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Neurology SOH > Headaches > Flashcards

Headaches Flashcards

1
Q

Investigations are required to differentiate between different types of headaches. True or false?

A

False

- investigations are carried out to rule out more sinister conditions

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2
Q

Acute onset - think

A

Haemorrhage

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3
Q

Sub-avute onset - think

A

Migraine

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4
Q

Associated features to ask about

A 
N+V
Photophobia 
Blurred vision
Ptosis 
Nasal stuffiness
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5
Q

Red flag - new onset headache at which age

A

55 and ABOVE

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6
Q

Early morning headache is a red flag. True or false

A

True

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7
Q

A headache that is exacerbated by coughing/sneezing (valsalva) is not a red flag. True or false?

A

False

- it is a red flag

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8
Q

Migraine - most common in young males. True or false?

A

False

- young females

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9
Q

Migraine - triggers

A 
Stress 
Hormonal - menstrual related 
Sleep 
Environment
After exercise 
Dietary: red wine, cheese
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10
Q

Migraine - Trigger factor causes changes in the brain which results in the release of _____

A

Serotonin

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11
Q

Migraine - release of serotonin causes activation of which system, resulting in what?

A

Activation of trigeminal vascular system

Causes cranial blood vessels to constrict and dilate

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12
Q

Give examples of chemicals which irritate nerves and blood vessels to cause pain

A

Substance P
Neurokinin A
CGRP

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13
Q

Which part of the brain is the migraine generating centre found?

A

Brainstem

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14
Q

Migraine with aura - what is aura

A

Fully reversible

Visual, sensory, motor or language symptom which occurs before you get the headache

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15
Q

Migraine with aura - list some common visual symptoms

A

Central fortification spectra
Central scotoma
Hemianopic loss

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16
Q

Migraine with aura - how long does it typically last?

A

20-60 mins

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17
Q

If people have migraine with aura, which medication must they NOT receive

A

Combined OCP

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18
Q

Migraine without aura - criteria needed to diagnose - at least ___ attacks with duration ____ each time

A

at least 5 attacks with a duration between 4-72 hours each time

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19
Q

Migraine without aura - additional criteria needed to diagnose: at least 2 of the following

A

Moderate/severe headache
Unilateral
Throbbing pain
Worst with movement

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20
Q

Migraine without aura - additional criteria needed to diagnose: 1 of the following

A

N+V

Photophobia

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21
Q

Basilar migraine - clinical features

A

Vertigo
N+V
Dizziness

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22
Q

Who are most likely to get abdominal headaches ?

A

Children

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23
Q

Migraine - how often do people get them

A

Average is 1 attack per month

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24
Q

Migraine - clinical features

A 
Moderate/severe pain 
Unilateral
Throbbing/pounding sensation
N+V
Photophobia 
Phonophobia
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25
Q

When patients have a migraine where do they often want to rest?

A

Lie down in a dark room

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26
Q

Migraine - acute pharmacological management

A

NSAIDS

  • aspirin 900mg
  • naproxen 250mg
  • ibuprofen 400mg

+/- anti-emetics

Triptans

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27
Q

Migraine - acute pharmacological management - triptans - examples

A

5-HT agonist
Examples
- rizatriptan
- frovatriptan

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28
Q

Migraine - acute pharmacological management - these medications should be taken as early as possible. true or false?

A

True

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29
Q

Acute management of an uncomplicated migraine

A

Over the counter medication is first line

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30
Q

Migraine - non pharmacological management

A

Avoid triggers

Relaxation/stress management

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31
Q

When would you consider prophylaxis management

A

When the patient has more than 3 attacks per month

When the patient has very severe migraines

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32
Q

Migraine - prophylaxis management - must trial a drug for how long before giving up

A

4 months

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33
Q

Migraine - examples of drugs used for prophylactic management

A 
Propranolol
Atopiramate 
Amitryptiline 
Gabapentin
Sodium Valproate
34
Q

Migraine - drugs used for prophylactic management - side effects of propranolol

A

Avoid in asthmatics

Heart failure

35
Q

Tension headache is always stress related. True or false?

A

True

36
Q

Tension headache is more debilitating than a migraine. True or false?

A

False

- less debilitating

37
Q

Tension headache is unilateral. True or false?

