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Year 2 - BRS > 2.8 - Headache > Flashcards

2.8 - Headache Flashcards

1
Q

What are some stats about headaches?

A
  • one-year prevalence of headache disorders is 50%
  • 20% of what neurologists see and care for
  • headache is highly disabling - 100,000 people are absent from work or school everyday
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2
Q

What can headaches be classified as by the International headache society?

A

Primary vs secondary

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3
Q

What are primary headache syndromes? (3)

A
  • migraine
  • tension-type headache
  • trigeminal autonomic cephalalgias (including cluster headache)
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4
Q

What are secondary headaches?

A

Headache is precipitated by another condition/disorder - local or systemic. Serious causes of secondary headache are uncommon.

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5
Q

What kind of headache is more common?

A

Primary headache is a lot more common than secondary headache

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6
Q

What can primary headache disorders be further separated into?

A
  • long-lasting headache (duration >4 hours) –> migraine + tension-type headache
  • short-lasting headache (duration <4 hours) –> trigeminal autonomic cephalalgia –> cluster headache
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7
Q

What is medication overuse headache?

A
  • due to painkillers
  • makes migraine worse as those that take painkillers might then get medication overuse headache
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8
Q

What is the clinical approach to headache?

A
  • history and examination
  • red flag?
  • if yes, secondary headache –> diagnostic tests
  • if no, primary headache? preliminary diagnosis
  • if this is another red flag then secondary headache –> diagnostic tests
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9
Q

What are four key red flags suggesting secondary headache?

A
  • age - new onset or different headaches in a person >50yrs
  • onset - sudden, abrupt onset of a severe headache (thunderclap headache)
  • systemic symptoms - fever, neck stiffness, rash, weight loss
  • neurological signs - confusion, impaired consciousness, focal neurology, swollen optic discs
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10
Q

What is key to the diagnosis of primary vs secondary headaches?

A

The history

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11
Q

What forms can a migraine exist in?

A

Episodic or chronic disorder

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12
Q

What are the characteristics of a migraine? (5)

A
  • unilateral localisation (begins one side)
  • pulsating quality
  • moderate/severe pain intensity
  • aggravation by routine physical activity
  • lasts hours and sometimes days
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13
Q

What do the characteristics of a migraine need to be accompanied by to be classed as a migraine?

A

Either of:

  • nausea and/or vomiting
  • photophobia and/or phonophobia
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14
Q

What can be present in migraines?

A

Auras

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15
Q

What is an aura?

A
  • complex array of symptoms reflecting focal cortical or brainstem dysfunction
  • gradual evolution: 5-30min (<60min)
  • usually before headache
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16
Q

What are some examples of auras? (4)

A
  • zigzags
  • flashes of light
  • expanding ‘C’s
  • elemental visual disturbance
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17
Q

What are the phases of a migraine? (5)

A
  • premonitory
  • aura
  • headache
  • resolution
  • recovery
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18
Q

What are the symptoms of the premonitory phase? (7)

A
  • yawning
  • polyuria
  • mood change
  • irritable
  • light sensitive
  • neck pain
  • concentration difficulty
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19
Q

What happens in the aura phase? (4)

A
  • visual and sensory phenomena
  • numbness/paraesthesia
  • weakness
  • speech arrest
20
Q

What happens in the headache phase? (3)

A
  • head and body pain
  • nausea
  • photophobia
21
Q

What happens in the resolution phase?

A

Rest and sleep

22
Q

What small issues does the recovery phase include? (4)

A
  • mood disturbed
  • food intolerance
  • feeling hungover
  • can take up to 48 hours
23
Q

How is migraine managed (general)?

A
  • lifestyle
  • then pharmacological therapy (acute/abortive or long term preventative)
24
Q

What lifestyle factors can help manage migraines? (5)

A
  • avoid triggers
  • diet
  • sleep
  • exercise
  • mindfulness
25
Q

What are examples of acute/abortive pharmacological therapy for migraines (take within 5-10min)? (5)

A
  • paracetamol (analgesia)
  • NSAIDs (high dose and soluble) - analgesia
  • prokinetics
  • triptans (5-HT 1B/1D/1F receptor agonists)
  • anti-emetics
26
Q

How does long term preventative pharmacological management of migraines work?

