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Integrated Care > Headaches > Flashcards

Headaches Flashcards

1
Q

What are some acute causes of headache

A 
VICIOUS
Vascular 
- SAH, intracranial, intracerebral
- infarction esp posterior circulation 
- Venous: sinus thrombosis

Infection/inflammation
- meningitis, encephalitis, abscess

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2
Q

How does a tension headache present

A 
Associated with stress and anxiety 
Bilateral pressing, tightening pain (non-pulsatile)
Fronto-occipital
Mild/moderate intensity 
Not associated with vomiting 
Not aggravated by exercise 
Mild - moderate intensity 
Present at or soon after getting up in the morning G
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3
Q

Who are tension headaches more common in

A

More common in younger population

prevalence decreases with age

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4
Q

How are tension headaches managed

A

Non-pharmcological: Alleviate stress - meditation and mindfullness
Pharmcological: Simple analgesia
prophylaxis: accupuncture

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5
Q

How can tension headaches be classified

A

Episodic - 30mins to 7 days
less than 15 days per month

Chronic - more than 15 days per month for more than 3 months

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6
Q

What are the causes of the headaches

A 
Anxiety 
Depression 
Poor posture 
poor sleep 
Stress
Muscular tightness
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7
Q

What examination would you do in tension headaches

A

head and neck examination
BP
Fundoscopy

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8
Q

What would you examine in a patient presenting with headaches

A 
BP
Fundoscopy 
Neurological examination 
Visual acuity 
Gait 
Palpation of temporal regions
Examination of neck
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9
Q

What are the red flags for headaches

A

Headache with fever +/- purpuric rash
Thunderclap headache
progressive headache worsening over weeks
Headaches associated with postural change, sneezing, coughing
Recent head injury
Papilloedema
Change in personality, cognitive or neurological deficit
New onset headache in pt with HIV/cancer
Headache with atypical aura (>1hr +/- motor weakness)
Aura for first time and using COCP

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10
Q

What are cluster headaches

A

Extremely painful headaches focused around one eye with associated autonomic symptoms

  • red watery eye
  • forehead sweating
  • eye drooping
  • runny/blocked nose

Pain lasts 15-180 mins
1x every 2 days - 8x per day

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11
Q

What are the risk factors for cluster headaches

A

Smoking
Over 20 - rare in <20 years
male

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12
Q

What would you do with a patient presenting for the first time with cluster headaches

A

Referral to neurology or neuroimaging

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13
Q

What is given in an acute attack of cluster headaches

A

100% Oxygen 12L for 10-20 mins

5HT agonists - sumitriptan

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14
Q

What is the prophylaxis used for cluster headaches

A

Verapamil 80mg

no response to this =referral

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15
Q

What is trigeminal neuralgia

A

Intense, burning, stabbing, electric shock like pain in the trigeminal nerve distribution on face
Pain may be provoked by facial movements or by touching face
More common in >50 years old
No symptoms between attacks
Normally unilateral pain

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16
Q

Which disease is associated with trigeminal neuralgia

A

Multiple Sclerosis

17
Q

How is trigeminal neuralgia managed

A

Spontaneous remission may occur
carbamazepine
Pregabilin
Amitriptylline

18
Q

How does Giant Cell Arteritis present

A 
Scalp tenderness 
may have jaw claudication 
Unilateral throbbing headache 
Facial pain 
transient visual symptoms 
Temporal artery abnormality - tenderness, thickness, decreased pulsation
19
Q

Which investigations are done in GCA - temporal arteritis

A

Bloods: FBC, U+Es, ESR (>50)

Temporal artery biopsy

20
Q

Why might the temporal artery biopsy be negative

A

Skip lesions

21
Q

Which visual symptoms are associated with temporal arteritis

A

Diplopia
Sudden loss of vision
fleeting loss of vision (amaurosis fugax)

22
Q

What is the management of temporal arteritis

A 
Prednisolone 40-60mg OD 
Osteoporosis prophylaxis - bisphosphonates (if hx of fragility #s, >65), Vitamin D and Calcium 
Steroid card 
Consider aspirin 75mg OD
Referral to 
ophthalmology - same day if visual symptoms 
Rheumatology 
(for biopsy)
23
Q

What should be asked in a headache history

A

Timing

  • how recent
  • when do they occur during the day
  • how sudden when they start
  • how frequent
  • duration

Character

  • intensity of pain
  • nature and quality of pain
  • site and spread
  • associated symptoms

Cause questions

  • predisposing or triggering factors
  • lifestyle factors - poor sleep, stress, lack of exercise
  • aggrvating or relieving factors
  • Family hx of similar headaches

Response

  • what do you do when you have a heaache
  • how much are your activities limited
  • What medication has been used
  • how has the medication been used

State between attacks

  • well between attacks?
  • any residual or perssitent symptoms between attacks
  • any concerns about recurrent headaches
  • any concerns about cause

Integrated Care (6 decks)

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