A

False

- bilateral

38
Q

Tension headache - clinical features

A

Bilateral headache

Tingling sensation

39
Q

Tension headache - what are they NOT associated with

A

No N+V
No photophobia
No phonophobia

40
Q

Tension headache - management

A

Relaxation physiotherapy

Anti-depressant (amitryptiline)

41
Q

Trigeminal autonomic cephalgia (TAC) - definition

A

Group of primary headache disorders that affect the trigeminal vascular system

42
Q

TAC - general clinical features

A 
Unilateral trigeminal (CNV) distribution of pain + 
Prominent ipsilateral cranial autonomic features 
- ptosis
- miosis 
- nasal stuffiness 
- N+V
- tearing 
- eye lid oedema
43
Q

TAC - what are the 4 types

A

Cluster headache
Paroxysmal hemicrania
Hemicrania continua
SUNCT

44
Q

Patient with new onset unilateral cranial autonomic features require which type of investigation?

A

Imaging

45
Q

TAC - cluster headache - more common in men/women?

A

Men

46
Q

TAC - cluster headache - average age range

A

30-40

47
Q

TAC - cluster headaches - triggers

A

Sleep

Seasonal variation

48
Q

TAC - cluster headaches - unilatera/bilateral

A

Unilateral

49
Q

TAC - cluster headaches - clinical features

A

Severe unilateral headache
Patient wants to walk about
Patient can’t sit still

50
Q

TAC -cluster headache - the pain is worse than a migraine. True or false?

A

True

51
Q

TAC - cluster headache - duration

A

Short

- 30 mins -> 2 hrs

52
Q

TAC - cluster headache - how often do they occur

A

Around 1-8 per day

53
Q

TAC - cluster headache - acute management

A

High flow oxygen for 20 mins

Subcutaneous sumitriptan 6mg

54
Q

TAC - cluster headache - management to treat a cluster bout

A

Steroids for 2 weeks

55
Q

TAC - cluster headache - prophylaxis mangement

A

Verapamil

56
Q

TAC - paroxysmal hemicrania - who gets it

A

Elderly (50-60s)

57
Q

TAC - paroxysmal hemicrania is more common in males/females?

A

Females

58
Q

TAC - paroxysmal hemicrania - - clinical features

A

Severe unilateral headache
Unilateral autonomic features
Pain comes and goes

59
Q

TAC - paroxysmal hemicrania - duration

A

Short duration

10-30 mins

60
Q

TAC - paroxysmal hemicrania - how often do they occur

A

1-40 per day

61
Q

TAC - paroxysmal hemicranias are SHORTER/LONGER duration and MORE/LESS frequent than cluster headaches

A

Shorter duration

More frequent

62
Q

TAC - paroxysmal hemicrania - management

A

Indomethacin

63
Q

TAC - paroxysmal hemicrania - if the headache doesn’t respond to indomethacin then what happens?

A

You have made the wrong diagnosis

64
Q

TAC - SUNCT - clinical features

A 
Short lived (15-120 secs) 
Unilateral 
Neuralgiform headache 
Conjunctibal injections 
Tearing
65
Q

TAC - SUNCT - management

A

Lamotrigine

Gabapentin

66
Q

Idiopathic intracranial hypertension - more common in males/females?

A

Females

67
Q

Idiopathic intracranial hypertension - more common in skinny/obese people?

A

Obese

68
Q

Idiopathic intracranial hypertension - clinical features

A 
Headache 
Papilloedema 
Diurnal vriation
Morning N+V
Visual loss
69
Q

Idiopathic intracranial hypertension - investigations

A

MRI scan
- should be normal
Lumbar puncture

70
Q

Idiopathic intracranial hypertension - why is an MRI scan necessary?

A

If there is headache + papilloedema it may be a brain tumour so it is necessary to do imaging investigations to check

71
Q

Idiopathic intracranial hypertension - what are the rules about lumbar puncture here

A

Only perform lumbar puncture once you are sure that MRI scan is normal

72
Q

Idiopathic intracranial hypertension - management

A

Weight loss can resolve the issue

Acetazolamide

73
Q

Trigeminal neuralgia - pathogenesis

A

Due to blood vessel touching CNV

74
Q

Trigeminal neuralgia - who gets it?

A

Elderly patients

75
Q

Trigeminal neuralgia - more common in men/women ?

A

Women

76
Q

Trigeminal neuralgia - clinical features

A

Severe, stabbing pain
Unilateral
Very short duration (1-90 secs)
Bouts of pain which may last weeks/months before remission

77
Q

Trigeminal neuralgia - investigations

A

MRI brain

78
Q

Trigeminal neuralgia - management (pharmacological)

A

Carbamazepine
Gabapentin
Phenytoin
Baclofen

79
Q

Trigeminal neuralgia management (surgical)

A

Ablation of CN V nerve root

Decompression if blood vessel is touching CN V

80
Q

What is the first line pharmacological management for trigeminal neuralgia?

A

Carbamazepine

Neurology SOH (31 decks)

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