Patho- Headaches

Question 1

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

Answer 1

Onset
Peak
Relief/exacerbators
Associated symptoms
Red flags

Question 2

What should you ask about the onset of the headache?

Answer 2

Acute or chronic onset

Question 3

What should you ask about the peak of the headache?

Answer 3

Worst at onset or progresses to it.

Question 4

What kind of things can relieve or exacerbate a headache?

Answer 4

Worse on standing/better on lying- Low ICP

Worse on lying/better on standing- High ICP

Question 5

What can be associated features with a headache?

Answer 5

N+V
Photo/phonophobia
Ptosis
Nasal stuffiness

Question 6

What are the red flags of headache?

Answer 6

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

Question 7

What are primary headaches?

Answer 7

Headaches not caused by another condition

Question 8

Give some examples of primary headaches

Answer 8

Migraine
Tension
Trigeminal Autonomic Cephalgias: cluster, Paroxsymal hemicrania

Question 9

What is the pathophysiology of a migraine?

Answer 9

Serotonin release causes vasoconstriction the dilation

SP irritates blood vessels and nerve causing pain

Question 10

What are the symptoms of a migraine?

Answer 10

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

Question 11

What can trigger a migraine?

Answer 11

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

Question 12

How do you treat a migraine?

Answer 12

Avoid triggers
Relaxation/stress management
Pharmacological

Question 13

What is the pharmacological management for acute migraine?

Answer 13

NSAIDS

Triptans- 5-HT3 agoinst

Question 14

What is the prophylaxis pharmacological management for migraine?

Answer 14

Amitriptyline
Propranolol
Topiramate
BtTx

Question 15

When does a patient get BtTx for migraines?

Answer 15

If failed 3 previos treatments

Question 16

What are some side effects of amityiptyline?

Answer 16

Dry mouth
Postural hypotension
Sedation

Question 17

WHo should not take propranolol?

Answer 17

Asthmatics

Peripheral vascular disease

Question 18

What are some side effects of topiramate?

Answer 18

Impaired conc
Paresthesia
Weight loss

Question 19

What is the pathophysiology of tension headaches?

Answer 19

Neurovascular irritation

Question 20

What are some symptoms of tension headaches?

Answer 20

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

Question 21

How do you treat tension headaches?

Answer 21

Antidepressants
Relaxation
Avoid precipetants

Question 22

Give some examples of Trigeminal Autonomic Cephalgias

Answer 22

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

Question 23

What are some general features of Trigeminal Autonomic Cephalgias?

Answer 23

Trigeminal distribution of pain

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

Question 24

What group classically get cluster headaches?

Answer 24

Men in 30-40s

Question 25

What are some symptoms of a custer headache

Answer 25

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

Question 26

How do you treat cluster headaches?

Answer 26

High flow O2 Sumatriptan Steroird

Question 27

What can be used for cluster headache prophylaxis?

Answer 27

Verapamil

Question 28

Who tends to get Paroxysmal hemicrania

Answer 28

Elderly women

Question 29

What are some symptoms of Paroxysmal hemicrania?

Answer 29

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

Question 30

How do you treat paroxysmal hemicrania

Answer 30

Indomethicin

Question 31

What are some symptoms of SUNCT?

Answer 31

Excruciating unilateral headache Lasts seconds to minutes Conjunctival injections Tearing feeling

Question 32

How do you treat SUNCT?

Answer 32

Lamotrigine | Gabapentin

Question 33

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

Answer 33

MRI

Question 34

What is a secondary headache?

Answer 34

Headache caused by another condition

Question 35

Give some examples of secondary headaches

Answer 35

``` Idiopathic intracranial hypertension Trigeminal neuralgia Temporal arteritis Pressure Subarachnoid heamorrhage ```

Question 36

What are some symptoms of idiopathic intracranial hypertension?

Answer 36

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

Question 37

How do you treat IIH?

Answer 37

Weight loss Acetazolamise Shunt- only do to save vision

Question 38

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

Answer 38

LP

Question 39

Who tends to get trigeminal neuralgia?

Answer 39

Elderly women

Question 40

What are some symptoms of trigeminal neuralgia?

Answer 40

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

Question 41

How do you treat trigeminal neuralgia?

Answer 41

Surgery- decompress nerve or ablate it | Pharma- Carbamazepine, Gabapentin, Phenytoin, Baclofen

Question 42

What are some symptoms associated with temporal arteritis headaches?

Answer 42

Jaw pain | Scalp tenderness

Question 43

How do you diagnose temporal arteritis?

Answer 43

Raised ERS and CRP | Biopsy

Question 44

How do you treat temporal arteritis?

Answer 44

High dose steroids

Question 45

How does a subarachnoid headache present?

Answer 45

Very painful sudden onset

Question 46

What kind of headaches can wake you from sleep?

Answer 46

Those caused by raised intracranial pressure such as tumors