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PAN- Neurology > Headaches > Flashcards

Headaches Flashcards

1
Q

How might patients describe a tension headache?

A

Tight band across the head
Head being in a vice
No GI or visual symptoms associated with the headache
May have coexisting anxiety or depression

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2
Q

What conditions may often coexist with tension type headaches?

A

Anxiety and depression

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3
Q

What might be used to treat tension type headaches?

A

Detox from caffeine, NSAIDs
Reassure the patient that there is not serious pathology
TCAs such as amitriptyline may be used

MRI not indicated but maybe done for reassurance

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4
Q

What is the most common type of headache?

A

Tension type

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5
Q

What are the features of a migraine headache?

A

Episodic headaches that typically last for several hours
Patients will want to go and lie down in a dark quiet room
Unilateral (but may move to a different side of the head)
Preceding aura
Pain felt behind the eye
Associated nausea, vomiting, photophobia and phonophobia
Sleep helps to relieve the headache

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6
Q

What are the features of a migraine headache?

A

Unilateral (but may shift sides)
Pain felt behind the eye
Associated nausea, vomiting, photophobia and phonophobia
Typically lasts several hours to a couple of days

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7
Q

What do patients often say they want to do when they have a migraine headache?

A

Lie down and go to sleep
(This would make headache much worse if due to raised ICP)

Migraine headaches are associated with photophobia, photophobia and nausea and vomiting. Pain is unilateral and often felt behind the eye.

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8
Q

Who is migraine more common in?

A

Young people

Women

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9
Q

What is the management for migraine?

A

Avoid trigger if known but there often isn’t one
Treat acute attacks with aspirin (high dose 900mg) and paracetamol
Antiemetics (some agents combined simple analgesia with antiemetic)
Triptans (5-HT agonists) commonly used- SC, Nasal Spray or PO.

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10
Q

What preventative options are there for the management of migraine?

A 
Propranolol
Amitriptyline
Topiramate 
Pizotifen- 5HT 2 Agonist
SSRI/SNRI
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11
Q

What causes a medication overuse headache?

A

Taking analgesia (especially containing codeine) almost on a daily basis. May have been done to manage migraine or tension headaches.

Headache is transiently relieved by analgesic.

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12
Q

How should medication overuse headaches be managed?

A

Try to reduce use of medication

Headache prevention- Amitriptyline

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13
Q

What is a cluster headache?

A

This is the most common type of trigeminal autonomic cephalalgia

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14
Q

Describe the features of a cluster headache

A

Headaches come in clusters- e.g. 1-2 per day for 4-8 weeks happening once or twice a year
Strictly side locked
Severe headache that lasts from 30 minutes to an hour to 2 hours
Often at night- tend to occur at the same time during the cluster
Associated autonomic activation- watering of the eye, redness of the eye, nasal blockage, Horner’s

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15
Q

What is interesting about the timings of cluster headaches?

A

They tend to occur at the same time during clusters
Typically at nightime

Clusters are headaches happen for around 4-8 weeks with one to two a day and this happens 1-2 times per year

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16
Q

Describe the pain felt in cluster headaches?

A

Strictly side locked
Severe pain
Behind the eye

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17
Q

What autonomic features might be seen in cluster headaches?

A

Watering of the eye
Redness of the eye
Constriction of the pupil
Nasal discharge/blockage

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18
Q

What is the management for cluster headaches?

A

Rescue treatment- Fact acting triptan e.g. sumatriptan, zolmitriptan and high flow oxygen
Break the cluster- Oral Prednisolone, topiramate, verapamil, pizotifen

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19
Q

What should verapamil never be combined with?

A

Beta blockers

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20
Q

How do triptans work?

A

5HT1 agonist- used for headache relief if severe

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21
Q

Describe the headaches felt in trigeminal neuralgia?

A

Hypersensitivity in the trigeminal distribution with electric shock sensations on touching the face
Shaving, washing and brushing teeth very painful

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22
Q

What branch of the trigeminal nerve is most often affected in trigeminal neuralgia?

A

Maxillary or mandibular

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23
Q

What is the treatment for trigeminal neuralgia?

A

Carbamazepine is 1st line
Phenytoin, lamotrigine and gabapentin are also used.
Surgical treatments- glycerol injections and microvascular decompression

24
Q

What two things may be a cause of trigeminal neuralgia?

A

Irritation by a blood vessel

Multiple sclerosis in younger patients

25
Q

What is a post-traumatic headache?

A

Headache experienced following head injury

26
Q

How soon after a head injury does a post traumatic headache happen?

A

Around 2 weeks

27
Q

What symptoms are experienced in concussion?

A

Confusion
Poor memory
Lack of concentration
Dizziness

28
Q

What is used as a treatment for post traumatic headache?

A

Amitriptyline

29
Q

What are the presenting features of giant cell arteritis?

