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Phase 3a Medicine > Neuro > Flashcards

Neuro Flashcards

1
Q

What is a primary headache?

A

No underlying cause - migraine, cluster, tension

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2
Q

What is a secondary headache?

A

Has an underlying cause - giant cell arteritis

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3
Q

What are red flags for secondary headache?

A

HIV, immunocompromised, thunderclap, seizure, rash, neck stiffness, red eye, new focal neurology

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4
Q

What is the clinical presentation of a migraine?

A

Two of: unilateral, pulsatile, moderate-severe pain, aggravated by activity
During headache, one of: nausea/vomiting, photophobia, phonophobia

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5
Q

What are migraines?

A

Recurrent throbbing headaches, preceded by aura and associated with nausea, vomiting and visual changes

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6
Q

How long do migraines last?

A

4-72 hours

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7
Q

What can trigger migraines?

A

CHOCOLATE: chocolate, hangovers, orgasms, cheese, OCP, lie-ins, tumult (loud noises), exercise

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8
Q

What visual disturbances can you get with migraines?

A

Chaotic cascading, jumbling, distorted lines, dots, zigzagz, scotoma, hemianopia

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9
Q

What somatosensory disturbances can you get with migraines?

A

Paresthesia (fingers to face)

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10
Q

How is migraine diagnosis made and what should be checked?

A

Clinical diagnosis. Examine eyes (papilloedema), BP, head and neck (scalp, neck muscles, temporal arteries)

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11
Q

How do you treat migraines?

A

Reduce triggers.

Acute: sumatriptan, NSAIDS (avoid paracetamol and ibuprofen), prochlorperazine (antiemetic)

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12
Q

Name an antiemetic used to treat migraines?

A

Prochlorperazine.

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13
Q

When is prevention treatment for migraines indicated?

A

More than 2 attacks per month, acute management required more than twice a week

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14
Q

Name 3 drug classes and an example of each used to treat migraines.

A

Beta-blocker - propranolol
TCA - amitriptyline
Anticonvulsant - topiramate

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15
Q

Define episodic and chronic tension headaches.

A

Episodic: <15 days per month
Chronic: >15 days per month

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16
Q

Describe a tension headache.

A

Bilateral, tight band, non-pulsatile.

17
Q

What advice would you give to a patient with tension headaches?

A

Reassurance, lifestyle advice, limit use of analgesia (<6 days per month)

18
Q

What treatment can be given for tension headaches?

A

Aspirin, paracetamol, NSAIDs, not opioids

Consider TCA

19
Q

What is the pathology of cluster headaches?

A

Unknown. May be due to superficial temporal artery smooth muscle hyper-reactivity to serotonin.

20
Q

When do cluster headaches occur?

A

Once or twice a day at the same time, last between 15 mins - 2 hours.

21
Q

What is the clinical presentation of cluster headaches?

A

Rapid onset, excruciating headache around the eye, temple or forehead.

22
Q

What cranial autonomic symptoms occur with cluster headaches?

A

Ipsilateral watery/bloodshot eye, lacrimation, facial flushing, miosis and ptosis

23
Q

What is the timing or cluster headaches?

A

Clusters lasting 4-12 weeks followed by pain free periods of up to 1-2 years. Can be chronic.

24
Q

How would you treat a cluster headache?

A

Analgesia not helpful. 100% O2 15 mins via non-rebreathable mask (not in COPD).

25
Q

Cluster headache prevention.

A

1st line - CCB Verapamil
Avoid alcohol
Prednisolone may help during cluster.

26
Q

Is the trigeminal nerve sensory, motor or both?

A

Both:
V.I - ophthalmic
V.II - maxillary
V.III - mandibular + motor routes for muscles of mastication

27
Q

Describe trigeminal neuralgia.

A

Chronic, debilitating condition resulting in intense/extreme episodes of pain.

28
Q

What is the cause of TGN?

A

Most commonly due to compression of trigeminal by loop of vein/artery.

29
Q

What local pathology is common in younger people with TGN?

A

Vestibular schwannoma.

30
Q

What is the pathology of TGN?

A

Compression of CNV resulting in demyelination and erratic pain signalling

31
Q

Pathology at what locations can cause fifth nerve lesions?

A

Within the brainstem, cerebellopontine angle, petrous bone, cavernous sinus.

32
Q

What is the main RF for TGN?

A

Hypertension.

33
Q

What are triggers to TGN?

A

Washing affected area, shaving, eating, talking and dental prostheses.

Phase 3a Medicine (6 decks)

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