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Stage 2: CMS > Headaches > Flashcards

Headaches Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

What are sinister causes of headache?

A
  • SAH/haematoma
  • Infection - men or en
  • Temporal arteritis/acute glaucoma (vision threatening)
  • Intracranial pressure (SOL, hydrocephalus)
  • Carotid dissection
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2
Q

What are non-sinister causes of headache?

A
  • Tension headache
  • Migraine
  • Cluster headaches
  • Trigeminal neuralgia
  • Sinusitis
  • Medication overuse headache
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3
Q

What are the features of a tension headache?

A
  • Generalised - usually frontal or occipital - bilateral
  • Gradual or acute onset
  • Feels like a tight band (non-pulsatile)
  • Lasts 3-4 hours
  • Moderate
  • ± scalp muscle tenderness
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4
Q

What can trigger a tension headache?

A
  • Stress
  • Exertion
  • Lack of sleep
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5
Q

What investigations do you do for a tension headache?

A

None

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6
Q

How do you treat tension headache?

A

Simple analgesics

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7
Q

What are the features of headache in migraine?

A
  • Unilateral
  • Pulsating/throbbing
  • Lasts 4-72h
  • Moderate to severe
  • Paroxysmal
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8
Q

What can make a migraine worse?

A
  • Physical activity
  • Stress
  • Straining
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9
Q

What are associated symptoms of migraine that are sometimes present?

A

Premonitory phase (aura)

  • Visual changes
  • Aphasia
  • Tingling or numbness
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10
Q

Which gender is more affected by migraines?

A

Female

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11
Q

What are possible triggers for migraines?

A
  • Cheese
  • OCP
  • Caffeine
  • Alcohol
  • Stress
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12
Q

What investigations do you do for migraine?

A

None - unless other differentials suspected e.g. meningitis/SAH

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13
Q

What is conservative migraine management?

A
  • Headache diary
  • Ask them to avoid precipitating factors
  • Rebreathing into paper bag
  • Acupuncture
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14
Q

What medication can you not give to people who have migraines esp. if with aura?

A

OCP (increased risk of stroke)

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15
Q

How do you treat migraines ACUTELY?

A
  • Sumatriptan
  • NSAID
  • Metoclopramide
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16
Q

How do you prevent migraines (prophylaxis)?

A
  • 1st line - propanolol or topiramate (teratogenic)

- 2nd line - amitriptyline

17
Q

What is there risk of when treating migraines?

A

Medication overuse headaches

18
Q

What are the features of cluster headaches?

A
  • Unilateral, behind the eye
  • Acute onset, same time each day (often nocturnal)
  • 15 min-3 hours
  • Severe - can be disabling
  • Clusters last 4-12 weeks then pain-free for months or 1-2 years
19
Q

What are some associated non-essential symptoms in cluster headaches?

A
  • Eyelid and forehead swelling
  • Nasal congestion
  • Horner’s syndrome
20
Q

What are risk factors for cluster headaches?

A
  • Male

- Smoking

21
Q

What investigations do you do for cluster headaches?

A

None - unless other differentials suspected e.g. meningitis/SAH

22
Q

How do you treat cluster headaches ACUTELY?

A
  • 100% O2 via non-rebreathe mask (not if COPD) for 15 min

- S/C sumatriptan

23
Q

How do you treat cluster headaches conservatively?

A

Avoid triggers e.g. alcohol

24
Q

How do you prevent cluster headaches (prophylaxis)?

A
  • Short term steroids
  • Verapamil
  • Lithium
25
Q

What are the features of trigeminal neuralgia?

A
  • Paroxysms of shooting, intense, stabbing pain lasting seconds
  • In the distribution of the trigeminal nerve
  • Unilateral - typically affects mandibular or maxillary branch
  • Face screws up with pain (tic douloureux)
26
Q

What are triggers of trigeminal neuralgia?

A
  • Washing affected area
  • Shaving
  • Eating
  • Talking
  • Dental prostheses
27
Q

What are risk factors for trigeminal neuralgia?

A
  • 60-80 years

- Multiple sclerosis + female + hypertension

28
Q

How do you treat trigeminal neuralgia?

A
  • Anticonvulsants - carbamazepine
  • Gabapentin
  • Surgery
29
Q

What investigations do you do for trigeminal neuralgia?

A

Usually none - can consider MRI

30
Q

What are the features of sinusitis?

A
  • 7-10 day history of fever and headache with nasal congestion or discharge
  • Diagnosed clinically
  • Supportive management - abx if suspect bacterial cause
31
Q

What are the features of medication overuse headache?

A
  • “Rebound” daily headaches, which can occur in individuals who normally suffer from episodic tension headaches or migraines
  • Use analgesia > 10 days in a month
  • Withdraw medication to treat - headaches will get worse at first

Stage 2: CMS (10 decks)

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