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OD2 (S1&2) > ND - Headaches - Week 10 > Flashcards

ND - Headaches - Week 10 Flashcards

1
Q

Define a headache.

A

Any pain in the head

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2
Q

Is a headache considered a symptom or a disease?

A

Symptom

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3
Q

Define active headache disorder.

A

Symptomatic in the past year

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4
Q

What percentage of headaches are migraines?

A

~10%

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5
Q

List the two classifications of migraines and the percentage of cases for each.

A

Migraines without aura - ~80%
Migraines with aura - ~20%

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6
Q

What percentage of headaches are tension-type headaches?

A

~40%

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7
Q

Which gender is more affected by migraines? Give the ratio.

A

Females 3:1

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8
Q

Which gender is more affected by tension-type headaches? Give the ratio.

A

5:4

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9
Q

What percentage of headaches are cluster headaches? Which gender is more affected? give the ratio.

A

~0.1%
Males more affected 6:1

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10
Q

What is the most common disabling neurological condition?

A

Migraines

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11
Q

What characteristics can a migraine without aura have, and how many need to be met to be diagnosed as such?

A

Unilateral location
Pulsating quality
Moderate/severe pain intensity
Aggravation by or causing avoidance of physical activity
At least two must be present

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12
Q

What two events may occur during a migraine without aura and how many need to occur in one episode to be diagnosed as such?

A

Nausea and/or vomiting
Photophobia and phonophobia
At least one must occur

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13
Q

What is the minimum number of attacks that need to occur and how long must they last for a headache to be diagnosed as a migraine without aura? What else must be met (3)?

A

At least 5 attacks fulfilling all the criteria, lasting 4-72h untreated
At least two of four characteristics must be present
At least one of two events must happen
It must not be better accounted for by another diagnostic criteria

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14
Q

What is the 5-4-3-2-1 rule?

A

At least FIVE attacks
Headache lasting a minimum of FOUR hours to THREE days
Has at least TWO characteristics
At least ONE event occurs during the headache

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15
Q

What is the minimum number of attacks that need to occur for a headache to be classified a migraine with aura?

A

At least two attacks fulfilling the diagnostic criteria

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16
Q

For a migraine to be classified migraine with aura. list 6 symptoms associated with diagnosing it including which must and must not occur.

A

Fully reversible visual, sensory, and/or speech/language symptoms
No motor, brainstem, or retinal symptoms

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17
Q

List three characteristics of a migraine with aura and the number of these that must be present to meet the diagnostic criteria.

A

At least one aura symptom spreads gradually over 5+ minutes
Two or more aura symptoms occur in succession
Each individual aura symptom lasts 5-60 minutes
At least one aura symptom is unilateral
At least one aura is positive
The aura is accompanied or followed within 60 minutes, by a headache

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18
Q

What are transient ischaemic attacks?

A

Stroke symptoms that resolve within 24 hours

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19
Q

What percentage of stroke victims will have a transient ischaemic attack first?

A

Up to 25%

20
Q

When assessing a headache case, what should you be wary of (4)?

A

Aura occuring for the first time after 40yoa
Symptoms that are exclusively negative
Symptoms that are very short or prolonged
Maximal neurological deficit at onset

21
Q

What is the minimum number of attacks that need to occur (frequency also)and how long must they last for a headache to be diagnosed as a tension-type headache? What else must be met (3)?

A

At least 10 episodes occurring on <1 day/month on average
Lasting from 30 mins to 7 days
Must have at least two characteristics of tension-type headache
All events associated with tension-type headache must occur
Must not be better accounted for by another criteria

22
Q

List four characteristics of a tension-type headache and the number which must be present to be diagnosed as such.

A

Bilateral location
Pressing or tightening quality (non-pulsating)
Mild/moderate intensity
Not aggravated by routine physical activity such as walking/stair climbing
At least two must be present

23
Q

List two events that can occur with tension-type headache. How many of these must occur for it to be diagnosed as such?

