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Neurology Year 3 > Headaches and Migraines > Flashcards

Headaches and Migraines Flashcards

1
Q

List the red flags that could indicate something more severe.

A 
New onset headaches >35
History or present malignancy
Immunosuppression
Early morning headache
Worsened by valsalva manoeuvre
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2
Q

Describe the frequency of migraines without an aura.

A

At least 5 attacks with a duration of 4-72 hours

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3
Q

Describe migraine without an aura?

A

Moderate to severe unilateral throbbing which is worse on movement.
Can be accompanied by photophobia or phonophobia

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4
Q

What is the pathophysiology of migraines?

A

Both vascular and nueronal causes
Stress causes seretonin release
Blood vessels constrict or dilate
Substance P is released which irritates vessels and nerves causing pain

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5
Q

What is an aura?

A

A fully reversible sensory motor or language symptom

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6
Q

How long do auras related to a migraine last?

A

20-60 mins

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7
Q

Do auras usually precede or follow a migraine?

A

Usually occur one hour prior to migraine onset.

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8
Q

Describe some common visual auras?

A

Central scotoma - central fuzziness

Hemianopia loss

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9
Q

What regions of the brain are linked to migraines?

A

Dorsal raphe nucleus

Locus Coeruleus

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10
Q

What chemicals have been linked to triggering a migraine?

A

Substance P
Neurokinin A
CGRP

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11
Q

What system when activated is thought to trigger a migraine with aura?

A

Trigeminal Vascular system

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12
Q

List some causes of migraines with aura?

A 
Sleep deprivation
Diet
Stress
Hormones
Physical exertion
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13
Q

What are some non pharmacological treatments for migraines?

A

Prevention

Education on triggers e.g. diet sleep relaxation etc

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14
Q

What are some pharmacological treatments for migraines once they have started?

A

NSAIDs Aspirin Naproxene Ibuprofen

Triptans- Fovatriptan

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15
Q

What are Triptans?

A

5HT seretonin agonists

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16
Q

How are triptans administered and when?

A

Orally, Sublingually or subcutaneously

Start of the headache for sustained relief

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17
Q

In order to be put on migraine prophylaxis what must the patient present with?

A

More than three attacks per month

Very severe migraines

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18
Q

What is the rule in terms of pharmacological treatment of migraines?

A

Start low go slow

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19
Q

What tricyclic can be used for migraine prophylaxis?

A

Amitriptyline 10-25mg

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20
Q

What are some common side effects of amitriptyline?

A

Dry mouth

Postural hypertension

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21
Q

What is first line in migraine prophylaxis?

A

Propanolol 80mg

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22
Q

What are some common side effects of propanolol?

A

Avoid in asthma

Peripheral vascular disease

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23
Q

If beta blockers are unsuitable what can be given for migraine prophylaxis ?

A

Topiramate 25-100mg

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24
Q

What is Topiramate?

A

Carbonic anhydrase inhibitor

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25
Q

What are some of the side effects with Topiramate?

A

AVOID if looking to conceive
Weight loss
Paraesthesia
Impaired concentration

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26
Q

List some other drugs which can be used for migraine prophylaxis?

A

Gabapentin
Sodium Valproate
Botulinum Toxin

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27
Q

How long should prophylaxis be used for before determining whether or not it is effective?

A

3 months at maximum dosage

28
Q

What lifestyles factors should be altered in someone complaining of chronic migraines?

A 
Healthy diet
Increase water to >2L
Reduce caffeine 
Regular exercise
Reduce stress
29
Q

What class of drug should be taken alongside the acute migraine treatment?

A

Anti emetic - Metoclopramide Hydroxychloride

30
Q

What is a Acephalgic Migraine?

A

Aura without the headache/migraine

31
Q

What is a basilar migraine?

A

Vertigo and severe N+V

32
Q

What is a retinal migraine?

A

Visual aura

33
Q

What is a hemiplegic migraine?

A

Familial or sporadic

Self resolving weakness down one side for 1-2 weeks

34
Q

Give a list of acephalic migraines.

