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Psychiatry > Headache > Flashcards

Headache Flashcards

0
Q

Causes of functional headaches (old classification)

A

External compression - muscle tension or tight headwear
Benign exertional - migraine or cough related pain
Sexual activity - preorgasmic or postorgasmic, orgasmic headaches are disease related

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1
Q

Headaches can be broken into

A

Functional and disease associated

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2
Q

Symptoms of disease related (sinister) headaches

A

Stabbing headache - icepick pain (brain freeze) <3mins
Exploding head syndrome - loud bang in head or myoclonic jerk equivalent, common when falling asleep
Epilepsy

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3
Q

Environmental causes of headaches

A

Drugs - alcohol, weed, coke, Chinese restaurant syndrome, hot dog syndrome, histamine
Location - mountain sickness (hydration and aspirin)
Metabolic - low oxygen, high CO2, low glucose, rebound after vasodilators

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4
Q

Chinese restaurant syndrome

A

Headache due to high mono sodium glutamate intake

Pressure tightness in face and burning trunk

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5
Q

Hot dog syndrome

A

Headache due to nitrates in cured meats

Used to give a red appearance

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6
Q

For a diagnosis of migraine

A

Five or more lifetime attacks lasting 4-72hrs
Two or more headache features - Moderate/severe pain, Unilateral,Throbbing/pulsating,Exacerbated by routine activities
One or more non-headache features - nausea, photophobia, phonophobia, smell sensitivity
Aura
Must exclude other causes of headaches

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7
Q

Types of benign headache

A

Acute - migraine, everyday-tension-type headache, other

Chronic - cluster (4hrs), other

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8
Q

A common cause of chronic daily headaches

A

Long term high dose Analgesic use

Different drugs take longer to ware off, codeine and caffeine may take three month. NSAIDs only a couple of days

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9
Q

Migraine prevalence

A

Much more common in women, linked to hormones
Affect mid aged people most
Peak at 40-50 years
Onset early in life with increased frequency with age

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10
Q

Likely diagnosis of patients presenting to headache clinic

A

Chronic daily headache (CDH) - 60%
Migraine - 33%
Cluster headaches - 5%
Short sharp headaches - 4%

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11
Q

Cluster headaches

A

Severe, recurrent unilateral headache affecting the temporal and periorbital region
Rapid onset lasting up to an hour, associated with redness of the eye, ipsilateral lacrimation and horner’s syndrome

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12
Q

Cluster headaches most often occur

A

More common In Men with peak onset at 30

Often will continue occurring for 1-4 months followed by a 6 month headache free period

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13
Q

Tension headaches

A

Feeling of tightness around the occipitotemporal area bilaterally due to tension in the muscles
Usually without associated features
Often occur chronically and daily and can be precipitated by a stressful event

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14
Q

Raised intracranial pressure

A

Dull throbbing pain generalised around the whole top half of the head getting worse over time
Is worse on waking and often wakes the patient from sleeping
Is aggregated by straining and improves when the patient stands
Associated with nausea/vomiting, confusion, papilloedema and visual disturbances

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15
Q

Migraines are associated with

A

Patent foremen ovale - higher frequency of significant PFO in patients with migraine with aura, no effect of closure
Mental disorders - causality unknown. Likely that in part due to the QOL impact of frequent severe migraines

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16
Q

Patent foremen ovale are also associated with

A 
As well as migraine with aura
Arterial hypoaemia
Transient global amnesia
Paradoxical gas embolism/decompression illness
Paradoxical thromboembolism and stroke
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17
Q

Temporal Arteritis

A

Unilateral temporal pain with scalp tenderness, and jaw claudication
Palpation of the sup. temporal artery is painful and pulseless
If untreated permanent visual loss is possible, other features include fever, malaise and weight loss.

