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Clinical neuroscience > Headaches > Flashcards

Headaches Flashcards

1
Q

What is meant by a secondary headache?

A
  • Headache occurs because of another condition
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2
Q

What are the acute causes of headache?

A
  • Vascular
  • Infective/inflammatory
  • Ophthalmic
  • Situational
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3
Q

What are the vascular causes of headache?

A
  • Haemorrhage (subarachnoid, subdural, extradural)
  • Thrombosis (venous sinus thrombosis)
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4
Q

What are the infective/inflammatory causes of headache?

A
  • Meningitis, encephalitis, abscess, temporal arteritis
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5
Q

What are the ophthalmic causes of headache?

A
  • Glaucoma
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6
Q

What are the situational causes of headache?

A
  • Cough
  • Exertion
  • Colitis
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7
Q

What are the causes of chronic headaches?

A
  • Migraine
  • Cluster headaches
  • Drug side effects
  • Tension headaches
  • Trigeminal neuralgia
  • Raised ICP
  • Temporal/giant cell arteritis
  • Systemic
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8
Q

Which drugs can lead to headaches as a side effect?

A
  • Analgesics
  • Caffeine
  • Vasodilators
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9
Q

What are the systemic causes of headaches?

A
  • Hypertension
  • Pre-eclampsia
  • Phaeochromocytoma
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10
Q

What history do we need to take from a patient with a headache?

A
  • Full history of presenting complaint using SQITARS
  • What might be causing/triggering the headache?
  • PMH of headache
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11
Q

What drug history do we need to take from a patient with a headache?

A

-Analgesics
- Side effects causing headache e.g. vasodilators

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12
Q

What family history do we need to take from a patient with a headache?

A
  • E.g. migraine with aura has some heritability
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13
Q

What social history do we need to take from a patient with a headache?

A
  • Stress
  • Diet (some foods can trigger migraine)
  • Hydration
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14
Q

What should we look for when examining a patient with a headache?

A
  • Vital signs/ obs
  • E.g. raised ICP can cause bradycardia/hypotension
  • Hypertension itself can cause headache
  • Neurological examination - full peripheral and cranial nerve
  • Other relevant systems as guided by history
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15
Q

What are the red flag features of headache?

A
  • Systemic signs and disorders e.g. of meningitis or hypertension
  • Neurological symptoms
  • Onset is new or changed and patient is >50 yo (suggestive of malignancy)
  • Onset in thunderclap presentation (suggests vascular cause)
  • Papilledema
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16
Q

Outline the characteristics of a headache caused by a space occupying lesion such as a tumour?

A
  • Gradual onset
  • Progressive
  • Associated neurological features e.g. visual disturbance or focal signs
  • Early morning headache
  • Nausea and vomiting
  • Worse on coughing and bending
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17
Q

What is the epidemiology of migraine?

A
  • 2% of general population
  • Twice as many females as males
  • Most have had first attack when young
  • Severity decreases as age increases
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18
Q

What is the site of a migraine?

A
  • Unilateral, often frontal
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19
Q

What is the quality of migraine?

A
  • Onset can be sudden or gradual
  • Throbbing/pulsating
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20
Q

What is the intensity of migraine like?

A
  • Moderate
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21
Q

What is the timing of migraine like?

A
  • Lasts between 4 and 72 hours, possibly with cyclical character
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22
Q

What are the aggravating factors of migraine?

A
  • Photophobia/phonophobia (dislike of loud noise)
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23
Q

What are the relieving factors of migraine?

A
  • Sleep helps
  • A number of medications are available (e.g. triptans)
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24
Q

What are the secondary symptoms of migraine?

A
  • May have aura
  • Nausea and vomiting
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25
Q

What are the triggers of migraines?

A
  • Certain foods
  • Cheese
  • Chocolate
26
Q

What is the pathophysiology of migraine?

A
  • Unclear
  • Often clear family history
27
Q

What is the epidemiology of tension headaches?

A
  • Most common type of headache
  • Females > men
  • Young > old
  • First onset in over 50s is unusual
28
Q

What is the site of tension headaches?

A
  • Bilateral frontal
  • Can radiate to neck
29
Q

What is the quality of tension headaches?

A
  • Squeezing/band-like constriction
  • Non-pulsatile
30
Q

What is the intensity of tension headaches like?

A
  • Mild-moderate
31
Q

What is the timing of tension headaches like?

A
  • Worse at end of day (as stress builds up)
  • Chronic if > 15 times per month
  • Episodic if <15 times per month
32
Q

What are the aggravating factors of tension headaches?

