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Neurology > Headaches > Flashcards

Headaches Flashcards

1
Q

What is a primary headache ?

A

A headache that has no underlying medical cause

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2
Q

What are the 3 primary headaches ?

A
  • Tension type headache
  • Migraine
  • Cluster headache
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3
Q

What is a secondary headache ?

A

A headache that has an underlying medical cause

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4
Q

What would the patient complain about if they had a TTH ?

A
  • Bilateral headache
  • Tightening feeling
  • No other features
  • Can last 30 minutes - days
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5
Q

What is classed as infrequent episodic TTH ?

A

< 1 day per month

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6
Q

What is classed as frequent episodic TTH ?

A

1 - 14 days per month

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7
Q

What is classed as a chronic TTH ?

A

> 15 days per month

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8
Q

How do you treat a TTH ?

What is the preventative treatment ?

A
  • NSAID’s
  • Aspirin
  • Preventative treatment - Tricyclic Anti-depressants
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9
Q

How many phases does a migraine have ?

A

5

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10
Q

What are the phases of a migraine ?

A 
Premonitory 
Aura
Early headache 
Advanced headache 
Postdrome
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11
Q

What occurs in premonitory ?

A
  • Behavioural changes/irritable
  • Mood changes
  • Food cravings
  • Muscle pain
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12
Q

What happens in the Aura phase ?

A
  • Hearing or vision changes
  • Funny smells
  • Tingling
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13
Q

What occurs in the Early headache ?

A
  • Dull pain
  • Nasal congestion
  • Muscle pain.
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14
Q

What happens during the Advanced headache ?

A
  • Unilateral throbbing
  • Photophobia
  • Phonophobia
  • Nausea
  • Vomiting
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15
Q

What occurs during the Postdrome ?

A
  • Fatigue

- Muscle pain

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16
Q

What is the definition of a Chronic Migraine ?

A

Headaches > 15 days per month with > 8 of these being Migraines. Must have occurred for 3 consecutive months.

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17
Q

What is the treatment for migraines ?

What are the preventative treatments ?

A
  • NSAID’s
  • Aspirin
  • Triptans
    Preventative measures include Tricyclic-Antidepressants, Anti-epileptics and Propranolol.
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18
Q

What treatments can be given in pregnancy ?

A

Propanolol and Paracetamol

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19
Q

What are the features of a cluster headache ?

A
  • Orbital/temporal
  • Unilateral
  • Patients are agitated and restless
  • Comes on quickly and stops quickly
  • Usually lasts 1-2 hours
20
Q

Do cluster headaches show any patterns ?

A

They occur at the same time everyday

21
Q

What can be used to treat cluster headaches ?

A
  • 100% oxygen

- Sumatriptan

22
Q

What is a medication overuse headache ?

A

Headache that has started and occurs > 15 days per month since talking regular symtomatic medication.

23
Q

What causes a medication overuse headache ?

A
  • Simple analgesics > 15 days per month

- Combination analgesics/opioids > 10 days per month

24
Q

What is paroxysmal hemicrania ?

A
  • Orbital and temporal
  • Unilateral
  • Rapid onset and rapid cessation
  • Less than 30 minutes
  • No circadian rhythm
25
Q

What can be used to treat paroxysmal hemicrania ?

A
  • Indometacin
26
Q

What are the features of a SUNCT headache ?

A
  • Unilateral
  • Supraorbital/temporal
  • Stabbing/pulsatile
  • Usually only lasts minutes
  • Cutaneous triggers
  • No refractory period
27
Q

How do you treat SUNCT ?

A

Gabapentin or Topiramate

28
Q

List the features of Trigeminal Neuralgia

A
  • Maxillary or mandibular pain
  • Last seconds
  • Stabbing pain
  • Has a refractory period
  • Cutaneous triggers
29
Q

What is used to treat Trigeminal Neuralgia ?

A
  • Carbemezapine

- Decompressive surgery

30
Q

What are some of the red flag symptoms with headaches ?

A
  • First and worst headache
  • New symptoms
  • Changing symptoms
  • Visual changes
  • Comes on with changes to posture
  • Stiff neck/fever
31
Q

What is a thunderclap headache ?

A
  • Peaks in less than one minute

- No differentiating features

32
Q

What is a thunderclap headache usually mistaken for ?

A

SAH, meningitis or a stroke

33
Q

What surgical treatment is needed in a SAH if due to a berry aneurysm ?

A

Coiling or clipping

34
Q

How do you investigate a SAH ?

A

CT scan, CT angiography if SAH found and LP if nothing found on CT scan (within 12 hours).

35
Q

How do you maintain a patient who has had a SAH ?

A

Three HHH rule :

  • Control Hypertension (BP)
  • Hydrate
  • Give plasma if needed to maintain volume
36
Q

What complications can arise from an SAH ?

A
  • Hydrocephalus
  • Vasospasm
  • Seizures
37
Q

What medication is given for up to 3 weeks after to prevent Vasospasm ?

A

Nimodipine

38
Q

If headache comes on due to position changes or patient is having seizures, what would you suspect ?

A

Space occupying lesion

39
Q

What causes intracranial hypotension ?

A

CSF leak due to Iatrogenic/ spontaneous hole formation

40
Q

What makes hypotension worse ?

A

Standing up

41
Q

How would you investigate/treat intracranial hypotension ?

A

MRI of brain and spine

  • Epidural blood patch
  • Bed rest
  • Caffeine
  • Analgesia
42
Q

What is Giant Cell Arteritis ?

A

inflammation of the large arteries. Should consider this in any patient over 50.

43
Q

What do patients with Giant Cell Arteritis present with ?

A
  • Scalp tenderness
  • Jaw claudication
  • Visual disturbances
  • Prominent temporal veins
44
Q

What tests are done and what do they show ?

Giant Cell Arteritis

A

Blood tests and should do a biopsy

High ESR and CRP

45
Q

What is used to treat Giant Cell Arteritis ?

A

Prednisolone

Neurology (16 decks)

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