A

Basilar
Hemiplegic
Retinal

35
Q

What are tension type headaches ?

A

Normal everyday headache

36
Q

Describe a tension type headache.

A

Bilateral mild to moderate pain
Photo/Phonophobia
Absence of Nausea + Vomiting

37
Q

What are some non pharmacological treatments for a tension type headache?

A

Physiotherapy
Relaxation
Sleep
Hydration

38
Q

What is the mainstay of pharmacological treatment for tension type headaches?

A

Amitriptyline

3 months

39
Q

List some Trigeminal Autonomic Cephalgias

A

Cluster
Paroxysmal Hemicrania
Hemicrania continua
SUNCT

40
Q

What are some autonomic features related to Trigeminal Autonomic Cephalgias?

A 
Ptosis
Miosis
Nasal Stiffness
N+V
Eye lid oedema
41
Q

Who is affected by cluster headaches?

A

M>F

30-40s

42
Q

Describe when someone is likely to be affected by a cluster headache?

A 
Around sleep (Circadian rhythm)
Seasonal variation
43
Q

Describe cluster headaches.

A

Sever unilateral headache
1-8 a day
Clusters last weeks to months

44
Q

What is the acute treatment for a cluster headache?

A

High flow O2
Sub cutaneous Sumatriptan
Reducing course of steroids

45
Q

What is the dosage of the 5HT serotonin agonist used in cluster headache treatment. Subcutaneous injection

A

Sumatriptan 6mg

46
Q

What is first line prophylaxis in cluster migraines?

A

Verapamil

47
Q

Who is affected in paroxysmal Hemicrania?

A

F>M

50-60s

48
Q

Describe Paroxysmal Hemicrania.

A

Severe unilateral pain

Unilateral Autonomic features

49
Q

Describe the course of Paroxysmal Hemicrania.

A

Lasts 10-30 mins

1 to 4x a day

50
Q

What is used in the treatment of Paroxysmal Hemicrania?

A

Absolute response to Idomethacin

51
Q

SUNCT

A 
Short Lasting - 15/120s
Unilateral
Neuralgiaform
Conjunctival injections
Tearing
52
Q

What is the treatment for SUNCT?

A

Lamotragine

Gabapentine

53
Q

Epidemiology of Idiopathic Intracranial Hypertension

A

F>M
Obese
Female of chid bearing age

54
Q

How does someone with idiopathic intracranial hypertension present?

A 
Diurnal variation headaches
Morning D+V
Visual Loss
Bilateral Papilloedema
Tinnitus
55
Q

What could be seen on the MRI of a patient with Idiopathic Intracranial Hypertension.

A 
Flattened optic discs
Empty Sella (Pituitary fossa)
56
Q

If a CSF sample was taken of someone with Idiopathic Intracranial Hypertension what would you expect to find?

A

Normal make up

Raised pressure

57
Q

What is an affective method of monitoring Idiopathic Intracranial Hypertension?

A

Visual Field

Take a base line and track progression

58
Q

What is the first line treatment for Idiopathic Intracranial Hypertension?

A

Weight Loss

Acetazolamide

59
Q

If Idiopathic Intracranial Hypertension continues to progress despite pharmacological treatment and lifestyle changes what is considered?

A

Lumbar peritoneal shunt

60
Q

Epidemiology of Trigeminal Neuralgia

A

F>M

>60 years

61
Q

How does someone with Trigeminal Neuralgia present?

A

Severe stabbing unilateral stabbing pain that lasts for up to 90s
Bouts of pain may recur for 100 days before remission

62
Q

What nerves are involved in Trigeminal Neuralgia?

A

CN V2 / V3

63
Q

What investigations are undertaken in trigeminal Neuralgia?

A

MRI

64
Q

In a patient with Trigeminal Neuralgia what could be seen on MRI?

A

Usually a vessel touching and irritating a cranial nerve

65
Q

What is the treatment for Trigeminal Neuralgia?

A

Carbezamapine
Gabapentine
Surgical ablation

Neurology Year 3 (29 decks)

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