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Neurology > Headaches > Flashcards

Headaches Flashcards

1
Q

What kind of onset may headaches have?

A

Acute
Subacute
Gradual

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2
Q

What kind of exacerbating factors may headaches have? Give examples.

A

Valsalva

e.g coughing, sneezing, straining

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3
Q

Headaches may have …….. variation

A

DIURNAL

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4
Q

Name some associated symptoms of headaches.

A

Photophobia, phonophobia, positive visual symptoms, ptosis, miosis, nasal stuffiness etc

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5
Q

Migraines tend to occur in…..

A

YOUNGER FEMALES

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6
Q

List the 5 red flags of headaches.

A 
New onset in someone >55
Known/previous malignancy
Immuno-suppressed
Early morning headache
Exacerbated by Valsalva
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7
Q

What should you be aware of in someone’s PMH?

A

Previous CA

Predisposition to thrombus

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8
Q

What should be asked about in FHx?

A

Migraines

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9
Q

What should you remember to ask about in drug history?

A

Over the counter medication

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10
Q

Headaches are more common in?

A

WOMEN

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11
Q

On average, how often do most people have an attack?

A

1 per month

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12
Q

What % experience migraine i) with aura ii) without aura?

A

i) 20%

ii) 80%

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13
Q

What is the HIS criteria for a migraine without aura?

A
  • At least 5 attacks.
  • Of duration 4-72hours.
    +
  • 2 of: moderate/severe, unilateral, throbbing pain, worse with movement.
  • 1 of: autonomic features, photophobia/phonophobia
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14
Q

What 2 influences cause an individual to be susceptible to migraines?

A

Neural and vascular

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15
Q

Describe the pathophysiology of a migraine.

A

Stress triggers changes in the brain, and these changes cause SEROTONIN to be released.

Blood vessels constrict and dilate.

Chemicals including SUBSTANCE P irritate nerves and blood vessels, causing pain.

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16
Q

Aura is a …….

A

FULLY REVERSIBLE visual, sensory, motor or language symptom

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17
Q

What does aura duration tend to be?

A

20-60 minutes

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18
Q

When does a headache occur in relation to aura?

A

<1 hour but both can occur simultaneously

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19
Q

What type of aura is most common?

A

VISUAL

positive symptoms usually monochromatic

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20
Q

Suggest factors which may trigger a headache.

A 
Sleep. 
Dietary – cheese, red wine. 
Stress. 
Hormonal – young females in early teens, or females in 40’s.
Physical exertion.
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21
Q

What can be used to help identify triggers?

A

A headache diary

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22
Q

Suggest non-pharmacological methods of treating a migraine.

A
  • Set realistic goals
  • Education – avoid triggers
  • Headache diary
  • Relaxation/Stress management
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23
Q

Pharmacological treatment is either?

A

Acute or Prophylactic

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24
Q

Outline the acute management of a headache.

A

Aspirin 900mg
Naproxen 250mg
Ibuprofen 400mg
+ anti-emetic

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25
Q

What kind of drug are triptans?

A

5 HT agonist

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26
Q

When are triptans taken?

A

At the start of the headache

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27
Q

What should be considered when deciding the route of triptans?

A

If patient has nausea and vomiting then don’t give oral

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28
Q

When should prophylaxis for headaches be considered?

A

If person is having more than 3 attacks per month, or very severe attacks

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29
Q

How long should a prophylactic drug be trialled for?

A

At least 3 months

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30
Q

What non-pharmacological methods should be tested for prophylaxis?

A

Acupuncture

Relaxation exercises

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31
Q

Name 2 prophylactic drugs.

A

Propanolol

Topiramate

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32
Q

What does propranolol do?

A

Reduction in migraine frequency in around 60-80% of patients.

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33
Q

What is the range of suitable doses of propanolol?

A

80-240mg

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34
Q

When should propranolol be avoided?

A

Asthma and PVD (heart failure)

35
Q

What type of drug is topiramate?

A

A carbonic anhydrase inhibitor

36
Q

What range of doses can be given for topiramate?

37
Q

What are the side effects of topiramate? What should you therefore do?

A 
Weight loss. 
Paraesthesia. 
Impaired concentration. 
Enzyme inducer
START LOW, GO SLOW
38
Q

What are the side effects of amitriptyline?

A

Dry mouth, postural hypotension, sedation

39
Q

What dietary advice should you give?

A

Ensure regular intake
Avoid triggers
Maintain a healthy balanced diet

40
Q

In terms of hydration, what should you tell patients?

A

At least 2 litres per day

Decrease caffeine

41
Q

For a typical migraine, what investigations are required?

42
Q

When should imaging for a migraine be considered?

A

If late onset - > 55.
Known malignancy.
Acephalgic (ie. no headaches) migraine

43
Q

Migraine is?

A

A common UNILATERAL headache of the young

44
Q

Consider prophylaxis for those who have more than 3 attacks per month

45
Q

Tension headaches can be either …….. or ……?

