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Neurology > Patho- Headaches > Flashcards

Patho- Headaches Flashcards

1
Q

What are the important things to look for in a headache history?

A 
Onset
Peak
Relief/exacerbators
Associated symptoms
Red flags
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2
Q

What should you ask about the onset of the headache?

A

Acute or chronic onset

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3
Q

What should you ask about the peak of the headache?

A

Worst at onset or progresses to it.

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4
Q

What kind of things can relieve or exacerbate a headache?

A

Worse on standing/better on lying- Low ICP

Worse on lying/better on standing- High ICP

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5
Q

What can be associated features with a headache?

A

N+V
Photo/phonophobia
Ptosis
Nasal stuffiness

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6
Q

What are the red flags of headache?

A 
New onset>55
Malignancy
Immunosuppression
Wakes them up
Worse on cough/sneeze
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7
Q

What are primary headaches?

A

Headaches not caused by another condition

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8
Q

Give some examples of primary headaches

A

Migraine
Tension
Trigeminal Autonomic Cephalgias: cluster, Paroxsymal hemicrania

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9
Q

What is the pathophysiology of a migraine?

A

Serotonin release causes vasoconstriction the dilation

SP irritates blood vessels and nerve causing pain

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10
Q

What are the symptoms of a migraine?

A

+/- aura- visual, sensory or motor symptoms
Moderate/severe unilateral throbbing pain
Worse on movement
Photo/phonophobia
Worse with time

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11
Q

What can trigger a migraine?

A 
Stress
Sleep deprevation
Diet- Dark chocolate, cheese
Hormones
Physical exertion
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12
Q

How do you treat a migraine?

A

Avoid triggers
Relaxation/stress management
Pharmacological

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13
Q

What is the pharmacological management for acute migraine?

A

NSAIDS

Triptans- 5-HT3 agoinst

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14
Q

What is the prophylaxis pharmacological management for migraine?

A

Amitriptyline
Propranolol
Topiramate
BtTx

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15
Q

When does a patient get BtTx for migraines?

A

If failed 3 previos treatments

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16
Q

What are some side effects of amityiptyline?

A

Dry mouth
Postural hypotension
Sedation

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17
Q

WHo should not take propranolol?

A

Asthmatics

Peripheral vascular disease

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18
Q

What are some side effects of topiramate?

A

Impaired conc
Paresthesia
Weight loss

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19
Q

What is the pathophysiology of tension headaches?

A

Neurovascular irritation

20
Q

What are some symptoms of tension headaches?

A

Pressing tingling feeling
Pressure behind eyes
Mild and bilateral
No N+V or photophobia

21
Q

How do you treat tension headaches?

A

Antidepressants
Relaxation
Avoid precipetants

22
Q

Give some examples of Trigeminal Autonomic Cephalgias

A

Cluster
Paroxsymal hemicrania
Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT)

23
Q

What are some general features of Trigeminal Autonomic Cephalgias?

A

Trigeminal distribution of pain

Ipsilateral cranial autonomic features: ptosis, nasal stuffiness, tearing, eye oedema

24
Q

What group classically get cluster headaches?

A

Men in 30-40s

25
Q

What are some symptoms of a custer headache

A 
10/10 pain
Unilateral
Worse on rest
45-90 minutes
1-8 a day
Bouts last weeks-months
26
Q

How do you treat cluster headaches?

A

High flow O2
Sumatriptan
Steroird

27
Q

What can be used for cluster headache prophylaxis?

A

Verapamil

28
Q

Who tends to get Paroxysmal hemicrania

A

Elderly women

29
Q

What are some symptoms of Paroxysmal hemicrania?

A

Severe unilateral headache
Autonomic features
10-30 minutes
1-40 a day

30
Q

How do you treat paroxysmal hemicrania

A

Indomethicin

31
Q

What are some symptoms of SUNCT?

A

Excruciating unilateral headache
Lasts seconds to minutes
Conjunctival injections
Tearing feeling

32
Q

How do you treat SUNCT?

A

Lamotrigine

Gabapentin

33
Q

What should you do to those with new onset unilateral headache with autonomic symptoms?

A

MRI

34
Q

What is a secondary headache?

A

Headache caused by another condition

35
Q

Give some examples of secondary headaches

A 
Idiopathic intracranial hypertension
Trigeminal neuralgia
Temporal arteritis
Pressure
Subarachnoid heamorrhage
36
Q

What are some symptoms of idiopathic intracranial hypertension?

A

Morning N+V
Visual loss
Diurnal headache
Elevated ICP- seen as papilloedema

37
Q

How do you treat IIH?

A

Weight loss
Acetazolamise
Shunt- only do to save vision

38
Q

What should you never do in a patient with IIH unless their CT is normal?

A

LP

39
Q

Who tends to get trigeminal neuralgia?

A

Elderly women

40
Q

What are some symptoms of trigeminal neuralgia?

A

Pain on touching V2/3 areas
Severe stabbing unilateral pain
Lasts 1-90s
Can have 100s in a day

41
Q

How do you treat trigeminal neuralgia?

A

Surgery- decompress nerve or ablate it

Pharma- Carbamazepine, Gabapentin, Phenytoin, Baclofen

42
Q

What are some symptoms associated with temporal arteritis headaches?

A

Jaw pain

Scalp tenderness

43
Q

How do you diagnose temporal arteritis?

A

Raised ERS and CRP

Biopsy

44
Q

How do you treat temporal arteritis?

A

High dose steroids

45
Q

How does a subarachnoid headache present?

A

Very painful sudden onset

46
Q

What kind of headaches can wake you from sleep?

A

Those caused by raised intracranial pressure such as tumors

Neurology (30 decks)

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