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Neurology > Headaches (excluding Migraine) > Flashcards

Headaches (excluding Migraine) Flashcards

1
Q

What are the characteristics of tension headaches?

A 
A band across forehead 
Diffuse, dull ache 
Aggravated by touching scalp, noise 
Usually does not disturb sleep 
Can manage usual activities 
Simple analgesics usually effective
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2
Q

Describe the duration of tension headaches

A

Hours to days

Worse towards end of day

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3
Q

What can cause tension headaches?

A

Anything that makes muscle over scalp or back of neck tense
Persistent contraction e.g clenching teeth, head posture, furrowing brow
Stress
Anxiety
Depression
Poor sleep

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4
Q

How can tension headaches be managed?

A

Explain that self limiting and not serious
Exercise
Improve posture

Simple analgesics:
Ibuprofen as first choice 
Other NSAIDS sometimes indicated 
Paracetamol if intolerant of NSAIDS 
Aspirin can also be used

Do not offer opioids

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5
Q

What is another name for cluster headaches?

A

Suicide headaches

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6
Q

Cluster headaches are more common in…

A

Men
Smokers
Any age

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7
Q

In cluster headaches, the bouts or “clusters” of head pain last how many weeks typically?

A

4 to 12 weeks once a year at the same time and often in spring or autumn
In between periods of no symptoms

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8
Q

How frequently do cluster headaches occur during a bout?

A

Usually once or twice per day

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9
Q

When does a cluster headache typically come on?

A

At night waking patient from sleep

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10
Q

How long does a cluster headache usually last?

A

10 minutes to 2 hours

Sudden onset, without warning

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11
Q

Describe the pain experienced in cluster headaches

A

Severe unilateral pain
Around one eye
May also have temporal pain
Prevents regular activity

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12
Q

Other than pain, what other symptoms are associated with cluster headaches?

A 
Eye may become blood shot and watery
Drooping eyelid
Lid swelling
Rhinorrhoea 
Facial flushing
Miosis +/- ptosis
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13
Q

What can trigger cluster headaches?

A

Alcohol
Strong smells
Exercise or becoming overheated

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14
Q

How can an acute attack (cluster headache) be treated?

A

Oxygen via non rebreathe mask

Sumatriptan injections at onset

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15
Q

What preventative treatment can be used in the case of cluster headaches?

A

Corticosteroids (short term only) - attempt to break the cycle
Verapamil - will need ECG monitoring initially while dose established
Lithium at low dose

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16
Q

People presenting with a first bout of cluster headache need confirmation of diagnosis by specialist. This may include…

A

Imaging

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17
Q

What is a chronic tension headache?

A

When you have a tension headache on at least 15 days every month for at least 3 months

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18
Q

What is the most common medication used to treat chronic tension headaches?

A

Amitriptyline

Taken everyday with aim to prevent headaches

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19
Q

Describe medication overuse headaches

A

Caused by taking regular painkillers for headache - body responds by making more pain sensors - so very sensitive
This headache typically present for 15 days or more per month

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20
Q

Which medications are most likely to cause medication overuse headaches?

A

Opioids

Triptans

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21
Q

How are medication overuse headaches managed?

A

Stop the medication - headache likely to get worse initially, then reduce
Best to stop altogether than cutting down gradually

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22
Q

Can medication overuse headaches occur even if taking medication as instructed?

A

Yes

23
Q

How many days per month of taking painkillers is considered overuse?

A

Ten days per month

24
Q

What is hemicrania continua?

A

Persistent headache, without pain free periods
Unilateral pain
Moderate intensity but with exacerbations
During exacerbation may get autonomic features on side of pain - conjunctival injection, lacrimation, rhinorrhoea, miosis/ptosis
Migrainous symptoms may be present e.g nausea, light sensitivity

25
Q

How is hemicrania continua treated?

A

Indomethacin - an NSAID

Positive response to this drug is part of criteria for diagnosis

26
Q

What are primary stabbing headaches? (Ice pick)

A

Short, stabbing headaches
Very sudden and severe
Last between 5 and 30 seconds
Often occur behind ear

27
Q

Primary stabbing headaches are more common in people who have…

A

Migraines

28
Q

How are primary stabbing headaches managed?

A

Too short to treat

Migraine medication may reduce number

29
Q

What is trigeminal neuralgia?

A

Paroxysms of intense, stabbing pain lasting seconds in the trigeminal nerve distribution

30
Q

In trigeminal neuralgia, what divisions of the trigeminal nerve are typically affected?

