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C. Year 3 MLA Neurology/Behaviour Conditions/Diseases > Tension-Type-Headaches > Flashcards

Tension-Type-Headaches Flashcards

1
Q

What is a primary headache?

1 - no known underlying cause
2 - trauma related headache
3 - infectious related headache
4 - headaches associated with a specific aetiology causing traction on or inflammation of pain-sensitive structures

A

1 - no known underlying cause

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2
Q

What is a secondary headache?

1 - no known underlying cause
2 - trauma related headache
3 - infectious related headache
4 - headaches associated with a specific aetiology causing traction on or inflammation of pain-sensitive structures

A

4 - headaches associated with a specific aetiology causing traction on or inflammation of pain-sensitive structures

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3
Q

What is the most common type of primary headache?

1 - migraines
2 - thunderclap
3 - tension type
4 - cluster

A

3 - tension type

  • incidence of 0.5-5%
  • difficult to identify exact incidence
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4
Q

In a tension type headache, is the pain bilateral or unilateral?

A
  • bilateral
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5
Q

In a tension type headache, how do patients typically describe the feeling of a tension type headache?

1 - drilling on head
2 - banging on head
3 - squeezing head
4 - all of the above

A

3 - squeezing head
- this is why its called a tension headache

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6
Q

What is the incidence of tension headaches?

1 - 150/100,000
2 - 1500/100,000
3 - 15,000/100,000

A

3 - 15,000/100,000

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7
Q

Are men or women more affected by tension headaches?

A
  • equal
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8
Q

Do tension headaches typically present with a severe or mild to moderate severity?

A
  • mild to moderate severity
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9
Q

Are men or women more likely to suffer with a tension headache?

A
  • women slightly
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10
Q

Tension headaches can be episodic or chronic. How many days in a month do tension-type headaches need to occur to be class as chronic?

1 - >5d/month
2 - >1-d/month
3 - >15d/month
4 - >25d/month

A

3 - >15d/month
- episodic is <15 days per month

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11
Q

How long do tension-type-headaches typically last?

1 - 4-72 hours
2 - 15-180 minutes
3 - 30 minutes to 1 week
4 - >1week

A

3 - 30 minutes to 1 week

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12
Q

Of the following, which is most likely to trigger a Tension type headaches?

1 - dehydration and stress
2 - food and weather
3 - cigarettes and alcohol
4 - medications

A

1 - dehydration and stress

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13
Q

Tension type headaches typically present with no specific symptoms. Which of the following is acceptable and can be seen in some patients?

1 - photophobia/phonophobia
2 - aura
3 - nausea and vomiting
4 - autonomic features

A

1 - photophobia/phonophobia

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14
Q

Medication-overuse headache are caused by taking painkillers too often for tension headaches . The body responds to this by increasing the number of pain receptors in the head.

When pain is felt it is overly sensitive and pain is felt all the time.

A
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15
Q

When performing a history on a patient with a headache, is an increase in the headaches symptoms when performing the Valsalva bad?

A
  • bad
  • indicates a mass or increased fluid overload in the cranial cavity
  • Valsalva is an increase in pressure with a closed glottis
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16
Q

When performing a history on a patient with a headache, which of the following is NOT typically a red flag?

1 - patient wakes up with headache
2 - change in character
3 - age of onset
4 - sudden onset (thunderclap)
5 - focal neurological deficits
6 - constitutional symptoms (fever, meningism, rash, weight loss)

A

1 - patient wakes up with headache
- RED FLAG if it wakes the patient whilst they are asleep

17
Q

When examining a patient, all of the following are RED FLAGS except which one?

1 - patient appears sick-appearing, skin changes
2 - evidence of trauma
3 - altered cognitive state
4 - ocular: hyphema, pupil non-reactivity, optic disc swelling, proptosis, restricted eye movements
5 - meningism
6 - weight loss
7 - focal neurological findings (eg limb weakness)

A

6 - weight loss

18
Q

Which of the following is NOT a differential for a tension like headache?

1 - migraine with aura
2 - medication overuse headache
3 - hypertension
4 - secondary headaches

A

3 - hypertension

19
Q

Patients with infrequent (<1 day/month) or frequent (<15 days/month) tension headaches, are advised to take aspirins or NSAIDs as soon as onset of symptoms. However, patients who cannot tolerate aspirin or NSAIDs should be encouraged to take what?

