1: Headaches Flashcards
(98 cards)
1
Q
What is the most common cause of headaches
A
Tension-type headache
2
Q
What. are the 6 types of sudden-onset headaches
A
Meningitis SAH Encephalitis Acute Glaucoma GCA Head trauma
3
Q
How does encephalitis present
A
- Odd behaviour
- Decrease consciousness
- Fever
4
Q
How does acute glaucoma present
A
Red injection eye
Severe eye pain radiating to the forehead
Reduced vision and halos
5
Q
What are the 8 sub-acute headaches
A
- Venous sinus thrombosis
- Tension Type Headache
- Cluster Headache
- Sinusitis
- Migraine
- Trigeminal Neuralgia
- Raised ICP
- Medication over-use headache
6
Q
How does venous sinus thrombosis present
A
Papilloedema
7
Q
How does sinusitis present
A
- Pain over frontal and maxillary sinuses
- Pain is worse on learning forwards
- Post-nasal drip
8
Q
How do tension headaches present
A
Tight band across the head
9
Q
Explain cluster headache presentation in acute-stage
A
Sudden-onset painful eye, erythematous with lid welling.
10
Q
When are cluster headaches more common
A
Pain is more common at night
11
Q
Explain timing of cluster headaches overall
A
Cluster headaches may occur several weeks in a row followed by months without symptoms
12
Q
How will raised ICP as a cause of headache present
A
- Chronic progressive headache
- Worse in the morning
- Worse on leaning forward, sneezing and coughing
13
Q
Describe pain in tension headache
A
Bilateral tight-band around the head
14
Q
What intensity is tension headache
A
Mild-Moderate
15
Q
How long do tension headaches usually last
A
30-minutes
16
Q
What defines episodic tension headache
A
Less than 15-days a month
17
Q
What defines chronic tension headache
A
More than 15-days a month
18
Q
Describe pain in migraine
A
Unilateral throbbing pain
19
Q
How long do migraine typically last in
a. Adults
b. Children
A
a. 4-72h
b. 1-48h
20
Q
What symptoms may be associated with migraine
A
- Aura
- Nausea and Vomitting
- Phonophobia
- Photophobia
21
Q
What is time-frame for episodic migraine
A
Less than 15 episodes a year
22
Q
What is time-frame for chronic migraine
A
More than 15 episodes a year
23
Q
Describe pain in cluster headache
A
Unilateral severe pain focused around one eye
24
Q
How long do cluster headaches last
A
50-180 minutes
25
What features are associated with cluster headaches
- Red, Swollen Eye
| - Nasal congestion
26
If suspecting a primary headache what is done
Ask individual to keep a headache diary for 8-Weeks
27
Who created diagnostic criteria for migraines
International Headache Society
28
Outline International Headache Society, Diagnosis of migraines
A. Required at least 5-headaches fulfilling B-D
B. 4-72h
C. Two Of: Unilateral, Throbbing, Moderate-Severe, Exacerbated by physical exercise
D. One of: phonophobia. photophobia, N+V
29
What is a mnemonic to remember triggers of migraines
CHOCOLATES
30
What are the triggers of migraines
```
Cheese
Hangover
Orgasm
Caffeine, Chocolate, Change weather
Oral contraceptive
Lie-ins
Alcohol
Travel
Exercise
Stress
```
31
What are three risk factors for migraines
- FH
- Female
- Obese
32
What % patients present with migraine with aura
25%
33
How long does aura usually last
15-30 minutes (Can continue during headache)
34
What does aura involve
Visual: Zig-zags, Scintillating scotoma
35
How does the headache present in migraine
- Unilateral, pulsating
- Nausea and Vomitting
- Phonophobia
- Photophobia
36
What is different about migraines in children
Shorter
| GI Disturbance
37
Explain investigations in migraines
Clinical Diagnosis
| Any investigation is to exclude secondary causes headache
38
What conservative management is given for management
- Avoid triggers
- Keep headache diary (8W)
- Sleep hygiene
- Maintain Fluid
- Regular exercise
39
What is first-line for acute migraine
NSAIDs and oral sumatriptan
40
In 12-17 year-olds what is given opposed to oral sumatriptan
Nasal sumatriptan
41
What is given second-line if suffering from nausea in headaches
Metclopramide
| Prochlorperazine
42
What should not be given in migraines and why
Opioids - as can worsen headache
43
When is prevention in migraines indicate
More than two migraines a month
44
What is first-line for prevention of migraines
Topiramate
45
When is topiramate contraindicated
Pregnant Women
46
What is used as an alternative to topiramate in women of child-bearing age
Propanolol
47
What are two alternative therapies recommended for migraines
- Acupuncture
| - Riboflavin (Vitamin B12)
48
What is given for menstrual migraines
- zolmatriptan
| - frovatriptan
49
What is an absolute contraindication to COCP
migraines with aura
50
what 'surgical' management can be used for migraines
botox type A
51
when is botox type A injection used for
- Headaches great 15-days a month
- More 8 episodes
- Tried three weeks prophylaxis
- Being managed for medication over-use headache
52
during pregnancy how should migraines be used an why
Paracetamol.
