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Neurology > Headaches > Flashcards

Headaches Flashcards

1
Q

Headaches : Red flag syptoms

A

CNS infection symptoms
1. Fever, photophobia or neck stiffness
(meningitis, encephalitis or brain abscess)

IC compression
2. New neurological symptoms (haemorrhage or tumours)
3. History of trauma
4. History of cancer (brain metastasis)

Optic nerve compression
5. Visual disturbance
(giant cell arteritis, glaucoma or tumours)

6 . Sudden-onset occipital headache
(subarachnoid haemorrhage)

Increased IC pressure
7. Worse on coughing or straining
8. Postural, worse on standing, lying or bending over
9. Vomiting

10 .Pregnancy (pre-eclampsia)

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2
Q

Tension headache : Clinical features

A

Symptoms
1. Bilateral headache
2. Mild ache / Pressure in a band-like pattern around the head.
3. No visual changes

Onset
* They develop and resolve gradually
* Recurrent

Associated with:
* Stress / Depression
* Alcohol/Caffeine
* Skipping meals/ Dehydration

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3
Q

Tension Headache : Mx

A
  1. First line
  • Reassurance
  • Simple analgesia (e.g., ibuprofen or paracetamol)
  1. Second line
  • Recurrent head ache : Amitriptyline
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4
Q

Sinusitis : Definition

A

inflammation of the paranasal sinuses in the face.

Sx
1. Pain and pressure following a recent viral upper respiratory tract infection.

  1. Tenderness and swelling on palpation of the affected areas.
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5
Q

Sinusitis : Management

A

Indic : Sx > 10 days
* Steroid nasal spray/antibiotic
1.Phenoxymethylpenicillin

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6
Q

Medication-overuse headache : Definition

A
  1. Headache caused by frequent analgesia use.
  2. Higher risk with opiod use
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7
Q

Medication-overuse headache : Cause

A
  1. Alter brain’s pain modulation pathway
  2. Sensitises pain pathways
  3. Brain becomes more sensitive to headache triggers and amplifies pain signals
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8
Q

Medication-overuse headache : Pathophysiology

A

Highest risk : Hx of Opiod / Triptan use
Symptoms

  1. Similar non-specific features to a tension headache
  2. Present for 15 days or more per month
  3. Developed/ Worsened whilst taking regular symptomatic medication
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9
Q

Medication-overuse headache : Management

A
  1. Withdrawal of the analgesia
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10
Q

Temporal arteritis : Definition

A
  1. (Giant cell arteritis: GCA) is a vasculitis of unknown cause that affects medium and large-sized vessels arteries.
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11
Q

Temporal arteritis : Clinical features

A

Overlap between temporal arteritis and polymyalgia rheumatica (PMR

Symptoms
1. headache (found in 85%)
2. jaw claudication (65%)
3. tender, palpable temporal artery

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11
Q

Temporal arteritis : Onset

A
  1. Typically patient > 60 years old
  2. usually rapid onset (e.g. < 1 month)
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11
Q

Temporal arteritis : Complications

A

1. Visual loss /changes

  • Inflammation and occlusion of posterior ciliary artery (branch of ophthalmic artery)
  • Ischaemia to Optic nerve } anterior ischemic optic neuropathy

2. Polymyalgia Rheumatic associated symptoms :

  • 50% have features of PMR: aching, morning stiffness in proximal limb muscles (not weakness)
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12
Q

Temporal arteritis : Investigations

A
  1. Raised inflammatory markers
    • ESR > 50 mm/hr (note ESR < 30 in 10% of patients)
    • CRP may also be elevated
  2. Temporal artery biopsy
    • skip lesions may be present
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13
Q

Temporal arteritis : Management

A

Urgent to prevent permanent visual loss
1. high-dose prednisolone if no visual loss
2. IV methylprednisolone } evolving visual loss
3. Opthalnology review

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14
Q

Trigeminal neuralgia: Definition

A

Trigeminal neuralgia causes intense facial pain in the distribution of the trigeminal nerve, which has three branches:
* Ophthalmic (V1)
* Maxillary (V2)
* Mandibular (V3)

15
Q

Trigeminal neuralgia: Clinical features

A

Symptoms

  • Unilateral
  • Pain over 1> trigeminal nerve distribution
  • Electricity-like, shooting, stabbing or burning pain
  • Trigger : light touch, taking, eating

Onset
1. Sudden onset
2. Last seconds to hours.

16
Q

Trigeminal neuralgia: Disease association

A

More common in patients with Multiple sclerosis

17
Q

Trigeminal neuralgia: Mx

A

First line : Carbamazepine

18
Q

Cluster headaches : Definition

A
  1. Severe and unbearable unilateral headaches, usually centred around the eye.
  2. Come in clusters of attacks and then disappear for extended periods.
19
Q

Cluster headaches : Clinical features

A

1. Symptoms
typically unilateral:

  • Red, swollen and watering eye
  • Pupil constriction (miosis)
  • Eyelid drooping (ptosis)
  • Nasal discharge
  • Facial sweating

2. Onset

  • Occur in clusters of attacks and then disappear for extended periods.
  • Attacks last between 15 minutes and 3 hours.
20
Q

Cluster headaches :Incidence

A

30-50 year old male smoker.

21
Q

Cluster headaches :Management

A

Acute attacks Mx
1. Triptans (e.g., subcutaneous or intranasal sumatriptan)
2. High-flow 100% oxygen (may be kept at home)

Prophylaxis Mx
1. Verapamil is the first line for prophylaxis

22
Q

Migraine : Types

A

Migraine can be categorised into four main types:
* Migraine without aura
* Migraine with aura
* Silent migraine (migraine with aura but without a headache)
* Hemiplegic migraine

23
Q

Migraine : Clinical features

A

Migraine headaches last between 4 and 72 hours.

Typical features are:

  1. Aura - progressive symptoms occurring hours before the headache
  • Visual aura : Sparks, blurred vision, Scomata (loss of visual field)
  • Paresthesia
  • Dysphasia

Symptoms
Usually unilateral but can be bilateral
1. Moderate-severe intensity

  1. Throbbing in nature
  2. Aversion to stimuli
    * Photophobia / Phonophobia / Osmophobia
  3. Nausea and vomiting
24
Q

Hemiplegic migraines : Definition

A
  1. Migraine with unilateral limb weakness
  2. Other symptoms may include ;
    * ataxia (loss of coordination)
    * impaired consciousness.

Hemiplegic migraines can mimic a stroke or TIA. It is essential to exclude a stroke with sudden-onset hemiplegia.

25
Q

Migraine : Acute Mx

A

Acute treatment
1. First-line: offer combination therapy with

  • an Oral Triptan and an NSAID,
    or
  • an Oral Triptan and paracetamol
26
Q

Migraine : Prophylaxis Mx

A

Indicated if ;
Migraine attack have a significant impact on quality of life and daily function or very severe/prolonged.

  • First line
    1 . Propranolol
    2 . Topiramate:
    • Teratogenic - avoid in women of childbearing age
    • it can reduce the effectiveness of hormonal contraceptives
    3 . Amitriptyline
  • Second line
    1. up to 10 sessions of acupuncture over 5-8 weeks’
27
Q

Triptans : MOA

A

MOA : Stimulate serotonin receptors

various mechanisms of action, including:

  • Cranial vasoconstriction (avoid in CVS disease + HTN)
  • Inhibiting the transmission of pain signals
  • Inhibiting the release of inflammatory neuropeptides
28
Q
A

Neurology (9 decks)

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