Neurology Flashcards
What are cluster headaches?
Unbearable unilateral headaches, centred around eye
Come in clusters and disappear for extended periods
What are the symptoms of cluster headaches?
3-4 episodes/d for wks/mths, then pain-free period lasting several yrs
Attacks last between 15mins and 3hrs
Unilateral
Red, swollen and watering eye
Pupil constriction
Eyelid drooping
Nasal discharge
Facial sweating
Outline acute management of cluster headaches
Triptans (eg: Sumitriptan)
High-flow 100% O2
Outline prophylactic management of cluster headaches
1st line: Verapamil
Occipital nerve block
Prednisolone- Given short course to break the cycle
Lithium
What are the 4 types of migraine?
Migraine w/o aura
Migraine with aura
Silent migraine (aura but no headache)
Hemiplegic migraine
What are the 5 stages of migraine?
- Premonitory/prodromal- Several days before headache
- Aura (lasts up to 60mins)
- Headache- Lasts 4 to 72h
- Resolution- Headache fades/relieved abruptly by vomiting or sleeping
- Postdromal/recovery phase
What are the typical features of a migraine headache?
Lasts between 4 and 72h
Usually unilateral
Moderate-severe intensity
Pounding or throbbing
Photophobia
Phonophobia
Osmophobia (discomfort with smells)
Aura (visual changes)
N&V
What are the common features of an aura?
Affects vision/sensation/language
Sparks in vision
Blurred vision
Lines across vision
Loss of visual fields (eg: Scotoma)
Tingling/numbness
Dysphagia
What is a hemiplegic migraine?
Unilateral limb weakness
Ataxia (loss of coordination)
Impaired consciousness
Familial hemiplegic migraine- Autosomal dominant
Can mimic stroke or TIA
List some of the triggers of migraines
Stress
Bright lights
Strong smells
Certain foods (eg: Chocolate, cheese, caffeine)
Dehydration
Menstruation
Disrupted sleep
Trauma
Outline acute management of migraines
NSAIDs
Paracetamol
Triptans (eg: Sumitriptan)
Antiemetics (eg: Metoclopramide or prochlorperazine)
Opiates can make migraine worse
Outline triptans
5-HT receptor agonists (bind to serotonin receptors
MoA:
Cranial vasoconstriction
Inhibit transmission of pain signals
Inhibit release of inflammatory neuropeptides
What are the CIs of triptans?
Associated with vasoconstriction:
HTN
Coronary artery disease
Previous stroke
TIA
MI
Outline prophylaxis of migraines
Headache diary and avoid triggers
Propanolol
Amitriptyline
Topiramate (teratogenic)
Specialist:
Pizotifen
Candesartan
Sodium valproate
MA- Erenumab or fremanezumab
CBT
Mindfulness and meditation
Acupuncture
Vit B2 (riboflavin)
Menstrual migraines- Prophylactic triptans (eg: Frovatriptan or zolmitriptan)
Which type of headache is the COCP CI in and why?
Migraine with aura
Associated with increased risk of stroke
What are the red flags of headaches?
Fever, photophobia, neck stiffness- Meningitis, encephalitis, brain abscess
New neuro symptoms- Haemorrhage, tumours
Visual disturbance- Giant cell arteritis, glaucoma, tumours
Sub-onset occipital headache- SAH
Worse on coughing or straining- Raised ICP
Postural, worse on standing/lying/bending over- Raised ICP
Vomiting- Raised ICP or CO poisoning
History trauma- ICH
History of cancer- Brain metastasis
Pregnancy- Pre-eclampsia
What is an important investigation in papilloedema?
Fundoscopy
Suggests raised ICP- Brain tumour, benign intracranial HTN, intracranial bleed
Outline tension headaches
Common
Mild ache or pressure in band-like pattern around head
Develop and resolve gradually
No visual changes
What are some of the associations of tension headaches?
Stress
Depression
Alcohol
Skipping meals
Dehydration
Outline management of tension headaches
Reassurance
Ibuprofen or paracetamol
Amitriptyline for chronic/frequent tension headaches
What are secondary headaches?
Similar presentation to tension headache, but with a clear cause
List some of the causes of secondary headaches
Infections- Viral URTI
OSA
Pre-eclampsia
Head injury
CO poisoning
Outline sinusitis
Inflammation of paranasal sinuses
Typically causes pain and pressure following recent viral URTI
Tenderness and swelling on palpation of affected areas
Resolve within 2-3wks
What is the management of sinusitis?
Usually spontaneously resolves within 10d
Steroid nasal spray
Antibiotics- Pen V