| NSAIDs in third-trimester can cause premature closure PDA
53
what is a complication of migraines
Medication over use headache
54
what is defined as medication over-use headache
Use of analgesia more than 15-days a month. Use of triptans more than 10-days a month
55
what is the most common cause of headaches
Tension-type headache
56
in which gender are tension headaches more common
Female
57
what triggers tension headaches
Stress
Anxiety
Sleep deprivation
58
how will a tension headache present
bilateral tight band across the head, no aura, 30-minutes
59
what is an episodic tension headache
<15-days a month
60
what is a chronic tension headache
>15-days a month
61
how are tension headaches diagnosed
clinical
62
how are episodic TTH managed
Analgesia: NSAID, Paracetamol
Conservative: Sleep hygiene
63
how are chronic TTH managed
```
Acupuncture
Amytryptiline (Off-Label)
```
64
what is a complication of TTH
medication over-use headache
65
what can cause TTH
- Use analgesia >15 days a month
| - Use triptans over 10 days a month
66
how is medication-overuse headache prevented
Restrict analgesia 1-2W
67
what is a cluster headache
Intense headache that occurs in clusters lasting several weeks
68
in which gender are cluster headaches more common
Male
69
what is the main risk factor for cluster headaches
Smoking
70
what is the stereotype for demographic for cluster headache
Male smoker
71
what can trigger acute episodes of cluster headache
Alcohol
| Worse at night
72
when are cluster headache attacks worse
Night-time
73
how do cluster headaches present clinically
- Sudden-onset severe unilateral pain around one eye
- Associated with lacrimation and lid swelling
- Rhinorrhoea
74
what are two eyes signs that may be present in cluster headaches
Miosis
| Ptosis
75
how long do episodes usually occur
150-180 minutes
76
when are episodes more common
Night-time
77
how long do clusters usually last
Usually last 2-4W, then have several months without symptoms
78
how may patient present during a cluster attack
Irritable and agitated
79
how are cluster headaches managed acutely
- Short burst oxygen therapy: 15L via non-recreate for 15-20 minutes
- SC sumatriptan
80
explain short-burst oxygen therapy
15L is given for 15-20 minutes
81
what medication is given for acute cluster headaches
SC Sumatriptan
82
what is used for prophylaxis of cluster headaches
Verapamil
83
what is problem with cluster headaches
most disabling primary headache disorder
84
define trigeminal neuralgia
sharp intense stabbing pain over distribution of trigeminal nerve
85
which gender is trigeminal neuralgia more common
female
86
what is 'classical' trigeminal neuralgia
compression of trigeminal nerve due to adjacent structures
87
what structure most commonly compresses trigeminal nerve
superior cerebellar.a
88
what are other causes of trigeminal neuralgia
- Multiple Sclerosis
- Structural: arnold-chiari, tumour, cyst
- Ischaemia
89
what can trigger trigeminal neuralgia
Washing, shaving. brushing teeth, eating
90
explain presentation of trigeminal neuralgia
causes intense sharp-stabbing pain over distribution of the trigeminal nerve. Then later presents as burning
91
what divisions of trigeminal nerve are more commonly affected
Maxillary
| Mandibular
92
why may face screw up in trigeminal neuralgia
Due to facial spasms
93
what is associated with trigeminal neuralgia
Suicidal Ideation
94
if a young female patient has bilateral trigeminal neuropathy, what is the likely cause
Multiple sclerosis
95
What investigation should always be ordered in trigeminal neuralgia and why
MRI - look for underlying lesion
96
What is assessed for in trigeminal neuralgia
Psychiatric assessment - for depression
97
What are red-flags for trigeminal neuralgia that indicate sinister cause
- Bilateral
- Skin Lesion
- Hearing Loss
- FH multiple sclerosis
- Onset before 40-years
- Pain in ophthalmic devision
- Sensory changes
- Optic neuritis
98
If no underlying sinister cause for trigeminal neuralgia, what is first-line
Carbamazepine
