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Neurological System > Headaches > Flashcards

Headaches Flashcards

1
Q

define migraines

A

a common primary headache disorder that is characterised by attacks of moderate/severe headaches with associated photophobia, phonophobia, nausea + vomiting

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2
Q

classifications of migraines

A

episodic or chronic, depending on attack frequency

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3
Q

causes of migraines

A

exacts are unknown but precipitated by disturbed sleep, irregular meal patterns, excessive caffeine intake

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4
Q

risk factors of migraines

A

high frequency of episodic migraines
obesity
excessive caffeine intake
overuse of acute migraine medication

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5
Q

clinical features of migraine without aura

A

headache lasting 4-72hrs with at least 2 of

  • unilateral location
  • pulsating quality
  • moderate/severe pain
  • aggravated by/avoidance of routine daily activities
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6
Q

associated symptoms of migraine (without aura)

A

nausea and/or vomiting
phonophobia
photophobia

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7
Q

clinical features of migraine with aura

A

typical migraine presentation WITH typical fully reversible aura 60mins prior to headache that can involve:

  • zigzag lines/scotoma
  • unilateral pins + needles or numbness
  • dysarthria
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8
Q

symptoms of atypical auras

A 
motor weakness
double vision 
unilateral visual symptoms
poor balance 
decreased consciousness
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9
Q

differentials of migraines

A

tension-type headache
trigeminal autonomic cephalgias
sinusitis

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10
Q

investigations for migraines

A

assess BP, HR, RR, temperature and O2 sats
assess extracranial structures (e.g. TMJ, sinuses and temporal arteries)
carry out fundoscopy

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11
Q

conservative management of migraines

A

recommend keeping diary to track triggers and monitor treatment effectiveness
treat any co-morbidities
restrict acute medication use to max 2 days per week
ensure women not using combined contraception
acupuncture

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12
Q

acute medical management of migraines

A

oral or intranasal sumatriptan with analgesia (e.g. paracetamol or NSAID)

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13
Q

when are anti-emetics used in migraines?

A

used if patient experiences vomiting during attacks OR if >2 triptans used and failed

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14
Q

when is prophylaxis treatment considered in migraine patients?

A

if attacks significantly impact QoL and daily function
acute treatments contraindicated or failed
patient at risk of MOH

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15
Q

what medications are utilised in prophylactic treatment of migraines?

A

propanolol
topiramate
amitriptyline

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16
Q

what are contraindications of prophylactic treatment in migraines

A

propanolol not used if patient has asthma

topiramate not used in pregnant women

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17
Q

common complications of migraines

A

reduced QoL
medical overuse headaches (MOH)
status migrainosus
increased risk of ischaemic stroke and mood disorders

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18
Q

medications used in women with menstrual-related migraines that does not respond to usual treatment

A

frovatripan

zolmitriptan

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19
Q

define hemiplegic migraine

A

sudden onset migraines that present with typical migraine symptoms plus hemiplegia, ataxia and changes in consciousness

  • mimic stroke so require fast action to exclude stroke
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20
Q

define tension-type headaches (TTH)

A

a common primary headache disorder that causes generalised headaches

  • described as pressure/tight band around head that spreads/arises from neck
21
Q

classification of TTH

A

episodic and chronic

  • episodic infrequent - <1 per month
  • episodic frequent - <10 for 1-14 days over month for >3mnths
  • chronic - >15 days affected per month for 3 mnths
22
Q

risk factors of TTH

A 
female sex
middle age
stress and anxiety
dehydration
brightly lit/noisy environments
large amount of screen time
23
Q

clinical features of TTH

A

bilateral and generalised pain described as tight/pressure band around head and neck
no aggravation of pain
no nausea
EITHER photophobia or phonophobia
pericranial tenderness on manual palpation

24
Q

requirements for further investigation in TTH

A

headache develop progressive nature

develop/have associated symptoms (e.g. nausea + vomiting, neck stiffness or neurological changes)