A
  • used when migraines occur >5 days/month
  • ‘low and slow’ with doses until at optimal dose
  • e.g. SNRIs, beta-blockers, serotonin antagonists, anticonvulsants
  • come with their own side effects
27
Q

What should be avoided in the management of migraines?

A

Opiate-based and mixed analgesics

28
Q

What are some migraine preventatives to be aware of? (8)

A
  • tricyclic anti-depressants (TCA): SNRIs
  • B-blockers
  • serotonin antagonists
  • anticonvulsants
  • calcium channel blockers
  • ACE inhibitors/angiotensin II receptor blockers
  • non-prescription
  • parenteral
29
Q

What are CGRP antibodies?

A

New medicines for preventing migraines

30
Q

What kind of headache is a tension-type headache?

A

Episodic

31
Q

What does a tension-type headache feel like?

A

Tight muscles around the head and neck, as though head is in a vice

32
Q

How long do tension-type headaches last?

A

Last around 30 mins but can be hours long

33
Q

What are some characteristics of tension-type headaches? (4)

A
  • bilateral
  • mild/moderate
  • not aggravated by movement
  • no added features typically: nausea/vomiting; photophobia/phonophobia
34
Q

How do we treat tension-type headaches?

A
  • reassurance may suffice in the majority of patients
  • individual attacks can be treated with simple analgesics e.g. aspirin/paracetamol
  • preventative medications rarely required
35
Q

What is a cluster headache?

A

Severe unilateral pain lasting 15-180 minutes untreated

36
Q

What do you see in cluster headaches (at least one of the following ipsilaterally)?

A
  • conjunctival redness and/or lacrimation
  • nasal congestion and/or rhinorrhoea
  • eyelid oedema
37
Q

What are some characteristics of cluster headaches? (3)

A
  • forehead and facial sweating
  • miosis and/or ptosis
  • a sense of restlessness or agitation
38
Q

What is a cluster headache not associated with?

A

Primary headache so not associated with brain lesion on MRI

39
Q

How do we acutely treat cluster headaches?

A
  • triptan - nasal or subcutaneous route
  • high flow oxygen - oxygen inhibits neuronal activation in the trigeminocervical complex
40
Q

How do we prevent cluster headaches? (Prophylactic treatment)

A
  • verapamil (calcium channel inhibitor) - get an ECG first
  • greater occipital nerve block (inject anaesthetic near nerve to relieve pain causing headaches)
41
Q

Migraine vs tension-type vs cluster: region affected?

A

Unilateral (though often bilateral) vs bilateral vs unilateral (never bilateral)

42
Q

Migraine vs tension-type vs cluster: type of pain?

A

Pulsating vs pressing/tightening/non-pulsating vs -

43
Q

Migraine vs tension-type vs cluster: severity?

A

Moderate or severe vs mild or moderate but not disabling vs very severe

44
Q

Migraine vs tension-type vs cluster: aggravations?

A
  • aggravated by/causing avoidance of routine physical activity VS
  • no aggravation by/avoidance of routine physical activity VS
  • restlessness, no aggravation by physical activity
45
Q

Migraine vs tension-type vs cluster: associated features?

A
  • nausea/vomiting, photophobia, phonophobia VS
  • no nausea/vomiting, photophobia, phonophobia VS
  • ipsilateral to pain: conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, eyelid swelling/drooping
46
Q

Migraine vs tension-type vs cluster: duration?

A

Attack lasts hours to days (usually 4-72h) vs attack lasts hours to days vs attack lasts from 15min to 3 hours

47
Q

Migraine vs tension-type vs cluster: frequency?

A

1-2 attacks per months vs - vs 1-3 attacks per day (up to 8) and usually occur daily for 2-3 months at a time

Year 2 - BRS (84 decks)

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