A

Episodic
OR
Chronic

46
Q

Describe the main features of a tension headache.

A

Pressing/Tingling quality
Mild to moderate
Bilateral

47
Q

What features sometimes associated with headache are absent in a tension-type headache?

A

Nausea
Vomiting
Photophobia
Phonophobia

48
Q

How are tension headaches managed?

A
  • Relaxation physio
  • Anti-depressant for 3 months - dothiepin or amitriptyline
  • Reassurance is often enough
49
Q

What are the Trigeminal Autonomic Cephalgias (TACs)?

A

A group of primary headache disorders, characterised by unilateral trigeminal distribution pain that occurs in association with prominent ipsilateral cranial autonomic features

50
Q

What are ipsilateral cranial autonomic features?

A 
Ptosis. 
Miosis. 
Nasal stuffiness. 
Nausea/vomiting. 
Tearing. 
Eye lid oedema
51
Q

Name the 4 main types of TAC.

A
  • Cluster.
  • Paroxysmal hemicrania.
  • Hemicrania continua.
  • SUNCT
52
Q

Who tends to get cluster headaches?

A

young 30’s - 40’s

men > women

53
Q

When do cluster headaches occur?

A
  • Striking circadian (around sleep).

* Seasonal variation.

54
Q

Describe features of a cluster headache.

A
  • Severe UNILATERAL headache.

 unlike people with migraine, these people struggle to stay still.

55
Q

What is the duration of cluster headaches?

A

45-90 minutes

56
Q

What is the frequency of cluster headaches?

A

1 to 8 days

57
Q

How long may cluster bouts last?

A

From a few weeks to months

58
Q

Outline the treatment of cluster headaches.

A
  • High flow oxygen, 100% for 20 mins.
  • Subcutaneous sumatriptan 6mg.
  • Steroids – begin at start of cluster, then reduce course over 2 weeks.
59
Q

What is given as prophylaxis of cluster headaches?

60
Q

Who gets paroxysmal hemicrania?

A

Elderly people – 50s-60s.

Women > men

61
Q

Outline the features of paroxysmal hemicrania.

A
  • SEVERE UNILATERAL headache, with UNILATERAL AUTONOMIC features
62
Q

What is the duration of paroxysmal hemicrania headaches?

A

10-30 mins

63
Q

What is the frequency of paroxysmal hemicrania headaches?

64
Q

Paroxysmal hemicrania headaches are SHORTER in duration, and more FREQUENT than cluster

65
Q

What is the treatment of paroxysmal hemicrania/hemicrania continua?

A

ABSOLUTE response to INDOMETHICIN

66
Q

Explain what SUNCT is.

A 
S = Short lived (15-120secs). 
U = Unilateral. 
N = Neuralgiaform headache. 
C = Conjunctival injections. 
T = Tearing
67
Q

What is SUNCT treated with?

A

Lamotrigine.

Gabapentin

68
Q

When is investigations needed?

A

Those with new onset unilateral cranial autonomic features require imaging.

69
Q

What imaging is done?

A

MRI brain

MR angiogram

70
Q

Who is affected by IIH?

A

F>M

Obese people - almost never see people with normal BMI with this

71
Q

Outline the features of IIH.

A

Headache that has diurnal variation.
Morning n + v.
Visual loss.

72
Q

What investigations should be done for IIH? What are the expected results of each of these?

A

Fundoscopy.
* papilloedema, absence of venous pulsation

MRI brain with MRV sequence.
* normal

Lumbar Puncture.
* CSF – elevated pressure, normal constituents

Visual fields

73
Q

These are the one group of pts where you can do a lumbar puncture even if they have papilloedema. First, ensure MRI is normal.

74
Q

How is IIH managed?

A
  • Weight loss.
  • Acetazolamide.
  • Ventricular atrial/lumbar peritoneal shunt.
  • Monitor visual fields and CSF pressure.
75
Q

Who gets trigeminal neuralgia?

A
  • Elderly people, >60y/o.

* Women > Men

76
Q

What triggers trigeminal neuralgia?

A

Touch, usually in the CN V2/3 distribution

77
Q
  • Severe STABBING unilateral pain
A

TRIGEMINAL NEURALGIA

78
Q
  • What is the duration of trigeminal neuralgia?
A

1-90 seconds

79
Q

What is the frequency of trigeminal neuralgia?

A

10-100 days

80
Q

How long may bouts of pain last before remission in trigeminal neuralgia?

A

From a few weeks to months

81
Q

What investigations are done for trigeminal neuralgia? Why?

A

MRI brain.
IF there are any signs on examination, atypical features, poor response to medical treatment or if surgical treatment is being considered

82
Q

What drugs may be used in the medical tx of trigeminal neuralgia?

A

Carbamazepine.
Gabapentin.
Phenytoin.
Baclofen.

83
Q

What are the 2 main surgical options in the treatment of trigeminal neuralgia?

A

Ablation
OR
Decompression

Neurology (42 decks)

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