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OD2 Semester 2 - Applied Clinical Training > wk10: ND - Headache > Flashcards

wk10: ND - Headache Flashcards

1
Q

What is the overall prevalence of “active’ headache disorder?

A

50%

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2
Q

What percentage of people with headache disorders have migraines?

A

around 10%

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3
Q

What percentage of people with migraines have migraines with aura?

A

20%

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4
Q

What percentage of people with headache disorders have tension type headaches?

A

around 40%

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5
Q

What sex is more frequently affected by migraines and tension headaches?

A

female

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6
Q

What percentage of people with headche disorders have cluster headaches?

A

0.1%

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7
Q

Which sex is more frequently affected by cluster headaches?

A

Men

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8
Q

What is the number 1 disabling neurological condition?

A

Migraines

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9
Q

What are the 2 main subtypes of migraine?

A

Migraine with aura (20%)

Migraine without aura (80%)

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10
Q

What is the diagnostic criteria for migraine with aura (episodic)? (5)

A

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

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11
Q

What is a mnemonic to help us remember diagnostic criteria for migraine without aura (episodic)?

A

5-4-3-2-1

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12
Q

For a migraine with typical aura, what are the main symptoms? (2)

A

Aura with both of the following:

  1. fully reversible visual, sensory and/or speech/language symptoms
  2. No motor, brainstem or retinal symptosm
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13
Q

A migraine with typical aura must fulfil 3 of the following what 6 characteristics?

A

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

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14
Q

What should you be wary of in regards to suspecting transient ischaemic attacks? (4)

A

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

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15
Q

What is the diagnostic criteria for tension type headache (infrequent)? (5)

A

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

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16
Q

What is the diagnostic criteria for a cluster headache (infrequent)? (5)

A

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

17
Q

Define “active” headache disorder

A

headache symptoms within last 12 months

18
Q

List 9 ocular causes of headache

A

Rx, ocular misalignment, BV dysfunction, Incorrect Rx, Oc. inflammation/infection, Oc. surface disease, Oc. ischaemia, Acute angle closure, Nerve palsy/neuralgia

19
Q

List 7 indications for referral from an eye exam of a patient with headaches

A

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

20
Q

What is a good mnemonic for headache red flags for referral?

A

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

21
Q

List 8 red flags for referral in a headache patient

A 
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
22
Q

What headache types require an MRI scan? (6)

A

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

23
Q

Does migraine affect refractive error?

A

Little to no evidence

24
Q

Do migraines cause BV problems?

A

Not specifically related to migraines, but should be ruled out as a possible cause of headache

25
Q

Can migraines cause pupil abnormalities?

A

Yes, there are case reports of this (rare). Obviously refer if this happens

26
Q

How would you define a retinal migraine? (3)

A

Headache + fully reversible visual aura in one eye only with normal ophthalmological examination between attacks

27
Q

When you suspect retinal migraine, what other causes should you rule out? (3)

A

Rule out other causes of amaurosis fugax (e.g. ischaemic optic neuropathy, optic neuritis, carotid dissection)

28
Q

is there evidence for a higher prevalence of migraine in glaucoma patients?

A

Yes, but mainly for NTG patients

29
Q

What is migraine one of the strongest predictors for in NTG patients?

A

One of the strongest predictors of visual field progression in NTG

30
Q

Define vasopasm

A

sudden constriction of an artery, leading to a decrease in its diameter and in the amount of blood it can deliver

31
Q

Define Migraine

A

a primary headache disorder with vascular involvement

32
Q

What location in the eyes is a typical visual aura?

A

Homonymous (same location both eyes)

33
Q

As studied by McKendrick, what percentage of migraine patients had a VF defect of some kind when tested?

A

50%

34
Q

How does duration after migraine affect visual field results? (roughly)

A

In one px studied
After 24 days: large defect
After 36 days: back to normal roughly

35
Q

Since migraine is a potential confound, what are the recommendations when doing visual field testing in migraine patients? (3)

A

Consider baseline visual field test results in people with migraine
Note duration post migraine when testing
Note whether migraine medication taken

36
Q

What additional tests for glaucoma can you do in migraine patients after visual field testing? (3)

A

Check carefully for other glaucomatous risk factors
Check optic nerves very carefully
Pattern Electroretinography (PERG): ganglion cell function

37
Q

What percentage of the population have migraine with visual field anomalies?

A

4%

OD2 Semester 2 - Applied Clinical Training (63 decks)

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