A
  • Stress
  • Poor posture
  • Lack of sleep
33
Q

What are the relieving factors of tension headaches?

A
  • Simple analgesics can help
34
Q

What are the secondary symptoms of tension headaches?

A
  • Mild nausea
35
Q

What is the pathophysiology of tension headaches?

A
  • May be tension in muscles of head and neck (e.g. occipito-frontalisis)
  • Usually no family history
36
Q

What is the epidemiology of medication overuse headaches?

A
  • 3rd most common type of headache
  • 1-2% of UK population
  • 20% of headaches due to medication overuse
  • 30-40 years old
  • Females > males
37
Q

What are the clinical features of medication overuse headaches?

A
  • Present on at least 15 days per month
  • No improvement after OTC medication
  • Patient is using analgesics on at least 10 days per month
  • This headache only seems to come about in people who are taking analgesia for headache in the first place
  • Can get a variety of symptoms
  • Often co-exists with depression and sleep disturbance
38
Q

How are medication overuse headaches treated?

A
  • Discontinuation of medication (will get worse before it gets better)
39
Q

What is the pathophysiology of medication overuse headaches?

A
  • Related to upregulation of pain receptors in meninges
40
Q

What is the epidemiology of cluster headaches?

A
  • 1/1000 people
  • Males > females
  • Usual onset 20-40 years old
41
Q

What is the site of of cluster headaches?

A
  • Around/behind one eye
  • No radiation
42
Q

What is the quality of cluster headaches?

A
  • Sharp and penetrating
43
Q

What is the intensity of cluster headaches like?

A
  • Very severe
  • Constant intensity
44
Q

What is the timing of cluster headaches like?

A
  • Rapid onset
  • Attacks last 15 mins - 3 hours and occur 1-2 times per day
  • Usually at night
  • Clusters of attacks last 2-12 weeks
  • Remissions between clusters can last 3 months to 3 years
45
Q

What are the aggravating factors of cluster headaches?

A
  • Head injury
  • Alcohol
  • Smoking
46
Q

What are the relieving factors of cluster headaches?

A
  • Simple analgesics can help
47
Q

What are the secondary symptoms of cluster headaches?

A
  • Features associated with decreased sympathetic activity
  • Red, watery eye
  • Nasal congestion
  • Ptosis
48
Q

What are the triggers of cluster headaches?

A
  • Alcohol
  • Histamine
  • GTN
  • Heat
  • Exercise
  • Solvent inhalation
  • Lack of sleep
49
Q

What is the epidemiology of trigeminal neuralgia?

A
  • Peak incidence 50-60, increasing with age
  • 25/100 000 UK population
  • Females > males
50
Q

What is the site of trigeminal neuralgia?

A
  • Unilateral, often over one eye
  • Radiates to eyes, lips, nose and scalp (think distribution of CN V)
51
Q

What is the quality of trigeminal neuralgia?

A
  • Sharp and stabbing
  • Electric shock feeling
52
Q

What is the intensity of trigeminal neuralgia?

A
  • Severe
53
Q

What is the timing of trigeminal neuralgia like?

A
  • Sudden onset
  • Lasts a few seconds to 2 minutes
54
Q

What are the aggravating factors of trigeminal neuralgia?

A
  • Light touch to face
  • Eating
  • Cold wind
  • Vibrations
55
Q

What are the relieving factors of trigeminal neuralgia?

A
  • Can be difficult to alleviate
56
Q

What are the secondary symptoms of trigeminal neuralgia?

A
  • Can have numbness and tingling preceding an attack
57
Q

What is the pathophysiology of trigeminal neuralgia?

A
  • Mostly caused by compression of trigeminal nerve by a vascular malformation
  • Few cases are caused by tumours, MS, or skull base anomalies
  • More common in those with a history of chronic pain
58
Q

What are the investigations for headaches?

A
  • Clearly dependent on cause
  • Headache diary can be useful for chronic headaches
  • Imaging may be indicated if red flags
59
Q

How are headaches treated?

A
  • Dependent on underlying cause
  • Simple analgesia
  • Triptans for migraine
  • Cluster headaches may respond to high flow oxygen
60
Q

When do headaches need to be referred?

A
  • Suspicion of a tumour
  • Suspicion of raised ICP
  • Recent onset seizures
  • Previous cancer
  • Unexplained focal deficit
  • Unexplained cognitive/personality changes

Clinical neuroscience (19 decks)

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