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A. MLA Map Paediatrics > Tension-Type-Headaches > Flashcards

Tension-Type-Headaches Flashcards

1
Q

Primary headaches = no known cause
Secondary headaches = have a known cause

Which of these is more common?

A
  • primary
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2
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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3
Q

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

A
  • bilateral
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4
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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5
Q

Are tension like headaches pulsatile in nature?

A
  • No

Pulsatile may suggest increases BP or increased intracranial pressure

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6
Q

Are tension like headaches characterised by pressing/tightening or stabbing pain?

A
  • pressing/tightening
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7
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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8
Q

Are men or women more affected by tension headaches?

A
  • equal
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9
Q

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

A
  • mild to moderate severity
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10
Q

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

A
  • women slightly
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11
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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12
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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13
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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14
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

Other features are present in migraines and cluster headaches

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15
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. Which of the following is NOT typically linked to causing medication overuse headaches?

1 - codeine
2 - cyclizine
3 - triptans
4 - NSAIDs

A

2 - cyclizine

All others are pain medications, except triptan which is specific for headaches

Cyclizine is used to reduce nausea and vomiting

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16
Q

When performing a history on a patient with a headache, if there is an increase in headache symptoms when performing a Valsalva manoeuvre bad?

A
  • Yes

Indicates a space occupying lesion in cranial cavity

Causes an increased intracranial pressure

  • Valsalva is an increase in pressure with a closed glottis
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17
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

A RED FLAG here would be if the headache wakes the patient whilst they are asleep

18
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 gain

Weight loss is a red flag as it could be caused by malignancy

19
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

20
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
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, they should receive brain neuroimaging if they have how many of the following?

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

1 - >1
2 - >2
3 - all 3

A

1 - >1

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

Which of the following conditions has been linked with tension like headaches?

1 - strokes
2 - hypertension
3 - cervical spine arthritis
4 - aneurysms

A

3 - cervical spine arthritis

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, avoid caffiene and stress

Patients will also be advised to complete a headache diary

26
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
27
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

28
Q

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

A
  • no
29
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

30
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

31
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

32
Q

If tension-like headaches are persistent despite other therapeutic approaches, which of the following can then be prescribed next as part of preventative approach as a prophylactic?

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

Patients can experience drowsy/hungover feeling

33
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

34
Q

Migraines = feature full headaches

Tension like headaches = featureless headaches

A

This essentially means there are specific features associated with Migraines (aura, vomiting, photophobia etc..

35
Q

When thinking about red flags, which of the following is most likely to cause a new severe or unexpected headache?

1 - malignancy
2 - sub-arachnoid haemorrhage
3 - subdural bleed
4 - giant cell arteritis

A

2 - sub-arachnoid haemorrhage

Also described as a thunderclap headache

36
Q

When thinking about red flags, which of the following is most likely to follow a head trauma?

1 - malignancy
2 - sub-arachnoid haemorrhage
3 - subdural bleed
4 - giant cell arteritis

A

3 - subdural bleed

37
Q

When thinking about red flags, which of the following is most likely to cause a headache in an immunocompromised patient?

1 - malignancy
2 - sub-arachnoid haemorrhage
3 - subdural bleed
4 - giant cell arteritis

A

1 - malignancy

38
Q

When thinking about red flags, which of the following is most likely to cause a persistent headache that then changes drastically?

1 - malignancy
2 - sub-arachnoid haemorrhage
3 - subdural bleed
4 - giant cell arteritis

A

1 - malignancy

This is very common in >50s

39
Q

When thinking about red flags, which of the following is most likely to cause a headache in a current or recent pregnancy?

1 - malignancy
2 - sub-arachnoid haemorrhage
3 - pre-eclampsia
4 - giant cell arteritis

A

3 - pre-eclampsia

40
Q

When thinking about red flags, which of the following is most likely to cause a headache that is associated with pain, specifically in the temporal region?

1 - malignancy
2 - sub-arachnoid haemorrhage
3 - pre-eclampsia
4 - giant cell arteritis

A

4 - giant cell arteritis

A. MLA Map Paediatrics (61 decks)

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