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P2 NEURO > Headaches > Flashcards

Headaches Flashcards

1
Q

What are the two types of headaches?

A

Primary (common, chronic/ recurrent)

Secondary (acute, from specific underlying cause)

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2
Q

What are the primary headaches? (3)

A
  • Migraine
  • Tension-type
  • Cluster
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3
Q

What are some secondary headaches? (4)

A
  • SAH
  • GCA
  • Meningitis
  • Medication overuse
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4
Q

What is the most common type of primary headache?

A

Tension-type headache

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5
Q

What is the least common type of primary headache?

A

Cluster headache

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6
Q

What are the clinical features of tension-type headaches? (3)

A
  • Bilateral
  • Tightening/ pressing, band-like
  • Not aggravated by routine physical activity
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7
Q

How long do tension-type headaches usually last?

A

From 30min - 1 week

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8
Q

What symptoms wouldn’t you see in tension-type headaches? (2)

A

No nausea + vomiting

Both photophobia + phonophobia

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9
Q

How would you treat tension-type headaches? (3)

A
  • Conservative: reassurance, stress relief, avoid causes
  • Acutely: NSAIDs or aspirin
  • Chronic pain: amitriptyline (tricyclic antidepressants)
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10
Q

What are the triggers of tension-type headaches? (7)

A 
MC SCOLD
Missed meals
Conflict
Stress
Clenched jaw
Overexertion
Lack of sleep
Depression
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11
Q

What are the clinical features of a migraine? (7)

A
  • Unilateral
  • Pulsating/ throbbing pain
  • Aggravated by movement
  • N&V
  • Photophobia
  • Phonophobia
  • Aura
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12
Q

How long do migraines usually last?

A

From 4 - 72 hours

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13
Q

How would you treat migraines conservatively?

A

Avoid triggers

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14
Q

How would you treat acute attacks (mild + severe) in a migraine?

A

Mild - NSAIDs +/- antiemetics

Severe - oral triptan (sumatriptan- SSRI)

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15
Q

What 1st line prophylaxis would you give for migraines?

A

Propranolol (beta-blocker) or topiramate (anti-convulsant)

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16
Q

What 2nd line prophylaxis would you give for migraines?

A

Acupuncture

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17
Q

What 3rd line prophylaxis would you give for migraines?

A

Amitriptyline (tricyclic antidepressant)

18
Q

What are the triggers for migraines? (9)

A 
CHOCOLATE
Chocolate
Hangovers
Orgasms
Cheese
OCP
Lie-ins
Alcohol
Tumult (loud noises)
Exercise
19
Q

What are the clinical features of cluster headaches? (4)

A
  • Unilateral
  • Excruciating, burning/ hot poker pain behind one eye
  • Occurs at same time every day
  • Nothing provides comfort (restlessness, agitation)
20
Q

What autonomic symptoms are cluster headaches associated with? (3)

A
  • Ipsilateral eye lacrimation & redness
  • Rhinorrhoea (runny nose)
  • Miosis and/ or ptosis
21
Q

How would you give acute relief to a pt with a cluster headache? (3)

A
  • 100% oxygen therapy
  • SC sumatriptan (SSRI)
  • IN zolmitriptan
22
Q

What prophylaxis would you give to a pt with cluster headaches? (4)

A
  • Verapamil (CCB)
  • Lithium
  • Corticosteroids
  • Valproic acid
23
Q

What are the triggers for cluster headaches?

A

Have been associated with cigarettes and alcohol

24
Q

What is trigeminal neuralgia?

A

Facial pain

25
Q

What is the cause of trigeminal neuralgia?

A

Pain disorder due to compression of trigeminal nerve eg by intracranial vessels

26
Q

What are the clinical features of trigeminal neuralgia?

A
  • Unilateral

- Electric shock/ lightning-like pain in V1/2/3

27
Q

What clinical feature wouldn’t you expect to see in a pt with trigeminal neuralgia?

A

Neurological deficit (neuro exam should be NORMAL)

28
Q

How long does the pain last in trigeminal neuralgia?

A

Lasts a few seconds

29
Q

What are the triggers for trigeminal neuralgia? (5)

A

Any irritating activity

  • Chewing
  • Brushing teeth
  • Smiling
  • Talking
  • Washing affected area
30
Q

What is the first-line treatment for trigeminal neuralgia?

A

Carbamazepine (anti-convulsant)

31
Q

What is the second-line treatment for trigeminal neuralgia? (2)

A

Phenytoin
Gabapentin
(analgesics targeted for neuropathic pain)

32
Q

What are the surgical interventions for trigeminal neuralgia? (2)

A
  • Microvascular decompression

- Stereotactic radiotherapy

33
Q

What type of headache is giant cell arteritis (GCA)?

A

Secondary headache

34
Q

What is the cause of GCA?

A

Inflammatory disorder of blood vessels

35
Q

What are the clinical features of GCA? (4)

A
  • Unilateral headache
  • Scalp tenderness
  • Jaw claudication (cramping pain)
  • Amaurosis fugax (loss of vision)
36
Q

What are the extracranial symptoms od GCA? (4)

A
  • Fever
  • Malaise
  • Weight loss
  • Depression
37
Q

What are the signs of GCA? (3)

A

Palpable, tender and reduced pulsation of the temporal arteries

38
Q

How would you investigate GCA? (2)

A
  • Temporal artery biopsy (gold standard

- Bloods: raised ESR + CRP

39
Q

How would you treat GCA? (3)

A
  • Prednisolone 60mg/d immediately
  • Low dose aspirin 75mg
  • PPI eg omeprazole
40
Q

What are the risk factors for GCA?

A

Age (almost never occurs before age 50)

41
Q

Pt < 55y presents with GCA-like symptoms. What diagnosis should you consider?

A

Takayasu’s arteritis

P2 NEURO (13 decks)

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