25
Q

differentials of TTH

A 
migraine
MOH
temporal arteritis 
trigeminal autonomic cephalgias 
idiopathic cranial hypertension
26
Q

management of episodic TTH

A

offer simple analgesia and advise to take dose ASAP after

identify co-morbidities that may be associated and manage those

27
Q

management of chronic TTH

A

offer course of <10 acupuncture sessions for 5-8 weeks

provide low-dose amitriptyline as prophylaxis

28
Q

common complications of TTH

A

overuse of NSAIDs can lead to peptic ulcer disease

overuse of analgesics may cause MOH

29
Q

definition of cluster headaches

A

a rare and severe primary headache disorder characterised by unilateral periorbital pain attacks with ipsilateral autonomic symptoms for <3hrs

30
Q

characteristics of cluster headaches

A

attacks occur in series followed by remission periods and are either

  • episodic - attacks occur in periods of 7 days-year followed but 1 month remission
  • chronic - attacks occur over 1 year with no remission or remission <1mnth
31
Q

risk factors of cluster headaches

A 
male sex
age 20-50
smoking 
alcohol use
familial history of CH
32
Q

suggested causes of cluster headaches

A

aetiology is unknown but linked to
HCRTR2 gene inheritance
low melatonin levels
hypothalamic dysfunction and vascular changes

33
Q

clinical features of cluster headaches

A

unilateral peri-orbital pain

  • lasts 15-180 mins
  • sharp and pulsating in nature

ipsilateral autonomic symptoms
- nasal congestion, eyelid oedema, ptosis/miosis an and conjunctival lacrimation

restlessness/agitation

34
Q

differentials of cluster headaches

A 
migraine 
idiopathic intracranial hypertension
head/neck trauma
neoplasms
raised ICP
35
Q

investigations of cluster headaches

A

based on history and neurological examination

36
Q

requirements of cluster headache diagnosis

A

> 5 attacks of characteristic symptoms WITH headaches

occurrence of attacks every other day or 8 per day

37
Q

requirements for further investigations in cluster headaches

A 
change in headache pattern
new headache in >50s
onset of seizures 
associated symptoms of raised ICP
acute onset of 'worst headache ever'
38
Q

conservative management of cluster headaches

A

advise avoiding triggers
advise risk of MOH
identify and manage co-morbidities
provide oral and written info on CH and support groups

39
Q

medical management of cluster headaches

A

offer subcutaneous or nasal triptans (e.g. sumatriptan)

offer short-burst O2 therapy

40
Q

describe short-burst O2 therapy

A

patients provided with 100% oxygen at flow rate of 12-15L per min via a non-rebreather face mask for 15-20 mins

41
Q

prophylactic medical management of cluster headaches

A

offer patients verapamil, sodium valproate or prednisolone

42
Q

common complications of cluster headaches

A

reduced QoL
mood disorders
serious underlying 2ndary cause

43
Q

define trigeminal neuralgia

A

a chronic pain condition characterised by severe shooting or stabbing pain in the distribution of one or more division of CN V

44
Q

risk factors of trigeminal neuralgia

A 
MS
advanced age (>50yrs) 
female sex
FH of trigeminal neuralgia 
PMH of hypertension and stroke
45
Q

triggers of trigeminal neuralgia

A

light touch
eating
wind blowing on persons face

46
Q

clinical features of trigeminal neuralgia

A

sudden unilateral recurrent ‘stabbing’ pain in branches of CN V
autonomic symptoms

47
Q

red flag signs in trigeminal neuralgia

A 
onset < 40yrs 
pain only in CNV1 
FH of MS 
deafness/ear problems 
sensory changes
48
Q

medical management of trigeminal neuralgia

A

offer carbamazepine (1st) or phenytoin or gabapentin

49
Q

surgical management of trigeminal neuralgia

A

microvascular decompression

Neurological System (10 decks)

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