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Neurology > Headaches > Flashcards

Headaches Flashcards

1
Q

What are the 4 different onsets of headaches?

A

Acute, recurrent acute, subacute, chronic

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2
Q

What are some differentials of acute onset headaches?

A

meningitis, subarachnoid haemorrhage, encephalitis, acute glaucoma, sinusitis, head injury, gtn spray

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3
Q

What are some differentials of recurrent acute?

A

Migraine, cluster headache, coital headache, tension headache, medication-induced headache

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4
Q

What is a type of subacute headache?

A

Giant cell ateritis

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5
Q

What are some differentials of chronic headaches?

A

raised ICP due to hydrocephalus, space occupying lesion or benign raised intracranial pressure

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6
Q

What are the common triggers of Migraines

A 
Chocolate
Hormones
Oral contraceptive
Caffeine 
Obesity
Lights
Alcohol
Travel
Exercise
Others - cheese, pregnancy, common around puberty, menstruation, menopause
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7
Q

What are the aura features of a migraine with aura?

A

Aura fully reversible
Visual, sensory, motor or language symptom (aura)
Aura duration 20-60mins
Headache follows <1hour

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8
Q

What are the general symptoms of a migraine?

A 
throbbing sensation
photophobia
unilateral 
pain begins locally then spreads
vomiting
sensitivity to pain and stimuli
no neurological signs
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9
Q

What are the symptoms of a basilar migraine?

A

tongue tingling, vertigo, diplopia, visual disturbance, dysarthria, ataxia

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10
Q

What is the feature of a facioplegic migraine?

A

Unilateral face weakness

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11
Q

What are the other less common types of migraines?

A

Acephalgic, retinal, opthalmic, hemiplegic, abdominal

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12
Q

What is the diagnostic criteria of a migraine with aura?

A

headaches lasting 4/72 hours with aura

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13
Q

What are the diagnostic criteria of a migraine without aura?

A

at least 5 attacks
duration 4-72 hours
2 of: moderate/severe, unilateral, throbbing pain, worse movement
1 of: autonomic features, photophobia/phonophobia

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14
Q

What investigations could you consider in those presenting with migraine symptoms?

A

ESR
LP
CSF culture
CT head

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15
Q

What is the non-pharmacological management of migraines?

A 
set realistic goals
education
headache diary
relaxation/stress management
diet, hydration, regular exercise
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16
Q

What is the acute pharmacological of migraines?

A

offer combination therapy with a oral triptan (sumatriptain) and an NSAID (aspirin), or an oral triptan AND paracetamol

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17
Q

What is the prophylactic management of migraines?

A

1st line - topiramate or propranolol

Others - amitriptyline

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18
Q

What is the underlying pathophysiology of tension headaches?

A

increased tension in scalp muscles and neurovascular irritation, raised cortisol levels?

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19
Q

triggers of tension heads

A

stress, noise, concentrated visual effort, funes

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20
Q

clinical symptoms of tension headaches

A

bilateral, tight band sensation, radiate to neck, pressure behind the eyes, throbbing sensation, not sensitive to head movement, no nausea, absense of photo/phonophobia

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21
Q

management of tension headaches

A

reassurance, avoiding triggers, stress relief, massage, analgesia

22
Q

What are the ipsilateral cranial autonomic features?

A 
Ptosis
miosis
nasal stuffiness
nausea/vomiting
tearing
chemosis
23
Q

What are the 4 TAC headaches?

A

cluster
paroxysmal hemicrania
hemicrania continua
SUNCT

24
Q

What investigations should be done on those with TACSs?

A

MRI and MR angiogram

25
Q

pathophysiology of TACs

A

increased CGRP
increased VIP
simultaneous activation of trigeminal nerve and parasympathetic components of facial nerve
hypothalamus and endogenous clock

26
Q

Cluster headaches affect which group?

A

young (20-55)

Men>Women

27
Q

duration of cluster headaches

A

20mins - 3 hours

28
Q

frequency of cluster headaches

A

1 to 8

29
Q

acute management of cluster headaches

A

sumatriptan

high flow oxygen

30
Q

prophylactic management of cluster headaches

A

verapamil

steroids?

31
Q

paroxysmal hemicrania affects which group?

A

elderly

women

32
Q

duration of paraoxysmal hemicrania headaches?

A

2-45 minutes

33
Q

frequency of paraoxysmal hemicrania headaches?

A

1 to 40 a day

34
Q

management of paraoxysmal hemicrania?

A

Indomethicin

35
Q

Differences between paraoxysmal hemicrania and cluster headaches?

A

shorter duration, more frequent, affects elderly women (not younger men)

36
Q

what does SUNCT stand for?

A

short lived (15-120 secs, frequency 3-200 per day)
unilateral (temporal, retro-orbital, supraorbital)
neuralgiaform headache (sawtooth)
conjunctival injections
tearing

37
Q

management of SUNCT

A

lamotrigine, gabapentin

38
Q

trigeminal neuralgia effects which group?

A

elderly (>60)

women>men

39
Q

which divisions of the trigeminal nerve most commonly affected?

A

maxillary and mandibular

40
Q

underlying pathophysiology of trigeminal neuralgia

A

microanatomical small and large fibre damage in the nerve, essentially at its root entry zone, leads to ephaptic transmission, in which action potentials jump form one fibre to another
lack of inhibitory inputs
re-entry mechansim

41
Q

What are the risk factors of trigeminal neuralgia

A

increased age
MS
female
hypertension

42
Q

causes of trigeminal neuralgia

A 
focal compression by aberrant vascular loop (superior cerebellar artery)
demyelinating disease (demyelinating plaque)
43
Q

What are common triggers of trigeminal neuralgia?

A

touch, cold wind, shaving, brushing teeth, talking, eating and drinking

44
Q

clinical features of trigeminal neuralgia

A

severe unilateral pain (electric shock like)
duration: 1 to 90 secs (sometimes longer)
Frequency: 10 to 100 a day
Bouts can lasts months before remission
no weakness

45
Q

What are the different classifications of trigeminal neuralgia?

A

IDIOPATHIC TRIGEMINAL NEURALGIA TYPE I (TNI) ‘CLASSIC TRIGEMINAL NEURALGIA’ (CTN)
IDIOPATHIC TRIGEMINAL NEURALGIA TYPE II (TNII) ‘ATYPICAL TN’
TRIGEMINAL NEUROPATHIC PAIN
TRIGEMINAL DEAFFERENTATION PAIN ‘ANAESTHESIA DOLOROSA
SYMPTOMATIC TN
POST-HERPETIC TN
ATYPICAL FACE PAIN

46
Q

management of trigmenial neuralgia

A

Pain - carbamazepine (then gabapentin + amitriptyline)

Microvascular decompression, ablation

47
Q

Definition of medication overuse headaches

A

headache lasting 15 days, which started or got worse while patient was on regular medication use and improves within 2 months of discontinuing overused medications

48
Q

Features of primary cough headaches

A

occurs on coughing
sharp bilateral pain lasting short duration
most have underlying cause (chiari, anuerysm)

49
Q

features of primary exertion headache

A

occurs with exercise

pulsating headache, bilateral

50
Q

features of primary sexual headache

A

early coital cephalgia - dull, aching pain in occipital region that increases in severity as sexual excitement increases
Late coital cephalgia - severe and maximal during an organism

51
Q

features of carotid dissection

A

can be spontaneous or due to extreme hyper extension of neck, presents in head/neck with pain, symptoms of ischaemia distal to dissection with horners syndrom

52
Q

features of giant cell arteritis

A

scalp tenderness, jaw claudication

Neurology (18 decks)

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