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Neuro > Headaches > Flashcards

Headaches Flashcards

Conditions

1
Q

What are the three types of primary headache?

A

Tension type
Migraine
Cluster headache

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2
Q

What are six possible causes of secondary headache?

A 
Tumour
Meningitis
Vascular disorders
Systemic infection
Head injury
Drug-induced
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3
Q

What are the typical characteristics of a tension type headache?

A

Bilateral pain, present all the time
NOT disabling
Often related to muscle tightness/stress
No significant associated symptoms

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4
Q

What is the treatment for tension type headaches?

A

Aspirin
NSAIDs
(Limit to 10 days per month)

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5
Q

Are there any prophylactic treatments for tension type headaches?

A 
Rarely required
Tricyclic antidepressants (amitriptyline, dothiepin, nortriptyline)
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6
Q

What are the typical characteristics of a migraine?

A

Most disabling primary headache
Episodic attacks
Can be preceded by sensory aura
Can be induced by triggers

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7
Q

What might someone experience in migraine attack?

A

Nausea
Vomiting
Photophobia
Phonophobia

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8
Q

What kind of things can trigger migraines?

A 
Stress
Hunger
Sleep disturbance
Dehydration
Diet
Changes in oestrogen in women
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9
Q

What abortive treatments are available to treat migraine?

A

Aspirin
NSAIDs
Triptans
(Limit to 10 days per month)

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10
Q

What prophylactic treatments are available to treat migraine?

A

Propranolol, Candesartan
Anti-epileptics: Topiramate, Valproate, Gabapentin
Tricyclic antidepressants: amitriptyline, dothiepin, nortriptyline
Venlafaxine

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11
Q

What are SUNCT headaches?

A

Short-lasting Unilateral Neuralgiform headache with Conjunctival injection and Tearing

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12
Q

What are the typical characteristics of SUNCT?

A

Unilateral
Orbital, supraorbital or temporal pain
Pain is paired with conjunctival injection (red eye) and lacrimation (tears)

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13
Q

How long do SUNCT attacks last?

A

10-240 seconds

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14
Q

How often to SUNCT attacks occur?

A

3-200 times per day with no refractory period

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15
Q

What abortive treatments are available to treat SUNCT?

A

None

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16
Q

What prophylactic treatments are available to treat SUNCT?

A

Lamotrigine
Topiramate
Gabapentin
Carbamazepine/Oxcarbazepine

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17
Q

What are the typical characteristics of paroxysmal hemicrania?

A 
Unilateral
Mainly temporal and orbital pain
Rapid onset and rapid cessation
Excruciatingly severe
Prominent ipsilateral autonomic symptoms
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18
Q

How long do paroxysmal hemicrania attacks last?

A

15 minutes to 3 hours

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19
Q

How often do paroxysmal hemicrania attacks occur?

A

2-40 attacks per day

20
Q

What is the difference between chronic and episodic paroxysmal hemicrania?

A

Episodic: periods of remission of a month or longer between episodes
Chronic: attacks for over one year with no remission, or remission less than one month

21
Q

What abortive treatments are available to treat paroxysmal hemicrania?

A

None

22
Q

What prophylactic treatments are available to treat paroxysmal hemicrania?

A

Attacks can be prevented completely with indomethacin

23
Q

What are the typical characteristics of cluster headaches?

A 
Strictly unilateral
Rapid onset and cessation
Excruciatingly severe
Restless and agitated
Prominent ipsilateral autonomic symptoms 
Circadian rhythmicity to attacks
24
Q

How long do cluster attacks last?

A

15 minutes to 3 hours

25
Q

How often do cluster attacks occur?

A

1 every other day to 8 per day

Attacks occur at the same time each day and bouts occur at the same time every year

26
Q

What abortive treatments are available to treat cluster headaches?

A

Subcutaneous sumatriptan
Nasal zolmitriptan
100% oxygen

27
Q

What prophylactic treatments are available to treat cluster headaches?

A

Verapamil
Lithium
Topiramate
Methysergide

28
Q

What are the four types of trigeminal autonomic cephalalgias?

A

Cluster headache
Paroxysmal hemicrania
SUNCT
SUNA

29
Q

What classifies a medication overuse headache?

A

Present 15 or more days a month

Developed or worsened while taking medication

30
Q

What are the typical characteristics of trigeminal neuralgia?

A

Unilateral maxillary or mandibular division pain (can be ophthalmic)
Stabbing pain
Autonomic features are uncommon

31
Q

How long does trigeminal neuralgia pain last for?

A

5-10 second bursts

32
Q

How frequent are attacks of trigeminal neuralgia?

A

3-200 times a day with a refractory period

33
Q

What abortive treatments are there for trigeminal neuralgia?

A

None

34
Q

What prophylactic treatments are there for trigeminal neuralgia?

A

Carbamazepine
Oxcarbazepine

Or surgery: glycerol ganglion injection, stereotactic radiosurgery, decompressive surgery

35
Q

What classifies a thunderclap headache?

A

High intensity headache reaching maximum intensity in less than 1 minute, majority peak instantaneously

36
Q

What are the differential diagnoses for thunderclap headaches?

A 
1 in 10 = Subarachnoid haemorrhage
Intracerebral haemorrhage
TIA/stroke
Carotid/vertebral dissection
Cerebral venous sinus thrombosis
Meningitis/encephalitis
Pituitary apoplexy
Spontaneous intracranial hypotension
37
Q

What investigations can be carried out in suspected subarachnoid haemorrhage?

A

CT brain scan

Lumbar puncture, test for Xanthochromia

38
Q

CNS infection should be considered in any patient presenting with….?

A

Headache and fever

39
Q

What symptoms other than headache and fever could suggest meningism?

A

Nausea +/- vomiting
Photo/phonophobia
Stiff neck
Rash

40
Q

What symptoms other than headache and fever could suggest encephalitis?

A

Altered mental state or confusion
Focal symptoms/signs
Seizures

41
Q

Give six possible causes of raised intracranial pressure

A 
Glioblastoma multiforme
Cerebral abscess
Venous infarct with focal area of haemorrhage
Meningioma
Hydrocephalus
Papilloedema
42
Q

What symptoms are indicative of raised intracranial pressure?

A

Progressive headache with associated symptoms and signs

43
Q

What signs and symptoms are warning features to look out for in suspected raised intracranial pressure?

A

Headache worse in the morning or wakes patient from sleep
Headache worse lying flat or brought on by Valsalva
Focal symptoms/signs
Non-focal symptoms e.g. cognitive or personality change
Drowsiness
Seizures
Visual obscuration and pulsatile tinnitus

44
Q

What is giant cell arteritis?

A

Arteritis of the large arteries. Should be considered in any patient over the age of 50 presenting with new headache

45
Q

What symptoms are characteristic of giant cell arteritis?

A

Diffuse, persistent headache
May be systemically unwell
Scalp tenderness, jaw claudication and visual disturbance
Prominent beaded or enlarged temporal arteries

46
Q

What clinical findings support a diagnosis of giant cell arteritis?

A

Elevated ESR

Raised CRP and platelet count

47
Q

What can be used to treat giant cell arteritis?

A

High dose of prednisolone and a temporal artery biopsy should be taken

Neuro (4 decks)

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