Headaches Flashcards

Question

What could photophobia indicate?

Answer 1

migraine possibly, meningitis, SAH

Answer 2

E.g darkness & sleep – migraine relief, leaning forward – sinus pain

Answer 3

Temperature Pulse BP Respiration Observation Neck ROM – include meningeal irritation tests Cranial nerve examination Sensory & motor examination

Answer 4

Migraine headache Tension-Type Headache Trigeminal autonomic cephalalgias including cluster headaches Other primary headache disorders

Answer 5

List is extensive, headache as a result of other underlying cause. E.g. Cervicogenic headache

Answer 6

Tension-type headache is very common, with a lifetime prevalence in the general population ranging between 30% and 78% in different studies, and it has a very high socio-economic impact. Although this type of headache was previously considered to be primarily psychogenic, a number of studies strongly suggest a neurobiological basis, at least for the more severe subtypes of tension-type headache. Episodic - infrequent (most of population)and frequent (Considerable disability and QoL) Chronic (

Answer 7

with/without pericranial tenderness Infrequent episodes of headache, typically bilateral, pressing or tightening in quality and of mild to moderate intensity, lasting minutes to days. The pain does not worsen with routine physical activity and is not associated with nausea, but photophobia or phonophobia may be present. Diagnostic criteria: At least 10 episodes of headache occurring on <1day per month on average (<12 days per year) and fulfilling criteria B-D Lasting from 30 minutes to 7 days At least two of the following four characteristics: 1. bilateral location 2. pressing or tightening (non-pulsating) quality 3. mild or moderate intensity 4. not aggravated by routine physical activity such as walking or climbing stairs D. Both of the following: 1. no nausea or vomiting 2. no more than one of photophobia or phonophobia E. Not better accounted for by another ICHD-3 diagnosis. With Pericranial tenderness (WPT)- meeting above criteria with pericranial tenderness

Answer 8

Description:Frequent episodes of headache, typically bilateral, pressing or tightening in quality and of mild to moderate intensity, lasting minutes to days. The pain does not worsen with routine physical activity and is not associated with nausea, but photophobia or phonophobia may be present. Diagnostic criteria: A. At least 10 episodes of headache occurring on 1-14 days per month on average for >3 months(>12 and <180 days per year) and fulfilling criteria B-D B. Lasting from 30 minutes to 7 days C. At least two of the following four characteristics: 1. bilateral location 2. pressing or tightening (non-pulsating) quality 3. mild or moderate intensity 4. not aggravated by routine physical activity such as walking or climbing stairs D. Both of the following: 1. no nausea or vomiting 2. no more than one of photophobia or phonophobia E. Not better accounted for by another ICHD-3 diagnosis With Pericranial tenderness (WPT)- meeting above criteria with pericranial tenderness

Answer 9

A disorder evolving from frequent episodic tension-type headache, with daily or very frequent episodes of headache, typically bilateral, pressing or tightening in quality and of mild to moderate intensity, lasting hours to days, or unremitting. The pain does not worsen with routine physical activity, but may be associated with mild nausea, photophobia or phonophobia. Diagnostic criteria: A. Headache occurring on 15 days per month on average for >3 months (180 days per year), fulfilling criteria B-D B. Lasting hours to days, or unremitting C. At least two of the following four characteristics: 1. bilateral location 2. pressing or tightening (non-pulsating) quality 3. mild or moderate intensity 4. not aggravated by routine physical activity such as walking or climbing stairs D. Both of the following: 1. no more than one of photophobia, phonophobia or mild nausea 2. neither moderate or severe nausea nor vomiting E. Not better accounted for by another ICHD-3 diagnosis. With Pericranial tenderness (WPT)- meeting above criteria with pericranial tenderness

Answer 10

The diagnostic difficulty most often encountered among the primary headache disorders is to discriminate between tension-type headache and mild migraine without aura. This is more so because patients with frequent headaches often suffer from both disorders

Answer 11

Recurrent headache disorder manifesting in attacks lasting 4-72 hours. Typical characteristics of the headache are unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity and association with nausea and/or photophobia and phonophobia. Diagnostic criteria: A. At least five attacks fulfilling criteria B–D B. Headache attacks lasting 4-72 hours (untreated or unsuccessfully treated) C. Headache has at least two of the following four characteristics: unilateral location pulsating quality moderate or severe pain intensity aggravation by or causing avoidance of routine physical activity (e.g. walking or climbing stairs) D. During headache at least one of the following: 1. nausea and/or vomiting 2. photophobia and phonophobia E. Not better accounted for by another ICHD-3 diagnosis. Less than 5 attacks meeting the above criteria categorised as probable Migraine without Aura