A

No nausea/vomiting
No more than one of photophobia or phonophobia
Both must occur

24
Q

What is the minimum number of attacks that need to occur and how long must they last for a headache to be diagnosed as a cluster headaches? What part of the head must be affected (3)? Uni- or bilateral? What else must be met (3)?

A

At least 5 attacks with severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 minutes

25
Q

List 6 characteristics of cluster headaches and the number of these that must occur to be diagnosed as such.

A

Either or both of the following:
-At least one of the following:
-conjunctival injection and/or lacrimation
-nasal congestion and/or rhinorrhoea
-eyelid oedema
-forehead and facial sweating
-miosis and/or ptosis
-A sense of restlessness or agitation

26
Q

What frequency do cluster headaches occur?

A

Between one every other day and 8 per day

27
Q

What are most headaches? Explain.

A

Most are primary headaches and are benign

28
Q

List the PQRSTU mneumonic for headache assessment.

A

Provocative and palliative
Quality of pain
Radiating
Site of severity
Tining (onset, duration, frequency, time of day etc)
Unusual symptoms

29
Q

Give an example of quality of pain for the following:
Tension-type headache
Migraine
Cluster headache

A

Tension-type - band-like pressure
Migraine - half head throbbing
Cluster - sharp periorbital

30
Q

Describe the timing pattern for cluster headaches.

A

Attacks lasting days to weeks spread out between weeks to months of no attacks

31
Q

List 9 ocular causes of headaches.

A

Refractive error
Ocular misalignment
Binocular vision dysfunction
Incorrectly dispensed prescription
Ocular inflammation/infection
Ocular surface disease
Ocular ischaemia
Acute angle closure
Nerve palsy/neuralgia

32
Q

What are the 5 things that should be assessed for headaches?

A

Pupils
Eye movement
BV workup
Visual field testing
IOP

33
Q

List 7 indications for a referral from an eye exam when assessing a headache.

A

Decreased visiond
High IOP
Optic nerve swelling
Neurological signs
Fundus haemorrhage
An eye exam suggesting a problem behind the eye
An eye exam suggesting pathology that doesnt necessarily cause headache

34
Q

Describe the SNOOP5 mneumonic for headache red flags.

A

Systemic conditions (fever, chill, weight loss/gain)
neurologic symptoms, especially focal
O O older age at onset (especially 50+)
P5 peak intensity, precipitation with valsalva mannoeuvre or exertion, postural or positional, pattern change, or progressive, pregnancy

35
Q

List 7 red flags that suggest a secondary cause of headache.

A

New onset headache
Abrupt onset
Progressive symptoms
Abnormal neurological signs
Headache with exertion
Change with head position
Change with valsalva manoeuvre
Symptoms consistent with a trigeminal autonomic cephalalgia

36
Q

List 6 types of headaches that may require MRI imaging.

A

Trigeminal autonomic cephalalgia (including cluster headaches)
New daily persistent headache
Cough headache
Sex headache
Exertional headache
Headache suggestive of altered intracranial pressure

37
Q

Is refractive error affected by migraines?

A

Little to no evidence

38
Q

Are binocular vision problems like asthenopia specifically related to migraines?

A

Not specifically, but should be ruled out as a possible cause of headache

39
Q

Can migraines affect pupils?

A

There have been some cases

40
Q

Describe a retinal migraine. What must be ruled out (2)?

A

Headache + fully reversible visual aura in one eye only
Normal ophthamological examination between attacks
Rule out other causes of amaurosis fugax

41
Q

What kind of a headache is a migraine and with what involvement?

A

A primary headache disorder with vascular involvement

42
Q

What common tendency with migraine may contribute to what pathology in susceptible individuals?

A

Common vasospastic tendencies may contribute to glaucomatous pathology

43
Q

Is there evidence of high prevalence of migraine among glaucoma patients? Explain (2).

A

Yes, for POAG and NTG

44
Q

Can visual field defects from migraines resolve over time? When are they worse?

A

Yes
Visual field defects can be worse close to a migraine

45
Q

What are typical headaches? Give three examples

A

Primary headache disorders
-migraines
-tension type headache
-cluster headache

OD2 (S1&2) (174 decks)

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