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Year 3 Primary Care > Headaches > Flashcards

Headaches Flashcards

1
Q

Why can assessment of headaches be difficult?

A

Difficulties in quantifying symptoms as well as co-existence of several types in some cases

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2
Q

What are some specific symptoms to consider with headaches?

A 
Aura
Autonomic features
Systemic/neurological features
Contacts with similar symptoms
Effect on daily activities
Drug History
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3
Q

What is an Aura?

A

Visual, auditory or gustatory disturbances that preceed/accompany a headache

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4
Q

Why is the effect on daily activities important with headaches?

A

Some are debilitating, others are not

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5
Q

What are some features suggestive of a new-onset severe headache?

A 
Fever
Papilloedema
New-onset neurological deficit
Change in behaviour
Atypical aura
Dizziness
Visual disturbances
Vomiting
Recent severe head trauma
Current or recent pregnancy
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6
Q

Why is a current/recent pregnancy concerning with a new-onset headache?

A

Possibly Pre-eclampsia

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7
Q

What features suggest a headache being a Migraine without Aura?

A 
5 attacks of:
Headache lasting 4-72h
Unilateral, pulsing, moderate/severe pain
Aggrevated by exercise
N+V
Photophobia
Phonophobia
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8
Q

What features suggest a headache being a Migraine with Aura?

A 
2 attacks of:
Aura
2/more in succession
Aura lasts 5-60 mins
Aura accompanied by headache
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9
Q

What are some examples of Auras?

A

Visual symptoms
Sensory symptoms
Speech and language symptoms
Motor weakness

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10
Q

What features suggest a headache being a Tension-Type?

A

Recurrent episodes lasting from 30mins-7 days not associated with N+V with at least two of:
Bilateral
Pressing/Tightening quality
Mild/moderate intensity
Not aggrevated by routine physical activity

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11
Q

What features suggest a Cluster headache?

A

At least 5 attacks of unilateral orbital, supraorbital or temporal pain lasting 15-180 minutes

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12
Q

What associated symptoms can there be with Cluster headaches?

A

Nasal congestion
Facial Sweating
Miosis

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13
Q

How often do Cluster headaches occur while active?

A

At least every other day

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14
Q

What features suggest a Medication overuse headache?

A

Headache at least 15 days of the month after regularly overusing medication for more than 3 months to treat a primary headache

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15
Q

Which medications can lead to a medication overuse headache?

A

Ergotamines
Analgesics
Triptans
Opioids

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16
Q

What is a secondary headache?

A

A headache due to another pathology/cause

17
Q

What are some causes of secondary headache?

A 
Trauma/injury to the head/neck
Cranial or cervical vascular disorders
Non-vascular intracranial disorders
Exposure to/withdrawal from a substance
Infection
Disorders of Homeostasis
Disorders of Facial/Cranial structures
Psychiatric disorders
18
Q

What is the recommended management for Cluster headaches?

A

Sumatriptan Sub-Cut
6mg initially, another 6mg after 1 hour if needed
Maximum of 12mg per day

19
Q

What is Sumatriptan?

A

Serotonin (5HT) Agonist

20
Q

How does Sumatriptan work?

A

Serotonin agonist leads to blood vessel constriction and inhibition of pro-inflammatory neuropeptide release, reducing pain

21
Q

What is the recommended management for Medication overuse headaches?

A

Advise the patient on the cause of the headaches, then withdraw causative medication
Psychological symptoms

22
Q

What should the patient be told when withdrawing medication to treat a medication overuse headache?

A

Symptoms will get worse before they get better

23
Q

What information is useful for patients to collect when suffering from headaches?

A

Headache diary

24
Q

What is the recommended management for Tension-Type headaches?

A

Simple analgesia - Paracetamol + NSAIDs

25
Q

Which medication should Tension-type headaches not be offered?

A

Opioids

26
Q

What should be identified with diagnosed Tension-Type headaches?

A

Co-morbidities/Casuative factor

27
Q

What is the recommended management for Migraines?

A

Simple Analgesia
Sumatriptan - 50-100mg/day
Metacloperamide for N+V

28
Q

What preventative treatment for Migraines is recommended?

A

Propanolol
Topiramate
Amitryptylline

Year 3 Primary Care (4 decks)

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