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Year 3 Neuro > Headaches II > Flashcards

Headaches II Flashcards

1
Q

What are the features of migraines?

A 
Tendency to repeated attacks
Triggers
easily hung-over 
visual vertigo 
motion sickness
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2
Q

What are the three forms of migraine attacks?

A

Pain
Pain and focal symptoms
Focal symptoms

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3
Q

What are the phases of migraines?

A 
Prodrome
Aura
Headache
Resolution
Recovery
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4
Q

What is prodrome?

A

Changes in mood, urination, fluid retention, food craving, yawning

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5
Q

What is aura?

A

Visual, sensory (numbness/paraesthesia), weakness, speech arrest

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6
Q

What is headache?

A

Head and body pain, nausea, photophobia

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7
Q

What is resolution?

A

rest and sleep

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8
Q

What is recovery?

A

mood disturbed, food intolerance, feeling hungover

48 hours or so

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9
Q

What are negative aura symptoms?

A

Blackness

Loss of vision

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10
Q

What are positive aura symptoms?

A

Flashes
Zigzags
Starburst
Expanding Cs

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11
Q

What are treatments for an acute migraine attack?

A

Analgesia

Soluble preparations to aid absorption

Triptans-tablets (Sumitriptan), melts, nasal sprays, s/c injections (vasoconstrictors)

Synergise with NSAIDS
Hit the headache hard and fast

Opiates

A short nap

TMS

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12
Q

How can TMS treat migraine?

A

interrupts complex networks that trigger and perpetuate migraine, which is caused by spreading electrical depression across the cerebral cortex.

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13
Q

Why do have to be careful with opiates?

A

caution! Analgesic abuse potential.

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14
Q

What are lifestyle issues that come with migraines?

A

Migraineurs have sensitive heads even in between attacks.

Over-react to any sort of stimulation.

Can’t ignore the world around them, it overstimulates their brains.

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15
Q

What are potential migraine triggers?

A

dietary, environmental, hormonal, weather, dehydration, stress

Drink 2 litres water/day

Avoid caffeinated drinks

Don’t skip meals. Fresh food. Avoid ready meals & take-aways

Don’t oversleep or have late nights.

Electronics downstairs.

Analgesic abuse

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16
Q

What prophylactic methods can prevent migraines?

A

Over-the-counter preparations

Tricyclic antidepressants (TCAs)

Beta-blockers

Serotonin antagonists

Calcium channel blockers

Anticonvulsants

Greater occipital nerve blocks

Botox: crown of thorns

Suppress ovulation

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17
Q

What over the counter preparation can be used?

A

feverfew, coenzyme Q10, riboflavin, magnesium, EPO, nicotinamide

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18
Q

What TCAs can be used?

A

amitriptyline 7pm

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19
Q

What beta blockers can be used?

A

Propanlol

Atenolol

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20
Q

What serotonin antagonists can be used?

A

pizotifen, methysergide

21
Q

What calcium channel blockers can be used?

A

flunarazine, verapamil

22
Q

What anticonvulsants can be used?

A

: valproate, topiramate, gabapentin

23
Q

What is erenumab?

A

Injectable drug erenumab (Aimovig)

Monoclonal antibody
disables calcitonin gene-related peptide or its receptor (CGRP mAbs)

24
Q

What does erenumab do?

A

cut number of days people had migraines from an average of 8 a month to between 4 and 5 a month

25
Q

What is a tension type headache?

A

Tight muscles around head and neck bilaterally, as though head is in a vice.

26
Q

How do you treat tension type headache?

A

NSAID’s preferred:
Ibuprofen Naproxen, Diclofenac

Paracetamol

Tricyclic antidepressants:-
Amitriptyline 50-75mg daily
30-60% derive some symptomatic relief

SSRI’s probably less effective

27
Q

What is a cluster headache?

