Neurology: Headaches Flashcards
What are the 4 main groups of primary headaches?
Migraine
Tension type
Cluster headache and other trigeminal autonomic cephalagias
Other primary headaches
Describe a tension type headache
Symmetrical
Gradual onset
Usually lasts hours and gets worse towards end of day
Often described as tightness, a band or pressure
Usually no other symptoms
Usually relived by simple analgesia
Migraines without aura account for what percentage of migraines?
90%
In children how long to migraine episodes last?
1-72 hours
How do migraine without aura typically present in children?
Commonly bilateral, but may be unilateral
Pulsatile over temporal/frontal area
Often accompanied by GI disturbance - nausea, vomiting, abdo pain
Photophobia and phonophobia
Aggravated by physical activity and relived by sleep
In migraines with aura, what types of auras can occur?
Visual
Sensory
Motor
In migraines with aura, can the aura occur without the headache?
Yes
In cases of migraines with aura, are there symptoms between episodes?
No
In cases of migraine with aura, what kind of premonitory symptoms can occur?
Tiredness
Difficulty concentrating
Autonomic features
What is the most common aura?
Visual
Negative phenomena - hemianopia, scotoma (small areas of vision lost)
Positive - zigzag lines
What is a hemiplegic migraine?
Unilateral sensory or motor loss (rare)
What can often trigger migraines?
Late nights or early rises Stress Or relief of stress Foods - cheese, chocolate, caffeine Menstruation COCP
What is the criteria for migraine without aura according to the International Headache Society?
A >= 5 headache attacks fulfilling B to D B headache attack lasting 4-72 hours C at least 2 of following 4 features: Bilateral of unilateral Pulsatile Mod to severe intensity Aggravated by routine physical activity D one of following: Nausea and/or vomiting Photophobia and phonophobia
How are migraines without aura managed?
Ibuprofen thought to be more effective than paracetamol in paediatrics
Triptans if child >=12 years old, but follow up required
Sumatriptan nasal spray is only triptan that has proven efficacy, but poorly tolerated by young people due to taste
Oral triptans not licensed below 18y/o
Prophylaxis: pizotifen and propranolol = first line
Second line: valproate, topiramate, amitriptyline
What uncommon forms of migraine are there?
Familial hemiplegic migraine - calcium channel defect
Sporadic hemiplegic migraine
Basilar type migraine - vomiting with nystagmus and/or cerebellar signs
Periodic syndromes (often migraine precursors):
Cyclical vomiting
Abdominal migraine
Benign paroxysmal vertigo of childhood
What is abdominal migraine?
Idiopathic recurrent disorder Episodic midline pain Lasting 1-72 hours Mod to severe pain Vasomotor symptoms - nausea and vomiting
What are secondary headaches?
Medication overuse Head/neck trauma Vascular disorder e.g malformation or intracranial haemorrhage Raised ICP Idiopathic intracranial HTN Alcohol, solvent or drug abuse Meningitis, encephalitis, abscess HTN Hyercapnia Sinusitis Associated with emotional disorders
Headaches due to a space occupying lesion are worse when…
Lying down
What symptoms are associated with headaches due to space occupying lesion?
Morning vomiting
Night time waking
Change in mood, personality or educational performance
What features on examination suggest space occupying lesion?
Visual field defects
Diplopia
New onset squint
Facial nerve palsy