Answer 12

Recurrent attacks, lasting minutes, of unilateral fully reversible visual, sensory or other central nervous system symptoms that usually develop gradually and are usually followed by headache and associated migraine symptoms. Diagnostic criteria: A. At least two attacks fulfilling criteria B and C B. One or more of the following fully reversible aura symptoms: 1. visual 2. sensory 3. speech and/or language 4. motor 5. brainstem 6. retinal C. At least two of the following four characteristics: At least one aura symptom spreads gradually over 5 minutes, and/or two or more symptoms occur in succession Each individual aura symptom lasts 5-60 minutes1 At least one aura symptom is unilateral The aura is accompanied, or followed within 60 minutes, by headache The aura is the complex of neurological symptoms that occurs usually before the headache, but it may begin after the pain phase has commenced, or continue into the headache phase. Visual aura most common type of aura > 90% of patients aura. Next in frequency are sensory disturbances, in the form of pins and needles moving slowly from the point of origin and affecting a greater or smaller part of one side of the body, face and/or tongue. Less frequent are speech disturbances, usually aphasic but often hard to categorize. When the aura includes motor weakness, the disorder should be coded as Hemiplegic migraine or one of its subforms. Premonitory symptoms may begin hours or a day or two before the other symptoms of a migraine attack (with or without aura). They include various combinations of fatigue, difficulty in concentrating, neck stiff- ness, sensitivity to light and/or sound, nausea, blurred vision, yawning and pallor. In some cases migraine with aura may present without head pain. This increases diagnostic difficulty distinguishing from a more concerning neurovascular event. Migraine with brainstem aura exists also. 1. Dysarthria 2. Vertigo 3. Tinnitus 4. Hypacusis 5. Diplopia 6. Ataxia 7. Decreased level of consciousness When aura occurs for the first time after age 40, when symptoms are exclusively negative (e.g. Hemianopia) or when aura is prolonged or very short, other causes, particularly transient ischaemic attacks, should be ruled out. Before or simultaneously with the onset of aura symptoms, regional cerebral blood flow is decreased in the cortex corresponding to the clinically affected area and often over a wider area. Blood flow reduction usually starts posteriorly and spreads anteriorly, and is usually above the ischaemic threshold. After 1 to several hours, gradual transition into hyperaemia occurs in the same region. Cortical spreading depression of Lea˜o is the likely underlying mechanism.

Answer 13

Although the disease was previously regarded as primarily vascular, the importance of sensitization of pain pathways, and the possibility that attacks may originate in the central nervous system, have gained increasing attention over recent decades. Cortical Spreading Depression (https://www.ncbi.nlm.nih.gov/pubmed/23196498) Cortical spreading depression (CSD) is a slowly propagated wave of depolarization of neurons and glial cells, followed by a subsequent sustained suppression of spontaneous neuronal activity. Functional imaging studies of migraine patients have shown dramatic changes in blood flow and brain activity whose characteristics are similar to those of CSD, implicated in migraine visual aura. Although the trigeminal nerve innervates the meninges and participates in the genesis of migraine headaches, triggering mechanisms remain controversial and poorly understood. It is demonstrated by animal models that CSD activates trigeminovascular afferents and evokes a series of cortical meningeal and brainstem events consistent with the development of headache. The messenger molecules nitric oxide (NO), 5-hydroxytryptamine (5-HT) and calcitonin gene-related peptide (CGRP) are involved.

Answer 14

The trigeminal autonomic cephalalgias (TACs) share the clinical features of headache, which is usually lateralized, and often prominent cranial parasympathetic autonomic features, which are again lateralized and ipsilateral to the headache.

Answer 15

Attacks of severe, strictly unilateral pain which is orbital, supraorbital, temporal or in any combination of these sites, lasting 15–180 minutes and occurring from once every other day to eight times a day. The pain is associated with ipsilateral conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, forehead and facial sweating, miosis, ptosis and/or eyelid oedema, and/or with restlessness or agitation. Diagnostic criteria: A. At least five attacks fulfilling criteria B–D B. Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15–180 minutes (when untreated) C. Either or both of the following: 1. at least one of the following symptoms or signs, ipsilateral to the headache: a) Conjunctival injection and/or lacrimation b) Nasal congestion and/or rhinorrhoea c) Eyelid oedema d) Forehead and facial sweating e) Forehead and facial flushing f) Sensation of fullness in the ear g) Miosis and/or ptosis 2. a sense of restlessness or agitation D. Attacks have a frequency between one every other day and eight per day for more than half of the time when the disorder is active. E. Not better accounted for by another ICHD-3 diagnosis. Acute attacks involve activation in the region of the posterior hypothalamic grey matter. Cluster headache may be autosomal dominant in about 5% of cases. Some patients have been described who have both Cluster headache and Trigeminal neuralgia sometimes referred to as cluster-tic syndrome.