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Neurology > Headaches > Flashcards

Headaches Flashcards

1
Q

What parts of the symptoms graph are important to include in the history?

A
  1. onset
  2. peak
  3. relieving factors
  4. exacerbating factors
  5. associated features
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2
Q

What are the headache red flags?

A
  • new onset headache in >55 years old
  • known/previous malignancy
  • immunosuppressed
  • early morning headache
  • exacerbation by valsalva - coughing, sneezing
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3
Q

How often do migraines usually occur?

A

One attack a month

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4
Q

What is the criteria for headache diagnosis without an aura?

A

At least 5 attacks lasting 4-72 hours
2 of moderate severity, unilateral throbbing, worse on movement
1 with associated autonomic features - phonophobia/photophobia

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5
Q

Describe the pathophysiology of a migraine

A

Vascular and neural influences as a result of stress triggers leads to serotonin release - blood vessels constrict and dilate - chemicals including substance P irritate nerves and blood vessels causing pain

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6
Q

What is the migraine generating centre?

A

Dorsal raphe nucleus and locus coeruleus

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7
Q

What causes a migraine with an aura?

A

Triggers will cause activation of the trigeminal vascular system causing dilatation of cranial blood vessels, cortical spreading of depolarisation and ultimately release of substance P, neurokinin A and CGRP

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8
Q

How long do visual auras last?

A

20-60 minutes with a headache less than an hour after - can be simultaneous

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9
Q

What is the most common visual symptom?

A

Monochromatic

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10
Q

Name the triggers of migraines

A
  • sleep deprivation
  • dietary
  • stress
  • hormonal
  • physical exertion
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11
Q

What is the acute treatment for a migraine?

A

Analgesia - aspirin, naproxen, ibuprofen
+/- antiemetic if gastroporesis
Triptans

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12
Q

What are triptans?

A

5HT agonists that should be taken at the start of a headache

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13
Q

Name two triptans used?

A

Rizatriptan

Frovatriptan - for sustained relief

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14
Q

When should prophylaxis be given in migraines?

A

More than 3 attacks a month or very severe attacks - trial for 10-12 weeks aim to titrate drug as tolerated to achieve efficacy at lower dose

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15
Q

Name three drugs that can be used as prophylaxis for migraines

A
  • Amitriptyline
  • Propranolol
  • Topiramate
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16
Q

State the five types of ‘fancy’ migraine

A 
Acephalgic - aura without a headache 
Basilar - vertigo 
Retinal/ophthalmic 
Hemiplegic - encephalopathic, weakness
Abdominal - usually in kids +/- headache
17
Q

Describe a tension type headache

A

Episodice, chronic pressing tingling, tends to be mild to moderate bilateral with no associated features

18
Q

How is a tension headache treated?

A

Identify cause/triggers and relaxation physiotherapy

Amytriptyline/dothiepin can be used for three months

19
Q

What is a trigeminal autonomic Cephalgia? Name the three types

A

Primary headache complexes affecting the trigeminal nerve

  • cluster headache
  • paroxysmal hemicrania/continua
  • SUNCT
20
Q

What are the signs of trigeminal autonomic cephalgia?

A

Ptosis, miosis, nasal stuffiness, nausea/vomiting, tearing, eye lid oedema

21
Q

What is a cluster headache?

A

Often in young men, circadian rhythm with seasonal variation - severe unilateral headache lasting 20mins -3hours and 1-8 per day. Clusters can last weeks to months

22
Q

How are cluster headaches treated?

A

High flow oxygen at home
Sub-cutaneous sumatriptan (reduces severity)
Steroids for 2 weeks
Verampamil prophylaxis

23
Q

Describe paroxysmal hemicrania/continua

A

More common in elderly females - severe unilateral headache with unilateral autonomic features - lasts 2 mins to 45 hours and can have up to 40 attacks a day

24
Q

What does paroxysmal hemicrania respond to?

A

Inclomethicin

25
Q

What does SUNCT stand for?

A 
Short lived 
Unilateral 
Neuralgiaform headache 
Conjunctival injections
Tearing
26
Q

How can SUNCT be treated?

A

Lamotrigine or gabapentin

27
Q

What investigation is given in all trigeminal cephalgias?

A

MRI including angiogram to check for aneurysm

28
Q

How does idiopathic intracranial hypertension present?

A

Bilateral papilloedema, diurnal variable headache with nausea and vomiting in the morning. Visual loss when standing up often in overweight females.

29
Q

What will an MRI of idiopathic intracranial hypertension show?

A

Empty sella and flattened optic disc

30
Q

What will CSF in idiopathic intracranial hypertension show?

A

Elevated pressure but normal constituents

31
Q

How is idiopathic intracranial hypertension treated?

A

Weight loss, acetazolamide

If persistent visual loss ventricular atrial/lumbar peritoneal shunt may be done

32
Q

Describe trigeminal neuralgia

A

Elderly women, severe sharp stabbing many times a day often aggregated by touch. 10-100 a day lasting 1-90 seconds can last weeks/months before remission

33
Q

What is the most common cause of trigeminal neuraliga?

A

Aberrant blood vessel irritating the nerve

34
Q

How is trigeminal neuralgia treated?

A

Anticonvulsant - carbamazepine, gabapentin, phenytoin, baclofen
Ablation or compression if very severe

Neurology (29 decks)

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