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clinical neuroscience > Headaches > Flashcards

Headaches Flashcards

1
Q

Primary vs secondary headaches

A
  • primary: due to a headache condition - non life or sight threatening
  • secondary: due to another condition - can be life or sight threatening
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2
Q

Examples of primary headache disorders

A

Tension headache
Migraine
Cluster headache

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3
Q

What are red flags for life threatening headaches?

A

SNOOP
- Systemic signs + disorders
- Neurological symptoms
- Onset new or changed
- Onset in thunderclap presentation
- Papilloedema, Pulsatile tinnitus, Positional provocation, Precipitated by exercise

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4
Q

Pathophysiology of tension headache

A

Tension in muscles of head and neck e.g. occipitofrontalis

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5
Q

Epidemiology of tension headache

A
  • female > males
  • young > older
  • first onset > 50 is unusual
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6
Q

Presentation of tension-type headache

A
  • generalised to occipitofrontalis region
  • bilateral
  • +/- radiate to neck
  • squeezing/band like constriction
  • non pulsalitie
  • mild-moderate intensity
  • worse at end of day
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7
Q

Aggravating factors of tension type headaches

A
  • stress
  • poor posture e.g. at a computer
  • lack of sleep
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8
Q

What is the commonest headache?

A

Tension-type headache

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9
Q

Epidemiology of migraines

A
  • female > male
  • present early to mid-life
  • most likely first attack by 30
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10
Q

Pathophysiology of migraines

A
  • unclear
  • possibly due to inflammation of trigeminal sensory neurones > alters way pain is processed by brain > increased sensitivity
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11
Q

Presentation of migraine

A
  • unilateral + often frontal
  • throbbing + pulsating
  • moderate-severe (can be disabling)
  • prolonged (4-72 hours)
  • often family history
  • associated symptoms - photophobia, photophobia, aura, nausea
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12
Q

Aggregating factors of migraines

A
  • certain foods
  • menstrual cycle
  • stress
  • lack of sleep
  • photophobia
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13
Q

Relieving factors of migraines

A

Sleep
Simple analgesics
triptans

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14
Q

Epidemiology of medication overuse headache

A
  • female > male
  • 30-40 years old
  • in patients with pre-existing headache disorder
  • patient uses analgesics on at least 10 days/month
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15
Q

Pathophysiology of medication overuse headache

A

Up regulation of pain receptors in meninges

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16
Q

Presentation of medication overuse headache

A
  • presents of at least 15 days/month
  • no improvement after OTC meds
  • variable character
  • often co-exists with depression + sleep disturbance
17
Q

Management of medication overuse headache

A

Discontinue medication

18
Q

Epidemiology of cluster headaches

A
  • male > female
  • smoking history
  • 30-40 year olds
  • 1 in 1000
19
Q

Pathophysiology of cluster headaches

A
  • unkown
  • possible due to hypothalamic activation with secondary trigeminal + autonomic involvement
20
Q

Presentation of cluster headache

A
  • unilateral, around or behind eye
  • sharp, stabbing + penetrating
  • severe (often disabling)
  • occurs in clusters with periods of remission
  • usually at night
  • associated symptoms: red, watery eye, nasal congestion + ptosis
21
Q

Aggregating factors of cluster headaches

A
  • alcohol + smoking
  • volatile smells
  • warm temp
  • lack of sleep
22
Q

Management of cluster headaches

A

Oxygen
Triptans

23
Q

Associated autonomic symptoms of cluster headaches

A

Red, watery eye
Nasal congestion
Ptosis

24
Q

Presentation of headache due to space occupying lesion

A
  • gradual, progressive
  • dull
  • mild severity
  • worse in mornings
  • worsens on leaning forwards, coughing + valsalva manoeuvre
  • associated neurological signs + symptoms
25
Q

Aggregating factors of headache due to space occupying lesion

A
  • leaning forwards
  • cough
  • valsalva manoeuvre
26
Q

Epidemiology in trigeminal neuralgia

A
  • female > male
  • 50-60 /increasing age
27
Q

Pathophysiology of trigeminal neuralgia

A
  • compression of trigeminal nerve due to loop of blood vessel (most common)
  • tumours, MS or skull base abnormalities
28
Q

Presentation of trigeminal neuralgia

A
  • unilateral
  • pain felt in 1+ division of trigeminal nerve
  • sharp, stabbing, ‘electric shock’ feeling
  • severe
  • lasting seconds - 2 mins
  • sudden onset
  • associated symptoms: tingling, numbness, radiating pain to areas of CN V distribution
29
Q

Aggravating factors of trigeminal neuralgia

A
  • light touch to face
  • eating
  • cold wind
  • combing hair
  • vibrations
30
Q

Investigations of headaches

A
  • dependent on cause
  • headache diary for chronic
  • imaging if red flags
31
Q

Treatment of headaches

A
  • depends on cause
  • simple analgesia
  • triptans for migraines
  • high low oxygen for cluster headaches
32
Q

What is temporal arteritis?

A

Vasculitis involving small + medium sized arteries of head

33
Q

Epidemiology of temporal arteritis

A
  • female > male
  • > 50 years (most commonly >75 years)
34
Q

When should temporal arteritis is considered?

A

Any patient > 50 year old with abrupt onset of headache + visual disturbance or jaw claudication

35
Q

What artery is commonly involved in temporal arteritis?

A

Superficial temporal artery

36
Q

What is an important risk of temporal arteritis?

A

Irreversible loss of vision de to ischaemia of optic nerve

clinical neuroscience (20 decks)

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