A

Scalp tenderness
Pain on brushing hair
Jaw claudication
Loss of vision due to anterior ischaemic optic neuropathy
Large, boggy, tender, non-pulsatile temporal artery

30
Q

What is the investigation for GCA?

A

Temporal artery biopsy

Also ESR is typically raised

Treat with high dose prednisolone before biopsy to reduce risk of loss of vision

31
Q

What kind of patient typically has idiopathic intracranial hypertension?

A

Obese young women

32
Q

What features are seen with headaches due to raised ICP?

A 
Worse with coughing, straining
Papilloedema
Reduced peripheral vision
Nausea and vomiting
Morning headache or waking from sleep due to headache

Other red flags include:
Focal neurological signs
Visual disturbance
Papilloedema

33
Q

What should be done for all patients with papilloedema?

A

Brain MRI to rule out intracranial mass
CSF pressure measuring
MRV or CTV- Exclude central venous sinus thrombosis

34
Q

What is the management for idiopathic intracranial hypertension?

A

Weight loss
Monitoring of visual fields
Diuretics such as acetazolamide
Deteriorating vision is an indication for surgery to reduce intracranial pressure

35
Q

What do NICE recommend is the acute management for migraine?

A

Acute- Oral triptan NSAID/ Paracetamol (Nasal in young if issues with oral)
+ Antiemetic metoclopramide, prochlorperazine

36
Q

What do NICE recommend for prophylaxis of migraines?

A

1st- Topiramate (anti-epileptic) or Propranolol

2nd Acupuncture or Gabapentin (anti-epileptic)

Advise that riboflavin may help

37
Q

What should be used for prophylaxis of migraines in women of childbearing age?

A

Propranolol as topiramate may be teratogenic and reduces the effectiveness of the OCP

38
Q

When should prophylaxis be offered for migraines?

A

2 or more attacks per month

39
Q

What might be done for women with menstruation related headache?

A

Triptains as a preventative treatment

40
Q

What is a helpful mnemonic for remembering some red flags for headaches?

A

SNOOP

Systemic features
Neurological Signs
Onset sudden
Other associated features
Pattern- is it getting worse, staying constant, changes with posture and coughing?
41
Q

What should you immediately think about if someone describes the worst headache of their life that has come on very suddenly?

A

Subarachnoid haemorrhage

42
Q

What symptoms might a carotid or vertebral artery dissection cause?

A

Sudden onset headache after trauma
Radiates down one side of the neck
Horner syndrome
Pulsatile tinnitus

May lead to stroke

43
Q

What symptoms should raise concern of meningitis?

A 
Acute headache
Photophobia
Neck Stiffness
Fever
Altered mental status
44
Q

what symptoms could a cerebral abscess cause?

A

Headache
Focal neurological signs
Signs of raised ICP- papilledema, nausea, vomiting, worse on lying down and coughing

45
Q

What are the features of acute angle closure glaucoma?

A

Acute onset very painful red eye
Unilateral headache
More commonly occurs at night and in long sighted/hypermetropia

46
Q

What features might indicate a brain tumour?

A 
Focal neurological signs
Seizures
Papilledema
Heachache with N+V, worse at night when lying down and with coughing/straining
Headache worsened since initial onset
47
Q

What is the most common type of pituitary tumour?

A

Prolactinoma- therefore develop bitemporal hemianopia as about galactorrhoea or gynaecomastia, decreased libido, erectile dysfunction

48
Q

What procedure can be done if the vision is becoming threatened in idiopathic intracranial hypertension?

A

Optic nerve sheath fenestrations

49
Q

What features might you see with sinusitis if suspecting this could be a cause of headache?

A

Headache
Tenderness over the affected sinuses
Worse on leaning forward

50
Q

How can you divide the causes of headache?

A

Primary- Tension type, Migraine, Cluster

Secondary- Tumour, GCA, Carotid dissection, IIHT, Sinusitis, AACG

51
Q

What might be described in a migraine aura?

A 
Seeing bright lights
Seeing zig zag lines
Hallucinations
Tinnitus
Aphasia
Confusion

Less commonly temporary paralysis of 1 side of the body- hemiplegic migraine

52
Q

When are triptans contraindicated?

A

Coronary artery disease
Cerebrovascular disease
Pregnancy

Triptans are used for the acute management of migraine

53
Q

What drug is contraindicated in women with migraine with aura?

A

Oestrogen Contraceptive Pill

-Increased risk of stroke in this population

54
Q

What is the management of an acute cluster headache?

A

High flow oxygen
Triptans
High dose NSAIDs

55
Q

What is used in the prophylaxis of cluster headaches?

A

Verapamil first
Steroids
Topiramate

56
Q

What is the first line treatment for trigeminal neuralgia?

A

Carbamazepine,

Others- Phenytoin, Gabapentin, Baclofen

Surgical treatments to manage the irritant vessel or glycerol injections too.

PAN- Neurology (10 decks)

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