18
Q

Temporal arteritis commonly affects

A

Women over the age of 60

There is a strong association with polymyalgia rheumatica

19
Q

Sinusitis

A

Infection and Inflammation of the sinuses causing blockage
Presents as a persistent, worsening cold with a constant dull ache over the frontal and maxillary sinuses and facial tenderness
Associated with fever, congestion and sore throat.
Worse on bending over

20
Q

Trigeminal Neuralgia

A

Multiple episodes of unilateral stabbing pain lasting seconds
Mainly in the maxillary and mandibular areas of the trigeminal distribution
Triggered by brushing teeth, eating, drinking, shaving or washing

21
Q

Red flags for sinister headaches

A

Age of onset >50yrs
Additional symptoms: rash, temperature, scalp tenderness
Persistent symptoms or signs between attacks
Abrupt onset, especially with vomiting

22
Q

Time course of a migraine

A

A prodromal phase of increasing hypo perfusion leading to development of an aura
Onset of a headache with hyperperfusion which slowly normalises during recovery

23
Q

Drug Treatments for migraine

A

Triptans plus NSAIDs- relief from pain and associated symptoms
- 5HT1b mediated vasoconstriction
- 5HT1d trigeminal inhibition and decreased spinal pain transmission
Erogots - useful for symptomatic relief but worse side-effects

24
Q

Status migrainous

A

Frequent, semi-regular migraine attacks

Can become chronic migraine if superimposed over CTTH

25
Q

Preventative treatment for migraines

A

Topiramate

Acupuncture supported for frequent migraines

26
Q

Botox

A

Now approved for migraine treatment
Cgrp release is blocked to prevent central sensitisation and may down-regulate production of neuropeptides in the dorsal horn
Found to give extra 40hours a month of headache free life

27
Q

Cerebral abscess

A

Can present with continous headache leading to collapse and confusion and focal neurological symptoms

28
Q

Subarachnoid haemorrhage

A

Will present with symptoms of raised intracranial pressure after head trauma or exterior
May show very rapid progression

29
Q

Tumour or other space occupying lesion (SOL)

A

May present with headaches or symptoms of RIP

As tumour grows will develop focal neurological symptoms/visual disturbance/aura without migraine etc

30
Q

Meningitis

A

Continuous headache with sudden fever and blanching rash
Becomes confused with neck stiffness and possible positive kernig’s sign (pain limiting passive extension of a flexed knee when the hip is flexed) and brudzinski’s sign (flexion of the neck causing involuntary hip and knee flexion)

31
Q

Number of neurology referrals for headaches?

A

30%

32
Q

Migraines in children

A

Tend to finish faster, 1-12 hours

33
Q

Chance a headache is sinister?

A

1%

34
Q

ETTH

A

Episodic tension type headache

35
Q

Treatments for migraine

A

Non drug treatments - preventing attack, lifestyle
Preventers - propranolol, topiramate (not great,side effects)
Rescue drugs - triptans with NSAIDs,ergotamine,drugs to improve gastric motility

36
Q

Cerebral blood flow in migraine

A

Initial vasoconstriction linked to aura
Subsequent vasodilation associated with headache
Not clear causality

37
Q

Occipital migraine

A

Migraine with pain localises to back of head
More nausea and dizziness
Can cause collapse

38
Q

Treatments for tension type headache

A

Non drug mainly

Massage or stress relief

39
Q

Patients with confusing symptoms might have

A

May have multiple superimposed headache types
Chronic tension type headache with migraines or status migrainosus
May also be due to analgesic overload

40
Q

Chronic migraine

A

Over 8 days for 3 months

Sufficient migraine symptoms and previous migraine diagnosis

41
Q

Abdominal pain syndrome

A

Migraine equivalent
Similar precipitants
Common in children
Often cause unneeded appendectomy

42
Q

Treating cluster

A

Lifestyle - alcohol can trigger
Preventatives - verapamil, lithium, gapentin, steroids for a couple of weeks (useful in short clusters)
During attacks - oxygen and injectable triptans

Psychiatry (18 decks)

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