wk10: ND - Headache Flashcards
What is the overall prevalence of “active’ headache disorder?
50%
What percentage of people with headache disorders have migraines?
around 10%
What percentage of people with migraines have migraines with aura?
20%
What percentage of people with headache disorders have tension type headaches?
around 40%
What sex is more frequently affected by migraines and tension headaches?
female
What percentage of people with headche disorders have cluster headaches?
0.1%
Which sex is more frequently affected by cluster headaches?
Men
What is the number 1 disabling neurological condition?
Migraines
What are the 2 main subtypes of migraine?
Migraine with aura (20%)
Migraine without aura (80%)
What is the diagnostic criteria for migraine with aura (episodic)? (5)
A: at least 5 attacks fulfilling criteria B-D
B: Headache attacks lasting 4-72 hours
C: Headache has at least 2 of the following characteristics: unilateral, pulsating, moderate or severe pain, aggravation by or causing avoidance of routine physical activity
D: During headache at least one of: nausea/vomiting, photophobia + phonophobia
E: Not better accounted for by another ICHD-3 diagnosis
What is a mnemonic to help us remember diagnostic criteria for migraine without aura (episodic)?
5-4-3-2-1
For a migraine with typical aura, what are the main symptoms? (2)
Aura with both of the following:
1. fully reversible visual, sensory and/or speech/language symptoms
2. No motor, brainstem or retinal symptosm
A migraine with typical aura must fulfil 3 of the following what 6 characteristics?
At least one aura symptom spreads gradually over >/= 5 minutes
2 or more aura symptoms occur in succession
Each individual aura symptom lasts 5-60 minutes
At least one aura symptom is unilateral
At least one aura symptom is unilateal
The aura is accompanied or followed within 60 minutes y headache
What should you be wary of in regards to suspecting transient ischaemic attacks? (4)
aura occurring for the first time after 40yrs
Symptoms that are exclusively negative
Symptoms that are very short (or very prolonged)
Maximal neurological deficit at onset
What is the diagnostic criteria for tension type headache (infrequent)? (5)
A: At least 10 episodes occurring on <1 day/month on average and fulfilling criteria B-D
B: Lasting from 30 minutes - 7 days
C: At least two of the following: bilateral, pressing or tightening, mild or moderate, NOT aggravated by routine physical activity
D: Both of: No nausea/vomiting, No more than one of photophobia and phonophobia
E: Not better accounted for by another ICHD-3 diagnosis
What is the diagnostic criteria for a cluster headache (infrequent)? (5)
A: At least 5 attacks fulfilling criteria B-D
B: Severe or very severe unilateral orbital, suborbital, and/or temporal pain lasting 5-180 minutes (when untreated)
C: Either or both of: a sense of restlessness or agitation OR one of the following ipsilateral signs: conj infection, nasal congestion, eyelid oedema, forehead/face sweating, miosis and/or ptosis
D: Frequency between one every other day to one every 8 days
E: Not better accounted for by another ICHD-3 diagnosis
Define “active” headache disorder
headache symptoms within last 12 months
List 9 ocular causes of headache
Rx, ocular misalignment, BV dysfunction, Incorrect Rx, Oc. inflammation/infection, Oc. surface disease, Oc. ischaemia, Acute angle closure, Nerve palsy/neuralgia
List 7 indications for referral from an eye exam of a patient with headaches
Reduced vision
High IOP
Optic nerve swelling
Neurological signs
Fundus haemorrhage
An eye exam that suggests a problem behind the eye
An eye exam that suggests pathology that doesn’t necessarily cause headache
What is a good mnemonic for headache red flags for referral?
SNOOP5
S: systemic symptoms (fever, chill, weight change)
N: neurological symptoms (e.g. unilateral weakness, paralysis, numbness, vision loss, difficulty thinking)
OO: older age at onset, especially over 50
P5: peak intensity (10/10 pain especially in less than 1 minute), precipitation with valsava manouevre, postural or positional, pattern change, or progressive, pregnancy
List 8 red flags for referral in a headache patient
New onset headache
Abrupt onset
Progressive symptoms
Abnormal neurological signs
Headache with exertion
Change with head position
Change with Valsava manoeuvre, such as cough, sneeze, strain
Symptoms consistent with a trigeminal autonomic cephalgia (TAC) diagnosis
What headache types require an MRI scan? (6)
TACS (cluster headaches, paroxysmal hemicrania, SUNCT/SUNA, hemicrania continua)
New daily persistant headache
Cough headache
Sex headache
Exertional headache
Headache suggestive of altered intracranial pressure
Does migraine affect refractive error?
Little to no evidence
Do migraines cause BV problems?
Not specifically related to migraines, but should be ruled out as a possible cause of headache
Can migraines cause pupil abnormalities?
Yes, there are case reports of this (rare). Obviously refer if this happens
How would you define a retinal migraine? (3)
Headache + fully reversible visual aura in one eye only with normal ophthalmological examination between attacks
When you suspect retinal migraine, what other causes should you rule out? (3)
Rule out other causes of amaurosis fugax (e.g. ischaemic optic neuropathy, optic neuritis, carotid dissection)
is there evidence for a higher prevalence of migraine in glaucoma patients?
Yes, but mainly for NTG patients
What is migraine one of the strongest predictors for in NTG patients?
One of the strongest predictors of visual field progression in NTG
Define vasopasm
sudden constriction of an artery, leading to a decrease in its diameter and in the amount of blood it can deliver
Define Migraine
a primary headache disorder with vascular involvement
What location in the eyes is a typical visual aura?
Homonymous (same location both eyes)
As studied by McKendrick, what percentage of migraine patients had a VF defect of some kind when tested?
50%
How does duration after migraine affect visual field results? (roughly)
In one px studied
After 24 days: large defect
After 36 days: back to normal roughly
Since migraine is a potential confound, what are the recommendations when doing visual field testing in migraine patients? (3)
Consider baseline visual field test results in people with migraine
Note duration post migraine when testing
Note whether migraine medication taken
What additional tests for glaucoma can you do in migraine patients after visual field testing? (3)
Check carefully for other glaucomatous risk factors
Check optic nerves very carefully
Pattern Electroretinography (PERG): ganglion cell function
What percentage of the population have migraine with visual field anomalies?
4%
