ND - Headaches - Week 10 Flashcards
Define a headache.
Any pain in the head
Is a headache considered a symptom or a disease?
Symptom
Define active headache disorder.
Symptomatic in the past year
What percentage of headaches are migraines?
~10%
List the two classifications of migraines and the percentage of cases for each.
Migraines without aura - ~80%
Migraines with aura - ~20%
What percentage of headaches are tension-type headaches?
~40%
Which gender is more affected by migraines? Give the ratio.
Females 3:1
Which gender is more affected by tension-type headaches? Give the ratio.
5:4
What percentage of headaches are cluster headaches? Which gender is more affected? give the ratio.
~0.1%
Males more affected 6:1
What is the most common disabling neurological condition?
Migraines
What characteristics can a migraine without aura have, and how many need to be met to be diagnosed as such?
Unilateral location
Pulsating quality
Moderate/severe pain intensity
Aggravation by or causing avoidance of physical activity
At least two must be present
What two events may occur during a migraine without aura and how many need to occur in one episode to be diagnosed as such?
Nausea and/or vomiting
Photophobia and phonophobia
At least one must occur
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)?
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
What is the 5-4-3-2-1 rule?
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
What is the minimum number of attacks that need to occur for a headache to be classified a migraine with aura?
At least two attacks fulfilling the diagnostic criteria
For a migraine to be classified migraine with aura. list 6 symptoms associated with diagnosing it including which must and must not occur.
Fully reversible visual, sensory, and/or speech/language symptoms
No motor, brainstem, or retinal symptoms
List three characteristics of a migraine with aura and the number of these that must be present to meet the diagnostic criteria.
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
What are transient ischaemic attacks?
Stroke symptoms that resolve within 24 hours
What percentage of stroke victims will have a transient ischaemic attack first?
Up to 25%
When assessing a headache case, what should you be wary of (4)?
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
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)?
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
List four characteristics of a tension-type headache and the number which must be present to be diagnosed as such.
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
List two events that can occur with tension-type headache. How many of these must occur for it to be diagnosed as such?
No nausea/vomiting
No more than one of photophobia or phonophobia
Both must occur
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)?
At least 5 attacks with severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 minutes
List 6 characteristics of cluster headaches and the number of these that must occur to be diagnosed as such.
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
What frequency do cluster headaches occur?
Between one every other day and 8 per day
What are most headaches? Explain.
Most are primary headaches and are benign
List the PQRSTU mneumonic for headache assessment.
Provocative and palliative
Quality of pain
Radiating
Site of severity
Tining (onset, duration, frequency, time of day etc)
Unusual symptoms
Give an example of quality of pain for the following:
Tension-type headache
Migraine
Cluster headache
Tension-type - band-like pressure
Migraine - half head throbbing
Cluster - sharp periorbital
Describe the timing pattern for cluster headaches.
Attacks lasting days to weeks spread out between weeks to months of no attacks
List 9 ocular causes of headaches.
Refractive error
Ocular misalignment
Binocular vision dysfunction
Incorrectly dispensed prescription
Ocular inflammation/infection
Ocular surface disease
Ocular ischaemia
Acute angle closure
Nerve palsy/neuralgia
What are the 5 things that should be assessed for headaches?
Pupils
Eye movement
BV workup
Visual field testing
IOP
List 7 indications for a referral from an eye exam when assessing a headache.
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
Describe the SNOOP5 mneumonic for headache red flags.
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
List 7 red flags that suggest a secondary cause of headache.
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
List 6 types of headaches that may require MRI imaging.
Trigeminal autonomic cephalalgia (including cluster headaches)
New daily persistent headache
Cough headache
Sex headache
Exertional headache
Headache suggestive of altered intracranial pressure
Is refractive error affected by migraines?
Little to no evidence
Are binocular vision problems like asthenopia specifically related to migraines?
Not specifically, but should be ruled out as a possible cause of headache
Can migraines affect pupils?
There have been some cases
Describe a retinal migraine. What must be ruled out (2)?
Headache + fully reversible visual aura in one eye only
Normal ophthamological examination between attacks
Rule out other causes of amaurosis fugax
What kind of a headache is a migraine and with what involvement?
A primary headache disorder with vascular involvement
What common tendency with migraine may contribute to what pathology in susceptible individuals?
Common vasospastic tendencies may contribute to glaucomatous pathology
Is there evidence of high prevalence of migraine among glaucoma patients? Explain (2).
Yes, for POAG and NTG
Can visual field defects from migraines resolve over time? When are they worse?
Yes
Visual field defects can be worse close to a migraine
What are typical headaches? Give three examples
Primary headache disorders
-migraines
-tension type headache
-cluster headache
