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Pathologies of Neuro > Primary headaches > Flashcards

Primary headaches Flashcards

1
Q

Three main categories

A
  • Tension type headaches
  • Migraines
  • Trigeminal autonomic cephalagias
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2
Q

Main properties of tension type headache

A
  • Mild
  • Bilateral
  • Pressing/tightening sensation
  • Not aggravated by exercise
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3
Q

Classicification of a TTH?

A
  • Infrequent: less than 1 day per month
  • Frequent: 1-14 days per month
  • Chronic: more than 15 days a month
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4
Q

Treatment for TTH?

A

Abortive:

  • aspirine/ paracetamol
  • NSAIDs
  • 10 days per month

Preventative

  • Rarely used
  • Tricyclic antidepressants
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5
Q

What are the symptoms of migraine

A

During attack

  • Headache
  • Nausea
  • Photophobia
  • Phonophobia: fear of sound

In-between attacks:

  • Anticipatory anxiety
  • Predisposition
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6
Q

Description of the phases of beaches in migraine

A

1-Pre-monitary:

  • Mood changes
  • Fatigue
  • Cognitive changes
  • Muscle Pain
  • Food cravings

2-Aura :

  • Reversible
  • Neurological changes
  • Visual somatosensory

3-Early headache: No associated symptoms of migraine

  • Dull
  • Nasal congestion
  • Muscle pain

4-Advanced headache

  • Unilateral
  • Throbbing
  • Nausea
  • Photophobia
  • Phonophobia
  • Osmophobia

5-Postdrome : migraine symptoms remain despite resolution of headache

  • Fatigue
  • Muscle pain
  • Cognitive changes
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7
Q

What is an aura

A

Transient neurological symptoms resulting from cortical/brainstem dysfunction.
Affects the visual/motor/ sensory/ speech systems
Spreads from one area to another slowly
Usually lasts between 15-60 mins

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8
Q

Differences between a TIA and an AURA

A

TIA is sudden onset
Complete loss of function in TIA
Symptoms all start at the same time and can be localised to one area in a TIA

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9
Q

Triggers for a migraine

A 
Current thoughts are that people who are predisposed to triggers are more likely to be over-responsive to these triggers:
Dehydration 
Sleep deprivation 
Stress
Diet
Changes in oestrogen levels in women 
Environmental stimuli
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10
Q

Treatment for migraine

A

Abortive: only 10 days a month to prevent MOH

  • Aspirin/NSAIDs
  • Triptans

Prophylactic treatment:

  • Tricyclic antidepressants
  • Anti-epileptics
  • Propanarol, candesartan
  • Venlafaxine
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11
Q

Facts about migraine specific to women

A
  • First migraine can occur during pregnancy
  • Migraine with aura usually improves during pregnancy
  • Migraine without aura usually does not improve during pregnancy
  • Combined OCP is non indicated for women with migraine with aura
  • Avoid anti-epileptics in women of child bearing age
  • Treatment: Acute: paracetamol, Preventative: propanarol/amitriptaline
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12
Q

what is the definition of a chronic headache

A

Headache which presents for more than 15 days a month, of which 8 or more are migraneous, for over 3 months.

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13
Q

what are medication overdose headaches

A

Headache for 15 or more days a month- which has become more severe as a result of medication overuse

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14
Q

Example of drug use which can lead to medication headache overdose

A

Opiods, triptans for over 15 days a month
Simple analgesics for more than 10 days a month
Overuse of caffeine, tea..,

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15
Q

Definition of a migraine

A

Chronic disorder with reversible episodes of pain due to complex changes in the Brian (cortex, meninges, Trigeminal ganglion, brainstem)

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16
Q

Symptoms of a chronic headache which develops from migraines

A
  • Increased frequency of headaches over weeks, months, years
  • Migraneous symptoms become less severe/ less frequent
  • Could be a result of overuse of medication- when this is the case, the removal of medication can drastically improve the symptoms
17
Q

Definition of trigeminal autonomic cephalagias

A

A group of headache disorders characterised by attacks of moderate to severe unilateral pain in the head or face, with associated ipsilateral cranial autonomic features such as lacrimation, conjunctival injection, rhinorrhoea, nasal congestion, eyelid oedema and ptosis.

18
Q

Cluster headaches properties

A 
Orbital/temporal 
Unilateral 
Rapid onset- usually within 9 mins 
Can last from 15mins to 30 mins 
Rapid cessation
‘suicide headaches’ due to level of agony
Patients are restless
Ipsilateral autonomic symptoms
Usually present with premonitory aura symptoms 
1-8 attacks a day
19
Q

Paraoxymal hemicrania properties

A

Orbital/temporal
Unilateral
Rapid onset
2-30 mins duration
Prominent ipsilateral autonomic symptoms
Very severe
50% of sufferers are agitated and restless
Migraneous symptoms may be present
In 10% of cases symptoms may be precipitated by bending/rotating the head
No circadian rhythm
2-40 attack per day

20
Q

What does SUNCT stand for?

A

Short-lasting Unilateral Neuralgiform headache with Conjunctival injection and Tearing

21
Q

SUNCT properties

A 
Orbital/ supraorbital/ temporal pain 
Stabbing pain
10-240 second duration
Cutaneous triggers: wind, chewing, touch
3-200 per day
Conjectival infection/lacrimation
22
Q

Trigeminal neuralgia properties

A 
Unilateral maxillary/mandibular division pain greater than ophthalmic pain 
Stabbing pain 
Duration:5-10 seconds 
Cutaneous triggers 
Uncommon autonomic features
23
Q

What does SUNA stand for

A

Short unilateral neuralgiform headache with autonomic symptoms

24
Q

Which are the main categories of trigeminal autonomic cephalagias

A
  • Cluster headaches
  • Paraoxysmal
  • SUNCTA
  • SUNA
  • Unilateral head pain
25
Q

Episodes of pain in Cluster headaches

A
  • Attacks lasting 1-3 months with up to 1 month remission
  • Frequency: 1 attack every other day for up to 8 days
  • Continuos background pain in-between attacks
  • Circadian rhythm: usually occurs around same time of day/ around same time each year
  • In some patients: chronic clusters lasting a year with less than 1 month remission
26
Q

How do you treat SUNA SUNCTA

A

Treatment
•No abortive treatment

•Prophylaxis:
–Lamotrigine (anti-epilectic drug)
–Topiramate
–Gabapentin
-Carbamazepine / Oxcarbazepine
27
Q

How do you treat cluster headaches??

A

Abortive:
Subcutaneous sumatriptan
Oxygen

Preventative:
-Corticosteroids: verapamil

28
Q

How do you treat Paraoxymal hemicranial

A

Indomycin

29
Q

How do you treat trigeminal neuralgia?

A
  • Carbamezapine
  • Gabapentine
  • Lamotrigine

Surgery:

  • Decompressive
  • Radiosurgery
  • Glycerol ganglion injection

Pathologies of Neuro (25 decks)

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