerve pain

usually “stabbing” or “burning” and brief

19
Q

Where is nervus intermedius pain felt?

A

Within the ear

20
Q

What does Trigeminal neuralgia present as?

A

Spontaneous “stabbing” pain, each “stab” = 5-10 seconds.

21
Q

What causes the onset of trigeminal neuralgia? And what is it’s physiological cause?

A

It has triggers such as cold wind, touch or chewing.

Caused by copression of the trigeminal nerve, usually a vascular cause.

22
Q

How to treat trigeminal neuralgia?

A

Carbamazapine (main one)

Oxcarbazepine
Lamotrigine
Pregabalin / Gabapentin / Lacosamide
Phenytoin can be useful for severe
exacerbations

Surgical:
Glycerol ganglion injection
Stereotactic radiosurgery
Microvascular decompression

23
Q

What are the 4 types opf Trigeminal Autonomic Cephalagias?

A

Cluster headache
Paroxysmal Hermicrania
SUNCT/SUNA
Hemicrania Continua

24
Q

Wha are cluster headaches like?

A

Excruciating Orbital/temporal pain “Suicide headache”
unilteral
rapid onset
15mins -3h
Rapid stoppage of pain

25
Q

Why are tehy “cluster headaches”

A

Because they are episodic and come in regular patterns of flare ups.

26
Q

Can alcholoh rigger cluster headaches?

A

When in a bout but not whilst in remission

27
Q

WHen ius cluster headaches likely to happen?

A

Same time each day/ bouts in same time each year. Particularly during rem sleep

28
Q

What is the treatment for cluster headache?

A

Abortive - stop the headaches :

Triptans, sumatriptan SUBCUTANEOUSLY/Nasal Zolmatriptan

Oxygen - 10-15L 100%O2 for 15-20 mins.

Transitional - reduce length of bout:
Oral prednisolone taper
Greater Occipital nerve block (depomedrone +Lidocaine)

Preventatice treatment:
-Verapamil
-Lithium

-Gabapentin, Pregabalin, Sodium Valproate, Leveteracetam, Melatonin

29
Q

SUNCT vs cluster vs paroxysmal hemicrania

A

SUNCT = 3-200/day, 5-240s, stabbing and burning, no circaidian rhythm

Paroxysmal Hemicrania = 1-40/day, 2-30mins, sharp,throb, 45% circaidian periodicity

Cluster headache = 1-8/day, 15-180mins, sharp, throb, 70%Circaidianperiodicity

29
Q

Treatment for Paroxysmal Hemicrania and Hemicrania Continua

A

Indometacin

30
Q

What is hemicrania continua?

A

Unilateral continuous headache, baseline headache for weeks/months/unremitting, exacerbations 20 mins to several days

31
Q

Pain wuith conjunctival injection an dlacrimation and triggered by wind,cold etc?

A

SUNCT/SUNA

32
Q

SUNCT/SUNA treatment

A

Lamotrigine

Transitional: GON block

Surgical= Occipital nerve stimulation/deep brain stimulaiton

33
Q

Headache 4 - use anki/power point :’)

A

:))

Neuro 2 (9 decks)

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