Neuro Flashcards
What is a primary headache?
No underlying cause - migraine, cluster, tension
What is a secondary headache?
Has an underlying cause - giant cell arteritis
What are red flags for secondary headache?
HIV, immunocompromised, thunderclap, seizure, rash, neck stiffness, red eye, new focal neurology
What is the clinical presentation of a migraine?
Two of: unilateral, pulsatile, moderate-severe pain, aggravated by activity
During headache, one of: nausea/vomiting, photophobia, phonophobia
What are migraines?
Recurrent throbbing headaches, preceded by aura and associated with nausea, vomiting and visual changes
How long do migraines last?
4-72 hours
What can trigger migraines?
CHOCOLATE: chocolate, hangovers, orgasms, cheese, OCP, lie-ins, tumult (loud noises), exercise
What visual disturbances can you get with migraines?
Chaotic cascading, jumbling, distorted lines, dots, zigzagz, scotoma, hemianopia
What somatosensory disturbances can you get with migraines?
Paresthesia (fingers to face)
How is migraine diagnosis made and what should be checked?
Clinical diagnosis. Examine eyes (papilloedema), BP, head and neck (scalp, neck muscles, temporal arteries)
How do you treat migraines?
Reduce triggers.
Acute: sumatriptan, NSAIDS (avoid paracetamol and ibuprofen), prochlorperazine (antiemetic)
Name an antiemetic used to treat migraines?
Prochlorperazine.
When is prevention treatment for migraines indicated?
More than 2 attacks per month, acute management required more than twice a week
Name 3 drug classes and an example of each used to treat migraines.
Beta-blocker - propranolol
TCA - amitriptyline
Anticonvulsant - topiramate
Define episodic and chronic tension headaches.
Episodic: <15 days per month
Chronic: >15 days per month
Describe a tension headache.
Bilateral, tight band, non-pulsatile.
What advice would you give to a patient with tension headaches?
Reassurance, lifestyle advice, limit use of analgesia (<6 days per month)
What treatment can be given for tension headaches?
Aspirin, paracetamol, NSAIDs, not opioids
Consider TCA
What is the pathology of cluster headaches?
Unknown. May be due to superficial temporal artery smooth muscle hyper-reactivity to serotonin.
When do cluster headaches occur?
Once or twice a day at the same time, last between 15 mins - 2 hours.
What is the clinical presentation of cluster headaches?
Rapid onset, excruciating headache around the eye, temple or forehead.
What cranial autonomic symptoms occur with cluster headaches?
Ipsilateral watery/bloodshot eye, lacrimation, facial flushing, miosis and ptosis
What is the timing or cluster headaches?
Clusters lasting 4-12 weeks followed by pain free periods of up to 1-2 years. Can be chronic.
How would you treat a cluster headache?
Analgesia not helpful. 100% O2 15 mins via non-rebreathable mask (not in COPD).
Cluster headache prevention.
1st line - CCB Verapamil
Avoid alcohol
Prednisolone may help during cluster.
Is the trigeminal nerve sensory, motor or both?
Both:
V.I - ophthalmic
V.II - maxillary
V.III - mandibular + motor routes for muscles of mastication
Describe trigeminal neuralgia.
Chronic, debilitating condition resulting in intense/extreme episodes of pain.
What is the cause of TGN?
Most commonly due to compression of trigeminal by loop of vein/artery.
What local pathology is common in younger people with TGN?
Vestibular schwannoma.
What is the pathology of TGN?
Compression of CNV resulting in demyelination and erratic pain signalling
Pathology at what locations can cause fifth nerve lesions?
Within the brainstem, cerebellopontine angle, petrous bone, cavernous sinus.
What is the main RF for TGN?
Hypertension.
What are triggers to TGN?
Washing affected area, shaving, eating, talking and dental prostheses.
