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Y2 Neurology > Headaches > Flashcards

Headaches Flashcards

1
Q

what is a primary headache ?

A

headache with no underlying medical cause

- disturbance in brain function

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2
Q

give three examples of primary headaches ?

A
  1. migraines
  2. tension type headaches
  3. cluster head aches
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3
Q

what is a secondary headache?

A

a headache with an identifiable structural or biochemical cause

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4
Q

give 6 examples of secondary head aches ?

A
  1. tumours
  2. meningitis
  3. vascular disorders
  4. systemic infection
  5. head injury
  6. drug-induced
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5
Q

are all secondary headaches sinister ?

A

no

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6
Q

what percentage of headaches presenting at GPs are primary ?

A

90%

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7
Q

are tension head aches disabling ?

A

no

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8
Q

are migraine head aches disabling ?

A

yes

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9
Q

are tensions head aches unilateral or bilateral ?

A

bilateral

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10
Q

describe the pain of tension head aches

A

Mild, bilateral headache which is often pressing quality

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11
Q

what is the treatment for tension headaches

  • abortive treatment
  • preventative treatment
A

abortive treatment

  • NSAIDs
  • aspirin
preventative treatment (rare)
-  tricyclic antidepressants
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12
Q

how many people are affected by migraines ?

A

6 million

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13
Q

what gender are most effected by migraines ?

A

females

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14
Q

what age range is most effected by migraines ?

A

20-50yrs

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15
Q

what causes migraines ?

A

complex circuit changes in the brain

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16
Q

what symptoms are felt during a migraine ?

A 
headache 
nausea 
photophobia
phonophobia 
functional disability
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17
Q

is a migraine bilateral or unilateral ?

A

unilateral

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18
Q

can physical activity trigger a migraine ?

A

yes

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19
Q

can physical activity trigger a tension headache ?

A

no

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20
Q

state some triggers for migraines ?

A
  • dehydration
  • diet
  • change in oestrogen
  • stress
  • after stress
  • hunger
  • sleep disturbance
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21
Q

what are the 5 stages of a migraine ?

A
  1. premonitory
  2. aura
  3. early head ache
  4. advanced head ache
  5. postdrome
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22
Q

what occurs in the premonitory stage of a migraine ?

A

mood change
fatigue
muscle pain
food craving

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23
Q

what occurs in the aura stage of a migraine ?

A

visual somatosensory changes

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24
Q

what occurs in the early headache stage of a migraine ?

A

dull head ache
nasal congestion
muscle pain

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25
Q

what occurs in the advanced headache stage of a migraine ?

A 
unilateral 
throbbing 
nausea 
photophobia 
phonophobia
osmophobia
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26
Q

what occurs in the postdrome stage of a migraine ?

A

fatigue
cognitive changes
muscle pain

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27
Q

what percentage of migraineurs have aura?

A

33%

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28
Q

what can aura be confused with?

A

TIA

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29
Q

how many days a month does someone have to have a headache to have chronic migraines ?

A

> 15days for >3months

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30
Q

what substances can trigger a headache?

A
  • caffeine

- over use of analgesias

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31
Q

what is the treatment of migraines ?

  • abortive
  • preventative
A

abortive

  • aspirin
  • NSAIDs

preventative

  • b blocker
  • anti-epileptics
  • tricyclic antidepressants
  • venlafaxine
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32
Q

do migraines get better or worse with pregnancy ?

A

better

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33
Q

what two drugs are women told to avoid if they have migraines ?

A

Combined OCP

Anti epileptics

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34
Q

whats the treatment of migraines during pregnancy?

  • abortive
  • preventative
A

abortive
- paracetamol

preventative
- propranolol

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35
Q

what are the four types of trigeminal autonomic cephalalgias ?

A

cluster headache
paroxysmal hemicrania
SUNCT
SUNA

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36
Q

what are the symptoms someone experiences with trigeminal autonomic cephalalgias ?

A

very severe unilateral head pain

cranial autonomic symptoms

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37
Q

state some cranial autonomic symptoms

A
  • conjunctival infection
  • nasal congestion
  • eyelid oedema
  • forehead sweating
  • miosis/ptosis
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38
Q

where do patients with cluster head aches feel the pain?

A

around the eye and temporal area

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39
Q

are cluster head aches bi lateral or unilateral?

A

unilateral

40
Q

do cluster head aches have a gradual on sudden onset?

A

sudden onset

41
Q

what is the common duration of cluster head aches ?

A

15mins - 3 hours

42
Q

do patients with cluster head aches want to stay still or move about?

A

they want to move about

- whereas people with migraines want to stay still

43
Q

do the autonomic symptoms of cluster head aches happen on the same or opposite side of the pain?

A

same side of the pain

44
Q

can migraine symptoms be present during a cluster head ache?

A

yes

45
Q

state some migraine symptoms ?

A
  • tiredness (yawning)
  • nausea
  • photophobia
  • phonophobia
  • aura
46
Q

can alcohol trigger a cluster head ache ?

A

yes

47
Q

what is the typical episodic pattern of cluster head aches ?

A

1-3 months of attacks followed by 1 month of remission

attacks typically occur at the same time everyday at the same time of year

48
Q

what would make someone have chronic cluster head aches?

A

having attacks for over a year without remission

or remissions last less then 1 month

49
Q

is paroxysmal hemicranial unilateral or bilateral ?

A

unilateral

50
Q

what is the pain on the head for paroxysmal hemicrania ?

A

around the eye and temporal area

51
Q

are the autonomic symptoms on the same or opposite side of the pain during a paroxysmal hemicrania attack?