A

Maxilllary

Mandibular

31
Q

In trigeminal neuralgia where is the pain often located?

A

Around cheek and jaw on one side typically (but can be both)

32
Q

What can happen after an attack of pain in trigeminal neuralgia?

A

Dull ache or tenderness of affected area

33
Q

In trigeminal neuralgia, there are often trigger points. Where are they and what can trigger pain?

A

Where: often around nose and mouth
What: eating, talking, washing, shaving, dental prosthesis

34
Q

In trigeminal neuralgia how frequent are the pains?

A

Varies - can be 100s per day or just occasional

Often occur in bouts with periods of normalcy

35
Q

What are some secondary causes of trigeminal neuralgia?

A

Compression of trigeminal nerve - aneurysm, tumour
MS
Zoster
Skull base malformations e.g chiari

36
Q

How is trigeminal neuralgia diagnosed?

A

Based on typical symptoms

If secondary cause possible - MRI

37
Q

How is trigeminal neuralgia managed?

A

Carbamazepine is the usual treatment - lessens nerve impulses (taken for approx one month after pain stopped)
Alternative - gabapentin, baclofen, lamotrigine

Normal painkillers do not work

If very severe and not responding to medication: deep brain stimulation
Decompression surgery - relieve pressure on the nerve
Ablative surgery

38
Q

What is another name for giant cell arteritis?

A

Temporal arteritis

39
Q

What causes GCA?

A

A form of vasculitis
Inflammation of arteries in temple and behind the eye
Autoimmune condition - large and medium size arteries undergo giant cell infiltration with fragmentation of lamina and narrowing of lumen, resulting in distal ischaemia and pain sensitive fibre stimulation

40
Q

Who typically gets GCA?

A

Over 50 (average onset is 74)
Women 2x more common
Northern Europeans

41
Q

What symptoms are associated with GCA?

A

New, and persistent headache over temple region - severe and throbbing
Tenderness over temple and scalp e.g when combing hair
Tongue/ jaw claudication (fatigue or discomfort of jaw during chewing)
Sudden vision loss in one eye - amaurosis fugax
Risk of sudden blindness
Flu like symptoms at onset - fatigue, fever, appetite loss
Weight loss
Unequal or weak pulses

Pain and stiffness in neck, hips, shoulders which is worse in morning - PMR symptoms

42
Q

GCA typically affects vessels in scalp and neck (especially temples). It can also affect…

A

Aorta and its large branches to head, arms and legs

43
Q

Why is early treatment vital in GCA?

A

Can cause blindness or stroke - so urgent referral necessary

44
Q

What do blood tests typically demonstrate in GCA?

A

ESR and CRP elevated
Platelets elevated
Increased ALP
Decreased Hb

45
Q

How is GCA diagnosed?

A

Temporal artery biopsy

- negative biopsy does not exclude diagnosis as skin lesions occur

46
Q

How is GCA managed?

A

Immediate prednisolone 60mg/ d
Or IV methyl prednisolone is evolving vision loss or history of amaurosis fugax

Typically 2 year course then complete remission
Reduce dose once symptoms resolved and ESR reduced

With long term steroid use - PPI, bisphosphonate, calcium and vit d

47
Q

What can cause an acute single headache episode?

A 
Meningitis
Encephalitis 
SAH
Head injury 
Sinusitis 
Glaucoma - acute closed angle
48
Q

What usually causes a SAH?

A

Ruptured berry aneurysm

49
Q

Describe the headache seen in SAH

A

Sudden onset
THUNDERCLAP headache ie worst ever and explosive
Often occipital region

Other symptoms: neck stiffness, N&V, photophobia, focal signs, reduced consciousness, seizures

50
Q

What can chronic progressive headaches indicate?

A

Raised ICP

51
Q

Headaches associated with raised ICP have what features?

A

Chronic progressive
Worse on waking
Worse on bending, coughing

Also: vomiting, seizures, papilloedema, odd behaviour

52
Q

Headaches that recur tend to be…

A

Benign

53
Q

What symptoms are associated with sinusitis

A 
Dull constant ache all over frontal or maxillary sinuses
Tenderness
Post nasal drip 
Pain worse on bending 
Pain usually last 1-2 weeks

Ethmoid or sphenoid sinus pain felt deep in midline at root of nose

54
Q

What should you consider with acute eye pain, visual disturbance, red and hard eye?

A

Acute closed angle glaucoma

Neurology (31 decks)

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