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NEURO > Headache > Flashcards

Headache Flashcards

1
Q

what are the two type so headache

A

primary

secondary

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2
Q

what are more common - primary or secondary headaches

A

90% primary

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3
Q

what are types of primary headaches

A

tension type
migraine (+/- chronic)
cluster headache

medication overuse headache

trigeminal autonomic cephalagias

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4
Q

what are the characteristics of tension type headaches

A

most frequent type of primary headache

NOT disabling

  • mild, bilateral
  • pressing or tension quality
  • no associated features
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5
Q

what makes a tension headache infrequent, frequent or chronic

A

infrequent <1day/month

frequent 1-14 days/month

chronic >15 days/month

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6
Q

what are the treatments for tension type headaches

A

abortive

  • aspirin/paracetamol
  • NSAIDS

preventive
- tricyclic antidepressants

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7
Q

how should abortive treatment of TTH be taken and why

A

Limit to 10 days per month (~2 days per week) to avoid the development of medication overuse headache

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8
Q

what is migraine

A

most frequent DISABLING headache (in the WHO tope 20 disabling conditions)

chronic disorder with episodic attacks - complex brain changes

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9
Q

what is the basic pathology of migraine

A

arises from primary brain dysfunction that leads to activation and sensitisation of the trigeminal system

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10
Q

what are the symptomsfor migraine

A

during:
headache
nausea, photophobia, phonophobia
fucntional disability

inbetween:
enduring predisposition to future attacks

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11
Q

what are some triggers for migraine

A 
sleep disturbance 
hunger
dehydration
diet
stress
environmental stimuli
changes in oestrogen level in women
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12
Q

what are the five stages in a migraine

A

premonition (pre headache)

aura (mild)
early headache (moderate)
advanced headache (severe)

postdrome (post headache)

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13
Q

what are the symptoms seen in the premonition stage

A 
mood changes
fatigue
cognitive changes
muscle pain
food craving
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14
Q

what are the symptoms seen in the aura stage

A

fully reversible

neurological changes: Visual somatosensory

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15
Q

what are the symptoms seen in the early headache stage

A

dull headache
nasal congestion
muscle pain

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16
Q

what are the symptoms seen in the advanced headache stage

A 
unilateral throbbing
nasuea
photophobia
phonophobia
olfactophobia
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17
Q

what are the symptoms seen in the postdrome stage

A

fatigue
cognitive changes
muscle pain

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18
Q

what is aura

A

transient neurological symptoms from cortical/brainstem dysfunction

involves visual, sensory, motor, speech - slow evolution of symptoms from one area to the next

duration - 15-60 mins

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19
Q

how can aura be confused with an ischaemic attack

A

loss of function
sudden onset

symptoms all start at the same time and can be localised to a specific vascular area

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20
Q

what classifies a chronic migraine

A

headache >15 days/month of which >8 days are migraine

for more than 3 months

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21
Q

what is a transformed migraine

A

history of episodic migraine increasing in frequency over weeks/months/years

but migrainous symptoms become less frequent and severe

can occur with or without escalation in medication use

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22
Q

what is classified as a medication overuse headache

A

headache >15 days/month which has developed whilst taking regular symptomatic medication

particularly occurs in migraines

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23
Q

what can cause medication overuse headache and how can it be improved

A 
>10 days/month:
triptans
ergots
opioids
combination analgesics

> 15 days/month:
simple analgesics

caffeine overuse

improvement seen when stopping use

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24
Q

what are the treatments for migraine

A

abortive:
aspirins/NSAIDS
triptans

prophylactic:
propanolol, candesartan
anti-epileptics
tricyclic antidepressants
venalafaxine
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25
Q

how can migraine be affected in pregnancy

A

first migraine can present in pregnancy

migraine without aura gets better during pregnancy

treatment more difficult during pregnancy:
acute attack - paracetamol
preventative - propranolol, amitriptiline

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26
Q

what drug is contraindicated for active migraine with aura

A

combined OCP

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27
Q

what migraine treatments must be avoided in women of child bearing age

A

anti-epileptics - teratogenic

28
Q

what are the different types of trigeminal autonomic cephalagias

A

cluster headache

paroxysmal hemicrania

SUNCT - short lasting unilateral neuralgiform headache with conjunctival injection and tearing

SUNA - short lasting unilateral neuralgiform headache with autonomic symptoms

trigeminal neuralgia

29
Q

what are the characteristics of trigeminal autonomic neuralgia

A

unilateral head pain
very sever/excruciating

cranial autonomic symptoms

30
Q

what are some of the cranial autonomic symptoms

A

Conjunctival injection / lacrimation

Nasal congestion / rhinorrhoea

Eyelid oedema

Forehead & facial sweating

Miosis / ptosis (Horner’s syndrome)

31
Q

what are the characteristics of cluster headache

A

pain - mainly orbital and temporal

strictly unilateral

rapid onset

duration 15mins-3hours

rapid cessation of pain

“suicide headache”