A

Severe unilateral pain lasting 15-180 minutes untreated.
Classified as a trigeminal autonomic cephalgia. (phantom of the opera distribution)

At least one of the following, ipsilaterally:
Conjunctival redness and/or lacrimation
Nasal congestion and/or rhinorrhoea
Eyelid oedema

28
Q

What are other symptoms of cluster headaches?

A

Forehead and facial sweating

Miosis and/or ptosis

A sense of restlessness or agitation

Frequency between one on alternate days to 8 per day.

Not associated with a brain lesion on MRI

29
Q

How do treat cluster headaches?

A

Inhaled oxygen. Oxygen inhibits neuronal activation in the trigeminocervical complex

S/C or Nasal Sumatriptan so it acts faster

30
Q

What drug can you give to prevent prophylactically cluster headaches?

A

Verapamil (CCB)

31
Q

What is the difference in distribution between migraines and cluster headaches?

A

M: 33% men, 67% women

CH:90% men, 10% women

32
Q

What is the difference in duration between migraines and cluster headaches?

A

M: 3-12 hours

CH: 45min – 3 hours

33
Q

What is the difference in frequency between migraines and cluster headaches?

A

M: 1-8 attacks monthly

CH: 1-3 attacks daily (often at night)

34
Q

What is the difference in remission between migraines and cluster headaches?

A

M: Long remissions unusual

CH: Long remissions common

35
Q

What is the difference in nausea between migraines and cluster headaches?

A

M: Nausea & vomiting frequent

CH: Nausea rare

36
Q

What is the difference in pain between migraines and cluster headaches?

A

M: Pulsating hemicranial pain

CH: Steady, exceptionally severe, well localised pain, unilateral in each cluster

37
Q

What is the difference in symptoms between migraines and cluster headaches?

A

M: Visual or sensory auras seen

CH: Eye waters, nose blocked, ptosis etc

38
Q

What would SOCRATES be for a tension headache?

A 
Generalised site
Dull, band around head pain
Radiates to neck/shoulder
Lasts 3-4 hours
Exacerbating factors - stress, no sleep, anaglesia helps
39
Q

What are the investigations for a tension headache?

A

Clinical diagnosis

40
Q

What would SOCRATES be for a migraine?

A 
S: Unilateral
O: Paroxysmal (episodic)
C: Pulsating/Throbbing
A: N&V, Photophopbia, Aura
T: 4-72 hours
E: Activity, stress, hormone, menstruation, OCP, foods e.g. tyramine in cheese/wine
S: Moderate to Severe
41
Q

What are the causes of migraines?

A 
CHees
OCP
Caffeiene
alcohOL
Travel
Exercise
CHOCOLATE
42
Q

What are the features of Migraines?

A 
POUND
Pulsatile
One day diraation
Unilateral
Nausea
Disabling intensity
43
Q

What would SOCRATES be for a cluster headache?

A

S: Unilateral, behind the eye
O: Acute onset, same time each day
C: often burning/piercing pain
A: swollen eyelid, forehead swelling, nasal congestion, partial horner’s syndrome

44
Q

What are some features of cluster headaches?

A

Males primarily

Associated with

45
Q

What conditions cause facial pain?

A

Sinusitis
Trigeminal neuralgia
Cluster headache
Temporal arteritis

46
Q

What are the features of sinusitis facial pain?

A

Facial ‘fullness’ and tenderness

Nasal discharge, pyrexia or post-nasal drip leading to cough

47
Q

What are the features of trigeminal neuralgia facial pain?

A

Unilateral facial pain characterised by brief electric shock-like pains, abrupt in onset and termination
May be triggered by light touch, emotion

48
Q

What are the features of cluster headache facial pain?

A

Pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours
Clusters typically last 4-12 weeks
Intense pain around one eye
Accompanied by redness, lacrimation, lid swelling, nasal stuffiness

49
Q

What are the features of temporal arteritis facial pain?

A

Tender around temples

Raised ESR

Year 3 Neuro (17 decks)

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