A

same side

52
Q

how is paroxysmal hemicrania different from cluster head aches ?

A

paroxysmal hemicrania attacks are short and occur many in one day

53
Q

what quality of pain is experienced with SUNCT?

A

stabbing pulsating pain

54
Q

how long do SUNCT attacks last?

A

10-240 seconds

55
Q

what can trigger SUNCT attacks ?

A

Wind
Cold
Touch
Chewing

56
Q

where is the pain of trigeminal neuralgia?

A

unilateral maxillary or mandibular division pain

57
Q

what is the main difference between trigeminal neuralgia and trigeminal autonomic cephalalgias ?

A

trigeminal neuralgia occurs at the lower parts of the face

58
Q

what os the quality of pain with trigeminal neuralgia?

A

stabbing pain

59
Q

what is the duration of trigeminal neuralgia?

A

5-10 seconds

60
Q

what are some triggers of trigeminal neuralgia?

A

wind
cold
touch
chewing

61
Q

are autonomic symptoms present with trigeminal neuralgia?

A

not present

62
Q

what 3 treatments can be used for cluster head aches?

A

100%oxygen

subcutaneous sumatriptan

nasal zolmatriptan

63
Q

what drug type own work for cluster head aches?

A

tablets

64
Q

what four drugs can be used to prevent cluster head aches from occurring ?

A

verapamil
lithium
methysergide
topiramate

65
Q

is there any abortive treatment for paroxysmal hemicrania ?

A

no

- no drugs available

66
Q

which trigeminal autonomic cephalalgias and trigeminal neuralgia conditions don’t have any abortive treatment?

A

SUNCT
Trigeminal Neuralgia
Paroxysmal hemicrania

67
Q

what treatment can be used as prevention for paroxysmal hemicrania ?

A

indomethacin

68
Q

what treatment can be used as prevention for SUNCT ?

A

Lamotrigine
Topiramate
Gabapentin
Carbamazepine / Oxcarbazepine

69
Q

what treatment can be used as prevention for trigeminal neuralgia ?

A

Carbamazepine / Oxcarbazepine

70
Q

what three surgical options are available for trigeminal neuralgia ?

A

Glycerol ganglion injection
Steriotactic radiosurgery
Decompressive surgery

71
Q

what presentations may indicate a sinister headache ?

A
  • associated with head trauma
  • sudden onset
  • new daily persistent headache
  • change in headache pattern
  • returning patient
72
Q

is a headache likely to be sinister if the headaches have a longstanding pattern episode ?

A

no

73
Q

what are some red flags for head aches ?

A

new onset
new change in frequency, characteristic, associated symptoms
non-focal/focal neurological symptoms
neck stiffness

74
Q

in what position would a high pressure head ache be worse ?

A

worse lying down

75
Q

what can trigger a high pressure head ache ?

A

physical exertion

valsalva manoeuvre

76
Q

what is a risk factor for high pressure head aches ?

A

cerebral venous sinous thrombosis

77
Q

in which position would a low pressure head ache be worse ?

A

sitting or standing up

78
Q

what is the definition of a thunderclap head ache?

A

A high intensity headache reaching maximum intensity in less than 1 minute

79
Q

what are some differential diagnoses which would have to be ruled out for a thunderclap head ache ?

A 
SAH (subarachnoid haemorrhage) 
Intracerebral haemorrhage 
TIA/Stroke 
carotid/ vertebral dissection 
cerebral venous sinus thrombosis 
meningitis
80
Q

what percentage of people die form SAH?

A

50%

81
Q

what are the two surgical treatments for a cerebral aneurysm ?

A

coiling

clipping

82
Q

is examination usually normal with a SAH patient ?

A

yes

83
Q

what investigations should be done for a SAH?

A 
CT scan 
Lumbar puncture (>12 hours after headache onset) 
Both tests should be done on the same day
84
Q

state two types of CSF infections ?

A

Encephalitis and Meningitis

85
Q

what are the symptoms of meningitis ?

A

nausea +/- vomiting, photo/phono phobia, stiff neck

86
Q

what are the symptoms of encephalitis ?

A

altered mental state / consciousness, focal symptoms / signs, seizures

87
Q

what rash is present during a CFS infection ?

A

rash which doesn’t go away when you press on it

88
Q

what could be a cause of intracranial hypotension ?

A

dural CSF leak

89
Q

what are some warning signs which might indicate that the intracranial pressure is raised ?

A

head ache is worse

  • in the morning
  • when lying down
  • during valsalva

focal symptoms:
weakness in one arm
non focal symptoms:
personality change, drowsiness

seizures

visual impairment

90
Q

what investigation should be done for intracranial hypertension ?

A

MRI of brain and spine

91
Q

is intracranial hypotension worse when standing or lying down?

A

standing up

92
Q

what is the treatment for intracranial hypotension ?

A 
bed rest 
fluids 
analgesia 
caffeine 
epidural blood patch
93
Q

what is the main difference between intracranial hypotension and raised incracranial pressure ?

A

intracranial hypotension
- worse when standing up

raised incracranial pressure
- worse when lying down

94
Q

what is giant cell arteritis ?

A

inflammation of large arteries

95
Q

what are the symptoms of giant cell arteritis?

A 
headache is diffuse, persistent and severe 
systematically unwell 
scalp tenderness 
visual disturbance 
prominent temporal arteries
96
Q

what three blood tests should be done for giant cell arteritis?

A
  • elevated ESR (>50)
  • raised CRP
  • raised platelet count
97
Q

what treatment should be started if giant cell arteritis is suspected ?

A

high rise prednisolone

Y2 Neurology (52 decks)

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