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Neurology > Headaches > Flashcards

Headaches Flashcards

1
Q

What are some of the possible causes of headaches?

A 
Tumour 
Meningitis 
Vascular disorders 
Systemic infection 
Head injury 
Drug induced
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2
Q

What are the different types of primary headaches?

A

Tension type headache
Migraine
Cluster headaches

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3
Q

What are the clinical features of a tension type headache?

A 
Mild pain 
Bilateral 
Pressing or tightening 
No significant associated features 
Not aggravated by routine physical activity
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4
Q

What abortive treatment is used for tension type headaches?

A

Aspirin
Paracetamol
NSAIDs

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5
Q

What preventative treatments are used for tension type headaches?

A

Tricyclic antidepressants

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6
Q

What is a migraine?

A

Chronic disorder with episodic attacks due to complex changes in the brain

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7
Q

What are the clinical features of a migraine?

A 
Headache 
Nausea 
Photophobia 
Phonophobia 
Functional disability
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8
Q

What are some of the triggers of a migraine?

A 
Stress
Diet 
Dehydration 
Environmental stimuli 
Changes in oestrogen level in women 
Sleep disturbance 
Hunger
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9
Q

What are the different stages of a migraine?

A 
Premonitory 
Aura 
Early headache 
Advanced headache 
Postdrome
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10
Q

What is an aura?

A

Neurological symptoms resulting from cortical brainstem dysfunction, may involve visual, sensory, motor or speech systems

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11
Q

What can make headaches worse?

A

Medication overuse

Caffeine overuse

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12
Q

What is the abortive treatment for migraines?

A

Aspirin or NSAIDs

Triptans

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13
Q

What is the prophylactic treatment for migraines?

A

Propanolol or candesartan
Anti- epileptics
Tricyclic antidepressants
Venlafaxine

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14
Q

What effect can pregnancy have on migraines?

A

Migraines with aura get better

Migraines without aura usually don’t change

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15
Q

What is the effect of OCP on migraines?

A

Contraindicated in migraine with aura

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16
Q

What are the different types of trigeminal autonomic cephalagias?

A

Cluster headaches
Paroxsymal hemicrania
SUNCT
SUNA

17
Q

What are the clinical features of a cluster headache?

A 
Mainly orbital and temporal 
Strictly unilateral 
Rapid onset 
Excruciatingly severe 
Restless and agitated
18
Q

What are the clinical features of paroxysmal hemicrania?

A 
Mainly orbital and temporal 
Strictly unilateral 
Rapid onset 
Restless and agitated 
Absolute response to indometacin 
CHRONIC
19
Q

What are the clinical features of SUNCT?

A 
Unilateral orbital, supraorbital or temporal pain 
Stabbing or pulsating pain 
Short lived 
No refractory period
Conjunctival injection and tearing
20
Q

What are the clinical features of trigeminal neuralgia?

A

Unilateral maxillary, mandibular or ophthalmic pain
Stabbing
Short lived
Has a refractory period

21
Q

What are the triggers of trigeminal autonomic cephalagias?

A

Wind, cold
Touch
Chewing

22
Q

What is the abortive treatment for cluster headaches?

A

Subcutaneous sumatriptan
Nasal zolmatripan
Occipital depomedrone injection

23
Q

What is the preventative treatment for cluster headaches?

A

Verapamil

Lithium

24
Q

What is the treatment for paroxysmal hemicrania?

A

No abortive treatment
Indometacin
Topiramate

25
Q

What is the treatment for SUNCT/SUNA?

A

No abortive treatment
Topiramide
Lamotrigine

26
Q

What is the treatment for trigeminal neuralgia?

A 
No abortive treatment 
Carbamazepine 
Oxcarbazepine 
Glycerol ganglion injection
Steriotactic radiosurgery
27
Q

What presentations of headache are more likely to have a sinister cause?

A 
Associated head trauma 
First or worst 
Sudden (thunderclap) headache 
New daily persistent headache 
Change in headache pattern or type
28
Q

What are the red flag symptoms associated with headache?

A 
Neck stiffness 
Fever 
High or low pressure 
New onset or change in headache 
Abnormal neurological examination
29
Q

What is a thunderclap headache?

A

High intensity headache reaching maximum intensity in less than 1 minute

30
Q

What is the differential diagnosis of a thunderclap headache?

A 
Subarachnoid haemorrhage 
Intracerebral haemorrhage 
TIA/stroke 
Carotid/vertebral dissection 
Meningitis/encephalitis 
Cerebral venous sinus thrombosis
31
Q

What investigations are used for a subarachnoid haemorrhage?

A

CT scan

Lumbar puncture 12 hours after onset

32
Q

What are the signs of meningitis?

A

Nausea, vomiting
Photo/phonophobia
Neck stiffness

33
Q

What are the signs of encephalitis?

A

Altered mental state/ consciousness
Focal symptoms or signs
Seizures

34
Q

What are the features suggestive of a space occupying lesion or raised intracranial pressure?

A 
Progressive headache with associated symptoms and signs 
Visual obscurations 
Pulsatile tinnitis 
Seizures 
Personality change
35
Q

What investigations are used for intracranial hypotension?

A

MRI brain and spine

36
Q

What is the treatment for intracranial hypotension?

A

Bed rest, fluids, analgesia, caffeine
Epidural blood patch
IV caffeine

37
Q

What are the symptoms of giant cell arteritis?

A 
Diffuse, persistant headache
Systemically unwell 
Scalp tenderness 
Jaw claudication 
Visual disturbance 
Prominent, beaded or enlarged temporal arteries
38
Q

What is the treatment for giant cell arteritis?

A

High dose prednisolone

Temporal artery biopsy

Neurology (39 decks)

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