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Neuropsyciatry > HEADACHES > Flashcards

HEADACHES Flashcards

1
Q

Primary vs Secondary Headache

A

Primary

  • Due to the headache condition itself, not due to another cause
  • E.g. migraine, tension, cluster

Secondary

  • Headache that is present because of another condition
  • E.g. headache in meningitis/sinusitis/SAH
  • Medication overuse is in this category
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2
Q

Differential Of Headaches :

Acute vs Chronic

which one must go to A+E/ for emergency assessment

A
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3
Q

Red Flag symptoms of Headache

A
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4
Q

what associated symptoms would u ask about in the patient? and what coniditions could these symptoms be related to

A

N+V – may suggest raised intracranial pressure (ICP)

Visual disturbance – aura related / intracranial lesion / bleeding / stroke

Photophobia – raised ICP / meningitis

Neck stiffness – meningitis (may be related to infection or subarachnoid haemorrhage)

Fever – suggestive of an infective process (e.g. bacterial meningitis/abscess)

Rash – non-blanching purpuric rash may indicate meningococcal sepsis

Weight loss – suggestive of malignancy – consider cerebral metastases

Sleep disturbance – headaches causing sleep disturbance are concerning (raised ICP)

Temporal region tenderness – consider temporal arteritis

Neurological deficits – weakness / sensory disturbance / impaired coordination / cognitive symptoms / altered level of consciousness – consider space-occupying lesions / intracranial bleeding / stroke

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5
Q

what foods can be triggers for heaches?

which headche?

A

cheese, coffee, chocolate

cluster

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6
Q

Most common headache?

A

Tension headache

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7
Q

MOST PAINFUL HEADACHE EVER!!!

A

CLUSTER

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8
Q

when can u say the tension headache is chronic? episodic?

A

if it occur more than 15X per month

if less>> episodic

Medication overuse also the same! occurs more than 15X per month

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9
Q

MOH

Regular overuse greater than 3 months of one of the following:

A
  • Triptans or opioids (codeine) on at least 10 days of the month
  • Paracetamol, aspirin or NSAIDs on at least 15 days of the month
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10
Q

which one gets symoathetic overdrive?

explain further symtoms

A

Cluster!

  • red watery eye
  • congested runny nose
  • sweaty
  • skin redness
  • partial ptosis
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11
Q

when does overuse medication settle down?

A

resolves completely after 2 months following discontinuation of medication

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12
Q

made worse by stress and poor posture?

A

Tension headache

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13
Q

pain behind eye, sharp and penetrating

A

cluster

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14
Q

3rd most common type of headache!

A

medication overuse headache

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15
Q

how does cluster headache differ from trigeminal neuralgia?

since the both occur around eye?

A

TIMING

TN> lasts a few secs to 2 mins

Cluster> last longer

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16
Q

which one is mainly noctural?

A

Cluster

17
Q

mainly F r more than males,

which one do MEN mainly get it?

A

cluster

18
Q

squeezing headache?

A

tension

19
Q

what is triggered by alchohol? smoking? sudden heat?

A

cluster

20
Q

why can ppl with cluster headache get their cluster attack around summer time?

A

bc theyve got hay fever, HISTIMINE GOES UP, more prone to get attach

21
Q

throbbing pulsating

A

migraine

22
Q

in medication Overuse Headache, and patient has stopped medication.

what must u warn patient?

A

REBOUND HEADACHE

that the headache will get worse before it gets better!

but in 2 months it will go away!

23
Q

radiates to neck?

A

tension

24
Q

why can u get medication overuse headaches?

when do u mainly see this type of headche

A

increase in headache pain receptors

in patients who were taking medication to treat their headache in the first place!

25
Q

which headaches radiate? if so where?

A

TN> radiates to eyes, lips, nose and scalp

TEnsion> To neck

26
Q

Site and quality

  • Migraine
  • Tension
  • Cluster
  • trigeminal neuralgia
A
  1. Migraine>> Unilateral, often frontal,

Sudden or gradual onset, Throbbing/pulsating

  1. Tension>> Bilateral, frontol, squeezing, non-pulasatile
  2. Cluster>> around/ behind one eye, sharp, pentrating
  3. trigeminal neuralgia>> unilateral, over eye, stabbing, sharp, electric shock
27
Q

intensity and timing/onset/how long does attack last for?

  • Migraine
  • Tension
  • Cluster
  • trigeminal neuralgia
A
  1. Migraine>> moderate, btw 4hrs-3days, may be cyclical
  2. Tension>> less severe (mild-moderate), worse at end of day, less than 15 X permonth
  3. Cluster>> VERY SEVERE, RAPID onset,

Attacks last 15 min–3hrs, 1-2x/day, mostly nocturnal.

  • Clusters last 2 wks-3 mo, remission lasts 3mo-3yrs
  • Can be chronic vs. episodic
  1. TN>> severe, SUDDEN onset, last few sec-2 mins
28
Q

aggrevating and releiving/radiation

  • Migraine
  • Tension
  • Cluster
  • trigeminal neuralgia
A
  1. Migraine>> Photo/phonophobia, Sleep make better, medication, X radiaiton
  2. Tension>> stress, poor posture, lack of sleep R to neck
  3. Cluster>>head injury, alcohol, cigarette smoking, certain food, X radiation
  4. trigeminal neuralgia>> light touch to face, eating, cold wind, vibrations radiates to eyes, lips, nose and scalp
29
Q

secondary symptoms

  • Migraine
  • Tension
  • Cluster
  • trigeminal neuralgia
A
  1. Migraine>> +/- aura (mainly visual), mainly peripheral u see black dots or zig zaggy lines, N+V
  2. Tension>> mild nausea
  3. Cluster>> Red, watery eye, nasal congestion, sweating
  4. trigeminal neuralgia >> proceeding symptoms> tingling, numbness
30
Q

Treatment

  • Migraine
  • Tension
  • Cluster
  • trigeminal neuralgia
A
  1. Migraine >> triptans, can give nasally
  2. Tension >>
  3. Cluster >> high flow oxygen!
  4. trigeminal neuralgia
31
Q

Investigations?

A

Headache diary >> what where u doing when it happened?

Imaging- CT/ MRI

32
Q

Referral Criteria

A

Neuropsyciatry (21 decks)

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