32
Q

what are the symptoms of cluster headache

A

prominent ipsilateral autonomic symptoms

premonitory - tiredness, yawning

associated - nausea, vomiting, photophobia, phonophobia

typical aura

33
Q

when can cluster headaches occur

A

episodic bouts

  • bouts last 1-3 months
  • remission for ~1 month
  • attack frequency - 1 every other day to 8 per day
34
Q

what is the circadian rhythmicity of cluster headaches

A

attacks occur at the same time each day

bouts occur at the same time each year

35
Q

what constitutes a chronic cluster

A

bouts lasting >1 year without remission

remissions lasting <1 month

36
Q

what are the characteristics of paroxysmal hemicranias

A

pain - mainly orbital and temporal

unilateral

rapid onset

duration - 2-30 mins

frequency 2-40 attacks per day (no circadian rhythm)

rapid cessation of pain

10% attacks may be precipitated by bending or rotating the head

37
Q

what are the symptoms of paroxysmal hemicranias

A

no neurological symptoms associated with it

prominent ipsilateral autonomic symptoms

migraine symptoms

38
Q

what is the treatment for paroxysmal hemicrania

A

no abortive treatment

prophylactic:
indometacin

39
Q

what are the characteristics of SUNCT

A

pain - orbital, supraorbital, temporal

unilateral

stabbing or pulsating pain
- with red eye and lacrimation

duration - 10 secs - 4 mins

frequency - 3-200/day
- no refractory period

40
Q

what are the triggers for SUNCT

A

cutaneous triggers

  • wind, cold
  • touch
  • chewing
41
Q

what are the characteristics of trigeminal neuralgia

A

pain - maxillary, mandibular - ophthalmic division

unilateral

stabbing pain

duration 5-10 seconds

frequency - 3-200 day
- refractory period

42
Q

what are the triggers for trigeminal neuralgia

A

cutaneous triggers:
wind, cold
touch
chewing

43
Q

what are the treatments for cluster headache

A

abortive headache:
subcutaneous sumatriptan

abortive bout:
occipital depomedrone injection

preventative:
verapamil
lithium

44
Q

what are the treatments for SUNCT/SUNA

A

no abortive treatment

prophylaxis:
gabapentin
carbamazepine

45
Q

what are the treatments for trigeminal neuralgia

A

no abortive treatment

prophylaxis:
carbamazepine

surgical intervention

  • glycerol ganglion injection
  • decompressive surgery
46
Q

what features can predict a sinister secondary headache

A

Associated head trauma

First or worst

Sudden (thunderclap) onset

New daily persistent headache

Change in headache pattern or type

Returning patient

47
Q

what are some secondary headache red flags

A

new onset headache

new/change in headache (esp >50, immunosuppression, cancer)

neck stiffness/fever

high pressure - worse when lying down

low pressure - worse when sitting up

abnormal neurological examination

jaw claudication

visual disturbance

prominent/beaded temporal arteries

48
Q

what is a thunderclap headache

A

high intensity headache reaching maximum intensity in less than 1 minute

can be primary or secondary - no differentiating features

49
Q

what are the differential diagnosis for thunderclap headache

A

Primary headache (migraine, primary thunderclap headache, primary exertional headache, primary headache associated with sexual activity)

Subarachnoid haemorrhage

Intracerebral haemorrhage

TIA / stroke

Carotid / vertebral dissection

Cerebral venous sinus thrombosis

Meningitis / encephalitis

Pituitary apoplexy

Spontaneous intracranial hypotension

50
Q

what is a subarachnoid haemorrhage

A

bleeding into the subarachnoid space

51
Q

how might someone present with a subarachnoid haemorrhage

A

sudden severe headache that peaks within a few minutes and lasts for at last an hour

examination often normal - never consider a patient “too well” for SAH

52
Q

what investigations can diagnose SAH

A

SAME DAY hospital assessment

CT brain

LP - must be done >12 hours after headache onset - allows for breakdown of bilirubin

CT +/- LP unreliable beyond 2 weeks and angiography required after this time

53
Q

what is the most common cause of subarachnoid haemorrhage

A

aneurysm - early clipping/coiling can save lives!

54
Q

how might meningism present

A

nausea +/- vomiting
photo/phonophobia
stiff neck

headache and fever

look for non-blanching rash!

55
Q

how might encephalitis

A

altered mental state/consciousness
focal sympotms/signs, seizures

headache and fever

56
Q

what are the warning features for a space occupying lesion and /or raised ICP

A

progressive headache

Headache worse in morning or wakes patient from sleep

Headache worse lying flat or brought on by valsalva (cough, stooping, straining)

Focal symptoms or signs

Non-focal symptoms e.g. cognitive or personality change, drowsiness

Seizures

Visual obscurations and pulsatile tinnitus

57
Q

what can cause intracranial hypotension

A

dural CSF leak
spontaneous
iatrogenic (post LP)

58
Q

what are the characteristics of intracranial hypotension headache

A

clear postural component - develops or worsens soon after assuming an upright posture
- resolves when lying down

once it becomes chronic - often looses postural component

59
Q

what investigations cane diagnose intracranial hypotension

A

MRI - brain and spine

60
Q

what is the treatment for intracranial hypotension

A

bed rest, fluids, analgesia, caffeine

IV caffiene

epidural blood patch

61
Q

what can cause raised intracranial pressure

A

cerebral abscess
hydrocephalus
papilloedema
menangioma

62
Q

what is giant cell arteritis and when should it be considered

A

arteritis of large arteries

should be considered in any patient over the age of 50 years presenting with a new headache

63
Q

what are the characteristics of giant cell arteritis

A

usually diffuse, persistent, cane be severe headache

systemically unwell

scalp tenderness, jaw claudication, visual disturbance

prominent/beaded temporal arteries

64
Q

what can help diagnose GCA

A

elevated ESR
raised CRP
raised platelet count

65
Q

what is the treatment for GCA

A

high dose prednisolone

temporal artery biopsy

NEURO (51 decks)

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