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ADELE-Noodles of Neurology > Headaches > Flashcards

Headaches Flashcards

1
Q

Red flags for headaches

A 
New onset >55 years
Early morning/Wakes you up
Hx of malignancy
Immunosupressed
Exacerbation by Valsalva manouvre
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2
Q

If headache that is worse in the morning (wakes them up) and vomiting then what is it that we are worried about?

A

Tumour

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3
Q

If there is a headache that is increased with coughing/leaning forward that what are we worried about?

A

Congenital problem ass with cerebellum

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4
Q

If headache with flashing lights and one sided what is the most likely diagnosis?

A

Migraine

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5
Q

Headache with tiptoeing, ataxia and vomiting in children. What is the likely differential?

A

Posterior fossa tumour

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6
Q

on average how many attacks will someone with migraines have?

A

1 a month

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7
Q

Who is the classic migraine patient?

A

Young female

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8
Q

Triggers for migraines

A 
Stress
Skipping meals
Binge eating
Mensuration/ovulation
OCP
Bright sunshine
Sleep
Physical exertion
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9
Q

What criteria do you need to meet in order to be classified as a migraine without aura?

A

5+ attacks with duration of 4-72h with the following features
Phono/Photophobia
+ 2 of….
Binge eating, Mensturation, Throbbing headache, worse on movement and N&V

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10
Q

How do migraines with aura look different in children?

A

Short lasting
May be bilateral
more prominent gastrointestinal disturbance

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11
Q

Pathophysiology of migraine without aura

A
  • Stress triggers changes in the brain, these changes cause serotonin to be released
  • Blood vessels constrict and dilate
  • Chemicals inc Substance P irritate nerves and blood vessels causing pain
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12
Q

What is an aura?

A

A visible sign of migraine
occur before 20% of migraines
usually last 20-60m
Headaches follow<1h later but can occur simultaneously

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13
Q

Why is the COCP contraindicated in migraines with aura?

A

As migraines with aura increase chance of ischaemic stroke significantly

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14
Q

What is the pathophysiology of migraine with aura?

A

Cortical spreading depolarisation
Activation trigeminal vascular system-dilation cranial blood vessels
Release of substance P, Neurokinin A, CGRP

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15
Q

Acute treatment for migraines

A

Lie in a dark room

Oral triptan and/or NSAID + consider anti-emetic

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16
Q

What are 3 CI to triptans?

A

Coronary vasospasm
IHD
Previous cerebrovascular incidents

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17
Q

When would you use prophylaxis for migraines?

A

If >3 attacks per month OR if severe

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18
Q

What 3 drugs can be used as prophylaxis for migraines?

A

Propanolol
Topiramate
Amitriptyline

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19
Q

What lifestyle modifications can be made in order to reduce the likelihood of migraines?

A 
Diet
Hydration
Stress
Avoidance of triggers
Non-pharmacological methods
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20
Q

What is the name when migraines last more than 3 days?

A

Status migrainosus

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21
Q

Classic description of tension type headaches?

A

Band like pressure around the head radiating to the neck

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22
Q

TRUE/FALSE

In tension-type headaches there is absence of N&V and phono/ohotophobia

A

TRUE

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23
Q

Tension-type headaches have a strong association with

A

Depression and anxiety

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24
Q

Most patients who have tension-type headaches self-manage. If it is a chronic refractory type headache then what drug can be used?

A

Amitriptyline

25
Define TAC
A group of headache disorders categories by common features of unilateral pain (often severe) in the distribution of the trigeminal nerve.
26
What are the symptoms of TAC?
Symptoms on the ipsilateral side - ptosis - miosis - nasal stuffiness - N/V - Tearing - Eyelid oedema
27
What are cluster headaches affectionately known as?
Suicide headaches
28
When do cluster headaches occur?
Last 10m-3h occur in bouts (1-8x a day) for a certain period of the year (few weeks-months) before ceasing for a long period of time Occur when going to bed or in the early hours of the morning
29
What is the age of onset and sex distribution of cluster headaches?
M>F | Age 20-55
30
What are the 3 characteristic features of cluster headaches?
- Severe unilateral pain - Ipsilateral autonomic features - Circadian rhythm of onset
31
What investigation is undertaken in all cluster headache patients?
MRI and MR angiogram
32
Treatment of Cluster headaches
High flow O2 and SC sumitriptan
33
What is the prophylaxis of cluster headaches?
Verapamil
34
How are paroxysmal hemicranial different to cluster headaches?
They are slightly shorter (10-30m), more often (1-40 times a day), more common in females and have an older age of onset (50-60)
35
What is the Rx for paroxysmal hemicranial?
Indomethicin (has complete resolution)
36
What does SUNCT stand for?
``` S-short lived (15-120s) U-unilateral N-Neuralgiaform headache C-Conjunctival infections T-Tearing ```
37
Treatment of SUNCT
Lamotrigine or Gabapentin
38
Compression of CNV by the superior cerebellar artery at the dorsal root entry zone leads to
Trigeminal Neuralgia
39
What is another cause of trigeminal neuralgia aside from compression of the nerve?
Demyelinating disorder
40
TRUE/FALSE | Trigeminal neuralgia symtpoms tend to be bilateral
FALSE | Symptoms tend to be unilateral
41
How would you describe trigeminal neuralgia?
Electric shock like pain, usually around nose-mouth <90s 10-100 a day Can last weeks-months
42
Incidence of trigemenial neuralgia increases with age TRUE/FALSE
TRUE
43
What is trigeminal neuralgia exacerbated by?
Touching the area cold wind shaving or brushing teeth talking, eating and drinking
44
Why is MRI an important investigation for trigeminal neuralgia?
Use dot exclude compression of the dorsal root entry zone
45
Treatment for trigeminal neuralgia
1st line- Carbamazepine | 2nd line- Neurosurgical debulking or radio frequency ablation
46
What is the most common cause of secondary headache?
Medication overuse syndrome
47
If you have a primary cough headache what might be two underlying causes?
Chiari malformation | Aneursym
48
Primary exertion headache is bilateral and pulsating TRUE/FALSE
TRUE
49
What are the two subclassifications of primary sexual headache?
Early coital cephalgia | Post coital cephalgia
50
What is an early coital cephalgia headache like?
Dull, aching, pain in the occipital region
51
When is the most severe headache in post coital cephalgia?
During an orgasm
52
What headache is the acute thunderclap headache?
Subarachnoid headache
53
What are the two most likely causes for a carotid dissection?
1- Spontaneous | 2- Due to hyperextension injury of the neck
54
TRUE/FALSE | Giant cell arteritis can present as scalp pain aswell as ischaemic pain in the muscles of mastication
TRUE
55
What are the classic RF for IIH
Female, Fat, Fertile
56
What is IIH?
Idiopathic intracranial hypertension | An idiopathic process, chronically raised CSF pressures within the brain without any discernible SOL to raise ICP
57
What are the symptoms of IIH?
Headache Moderate/gross bilateral papiloedema N&V CN VI palsy
58
Is the headache caused by IIH relieved on standing?
TRUE
59
What is the treatment for IIH?
Wt loss Acetazolamide Lumboperitoneal shunt

ADELE-Noodles of Neurology (38 decks)

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