1 - stronger does of aspirin
2 - codeine
3 - morphine sulphate
4 - acetaminophen

A

4 - acetaminophen

  • this is essentially paracetamol
20
Q

Are primary or secondary headaches more common?

A
  • primary
21
Q

Do patients with a stable headache pattern for >6 months and an unremarkable neurological examination require brain neuroimaging?

A
  • no
22
Q

Patients with a stable headache pattern for >6 months and an unremarkable neurological examination do not require brain neuroimaging. However, if they have any of the following they should receive brain neuroimaging:

  • unexplained abnormal finding on neurologic examination
  • atypical headache features
  • headaches that do not fulfill the strict definition of a primary headache disorder
A
23
Q

In a patient who requires brain neuroimaging, which imaging modality is the primary choice?

1 - MRI
2 - ultrasound
3 - CT
4 - X-ray

A

1 - MRI
- with and without contrast

  • head CT is more expeditious for evaluating those suspected of having acute intracranial hemorrhage.
24
Q

In patients with infrequent (<1 day/month) or frequent (<15 days/month) tension headaches, what medications should they be advised to buy over the counter?

1 - aspirin
2 - codeine and aspirin
3 - morphine sulphate and aspirin
4 - paracetamol

A

1 - aspirin

  • NSAIDs essentially
  • can give a single dose of:
  • Ibuprofen (400 to 600 mg)
  • Naproxen sodium (220 to 550 mg)
  • Aspirin (500 to 650 mg)
  • Amitriptyline can be preventative
  • acupuncture can help
25
Q

What is typically the 1st line treatment patients with tension-type headaches are given as part of abortive approach?

1 - paracetamol
2 - lifestyle advice
3 - NSAIDs
4 - Triptan (serotonin agonist)

A

2 - lifestyle advice
- adequate sleep, hydration, exercise, cognitive behavioural therapy, biofeedback

26
Q

If lifestyle advice fails in patients with tension-type headaches, which of the following can then be prescribed next as part of abortive approach?

1 - paracetamol
2 - aspirin
3 - NSAIDs
4 - Triptan (serotonin agonist)

A

1 - paracetamol
- aspirin and NSAIDs could be tried if paracetamol is ineffective

27
Q

Should opioids ever be prescribed for the acute management of patients with tension-type headaches?

A
  • no
28
Q

What is typically the 1st line treatment patients with tension-type headaches are given as part of a preventative approach?

1 - Amitriptyline
2 - Lifestyle advice
3 - Propranolol
4 - Topiramate

A

2 - Lifestyle advice

29
Q

If lifestyle advice fails in patients with tension-like headaches, which of the following can then be prescribed next as part of preventative approach?

1 - Amitriptyline
2 - Lifestyle advice
3 - Propranolol
4 - Paracetamol

A

1 - paracetamol
- aspirin and NSAIDs could be tried if paracetamol is ineffective

30
Q

If lifestyle advice fails, paracetamol and/or NSAIDs fails in patients with tension-like headaches, which of the following can then be prescribed next as part of preventative approach?

1 - Amitriptyline
2 - Lifestyle advice
3 - Acupuncture
4 - Paracetamol

A

3 - Acupuncture

31
Q

If lifestyle advice, paracetamol and/or NSAIDs and acupuncture fails in patients with tension-like headaches, which of the following can then be prescribed next as part of preventative approach?

1 - Amitriptyline
2 - Lifestyle advice
3 - Acupuncture
4 - Paracetamol

A

1 - Amitriptyline
- inhibits norepinephrine or serotonin transporter (NET or SERT) at presynaptic terminals
- means more serotonin and/or noradrenaline

32
Q

Which of the following would be a suitable differential for a patient with suspected tension-type headaches?

1 - cluster headache/migraine
2 - cervical spondylosis
3 - intracranial pathology
4 - increased BP
5 - TIAs
6 - sinusitis/otitis media
7 - all of the above

A

7 - all of the above

C. Year 3 MLA Neurology/Behaviour Conditions/Diseases (28 decks)

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