Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical neuroscience > Lecture 15- Headaches > Flashcards

Lecture 15- Headaches Flashcards

1
Q

Headaches

A
  • Common presenting complain
  • Majority are benign (non life threatening and due to primary headache disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes of headache

A
  • Primary (due to headache disorder)
  • Secondary to another condition
  • Non-life threatening
  • Life or sight threatening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

(1) Primary headache disorders

A

Non-life or sight threatening- many chronic

  • Tension headache
  • Migraine
  • Cluster headache
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

(2) Secondary due to another condition

A

Some are life or sight threatening- many acute

Life threatening

  • Intracranial lesion
    • Tumour (benign/malignant or metastasis)
    • Haemorrhage (trauma or aneurysm)
  • Meningitis

Site threatening

  • Giant cell (temporal) arteritis)
  • Acute glaucoma

Non-life or sight threatening

  • Sinusitis
  • Medication-overuse headache
  • Trigeminal neuralgia
  • Drug side effect e.g. CCB and statins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Life threatening- secondary

A
  • Intracranial lesion
    • Tumour (benign/malignant or metastasis)
    • Haemorrhage (trauma or aneurysm)
  • Meningitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Site threatening- secondary

A
  • Giant cell (temporal) arteritis)
  • Acute glaucoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Non-life or sight threatening- secondary

A
  • Sinusitis
  • Medication-overuse headache
  • Trigeminal neuralgia
  • Drug side effect e.g. CCB and statins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Diagnosing cause of headache: Patients history is key

A

History taking

  • History of presenting complaint (HPC)
    • SQITARS/SOCRATES
      • Site
      • Onset
      • Character
      • Radiate?
      • Associated symptoms
      • Timing (day/night)
      • Exacerbating factors
      • Severity
  • Past medical history (PMH)
    • Prev. headaches, conditions causing secondary headache
  • Drug history (DH)
    • Analgesic use (medication over use)
    • Other drugs causative or headache?
  • Family history (FH)
    • Migraines?
  • Social history (SH)
    • Sleep? Stress?
    • Alcohol and caffeine consumptions, diet (triggers)

Red flags

Clinical examination

  • Vital signs
    • BP
    • PR
    • Temp
  • Neurological examination (cranial and peripheral nerve exam, Glasgow-coma scale)
  • Other relevant systems, guidance by history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

red FLAGS of headaches

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
A
  • vital signs
    • BP
    • PR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

headache types from common to least common

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

tension headaches

A

primary headaches

  • F>M
  • Common
  • Young (teenagers) and young adults (20-39yrs)
  • First onset >50 yrs unusual
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

pathophysiology of tension heafaches

A
  • Due to tension in muscles of the head and neck
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

features of a tension type headache

A
17
Q

migraine

A

primary headache

  • F>M (1 in every 5F_
  • Common
  • Present early to midlife
  • Most have first attack by 30
18
Q

pathophysiology of migraine

A
  • Pathophysiology
    • Unclear
    • Possible theories
      • Neurogenic inflammation of trigeminal sensory neurones innervating large vessels and meninges
      • Alters way pain processed by brain, sensitised to otherwise ignored stimuli
19
Q

features of migraines

A
20
Q

Associated symptoms of migraines

A
  • Photophobia
  • Nausea
  • Aura- peculiar sensory signs
21
Q

Medication over-use headache

A

secondary headache

  • Medication used to treat headaches
  • F>M
  • 30-40 yrs
  • Headache present on at least 15 days/month (constant)
  • Using regular analgesics (at least 10 days/month)
    • Headache not responding
  • Occurs in pts with pre-existing headache disorder
22
Q

Pathophysiology of medication overuse heaches

A

Regular use of analgesics leads to upregulation of pain receptors in the meninges e.g. codeine

23
Q

featues of medication over-use headaches

A
  • Variable character can be dull, tension-type or migraine-like
  • Co-exists with depression and sleep disturbance
  • Treatment: discontinue medication (headache worsens before improves)- resolves completely by 2 months
24
Q

Cluster headaches

A

primary headache disorder

  • M>F
  • Smoking history= risk factor
  • 1 in 1000
  • Usually begins 30-40 years
25
Q

Pathophysiology of cluster headaches

A
  • Unknown
  • Hypothalamic activation with secondary trigeminal and autonomic involvement
26
Q

features of cluster headaches

A
27
Q
A
28
Q

Secondary headaches

A
  • Intracranial haemorrhage- meningism
  • Raised ICP (e.g. space occupying lesion)
  • Trigeminal neuralgia
  • Temporal (giant cell) arteritis
29
Q

Raised intracranial pressure- space occupying lesion

A

Rarely occurs in absence of other suspicious historical or exam findings

30
Q

Trigeminal neuralgia aetiology

A
  • F>M
  • 50-60 years
31
Q

trigeminal neuralgia pathophysiology

A
  • Most caused by compression of CN V due to loop of blood vessels
  • 5% due to tumours/skull base abnormalities or AV malformations
32
Q

trigeminal neuralgia features

A
33
Q

Temporal arteritis

A
  • Vasculitis of large and medium sized arteries of head
    • Superficial temporal artery commonly involved.
  • F>M
  • >50 years (most common >75 yrs)
34
Q

major risk associated with temporal arteritis

A

Risk of irreversible loss of vision due to involvement of blood vessels supplying CN II (optic)

35
Q

General approach to headache

A
  • History and examination
    • Identify if red flag present
  • Build illness script for clinical features that would indicate to particular primary headache disorder or secondary causes
  • Treatment and management will depend on underlying cause
    • Simple analgesics, triptans, high flow oxygen (cluster) vs urgent referral for further investigation
36
Q

example scenario- most likely diagnosis

A
  • Recurrent
  • Tight band
  • Can carry on activities
  • Coughing doesn’t make it worse
  • No family history of note
  • No medication
  • Clinical exam normal
  • Recent stress

Diagnosis? Tension headache most likely

37
Q

example scenario- most likely diagnosis

A
  • Unilateral
  • Morning headache
  • Certain positions make headache worse
  • Hypertension
  • Upper motor neurone signs

Diagnosis?

  • Sign of ICP
38
Q
A

Clinical neuroscience (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions