Headache Flashcards
(26 cards)
What are the key features of a migraine headache?
Unilateral, pulsating headache lasting 4–72 hours, often with photophobia, phonophobia, nausea, and may have aura (visual or sensory).
What is the classical presentation of a cluster headache?
Severe unilateral periorbital pain with lacrimation, nasal congestion, ptosis, and redness of the eye; occurs in clusters over weeks.
What is a red flag feature of a thunderclap headache?
Sudden onset of severe headache reaching maximum intensity within seconds to minutes; consider subarachnoid hemorrhage.
What distinguishes tension-type headache from migraine?
Tension headache is typically bilateral, pressing/tightening (non-pulsating), mild to moderate intensity, and not aggravated by activity.
Which features suggest raised intracranial pressure as the cause of headache?
Worse in the morning or on coughing, associated with nausea/vomiting, blurred vision, and papilledema.
What secondary causes should be ruled out in a patient with new headache over age 50?
Temporal arteritis, intracranial mass, stroke, and hypertensive crisis.
What are the diagnostic criteria for temporal arteritis (GCA)?
Age >50, new headache, temporal artery tenderness, ESR >50 mm/h, and biopsy showing granulomatous inflammation.
What is the most appropriate initial investigation for suspected subarachnoid hemorrhage?
Non-contrast CT head; if negative and high suspicion persists, follow with lumbar puncture for xanthochromia.
What are common triggers for migraine?
Stress, lack of sleep, certain foods (e.g., cheese, chocolate), hormonal changes, alcohol, and bright lights.
How is idiopathic intracranial hypertension typically diagnosed?
Young overweight female with headache and visual changes; MRI to rule out mass, then LP shows raised opening pressure with normal contents.
What investigations are indicated for a new-onset headache with red flags?
Urgent non-contrast CT head, ESR/CRP (for temporal arteritis), MRI brain if subacute, LP if CT is normal but SAH suspected, and eye exam for papilledema.
What is the first-line acute treatment for migraine?
Oral triptans (e.g., sumatriptan) + NSAIDs or paracetamol. Avoid opioids.
How is chronic migraine managed prophylactically?
Lifestyle modification, beta-blockers (e.g., propranolol), topiramate, amitriptyline, or CGRP inhibitors.
What are the classic features of giant cell arteritis (GCA)?
New headache (usually temporal), scalp tenderness, jaw claudication, visual symptoms, and constitutional signs (fatigue, weight loss, fever).
What is the most feared complication of GCA?
Irreversible vision loss due to anterior ischemic optic neuropathy.
What investigations support the diagnosis of GCA?
ESR/CRP (usually very high), temporal artery biopsy (gold standard), ultrasound of temporal arteries (halo sign), and FBC (anemia, thrombocytosis).
How is GCA treated acutely?
Start high-dose corticosteroids immediately (e.g. prednisolone 40–60 mg/day or IV methylprednisolone if visual symptoms) — do not delay for biopsy.
What adjunctive treatments or monitoring are required in GCA?
Bone protection (bisphosphonates, calcium/vitamin D), PPI, monitor glucose and BP, taper steroids slowly over 12–18 months.
What are key features of a cluster headache?
Severe unilateral periorbital pain, occurring in clusters (e.g., daily for weeks), with ipsilateral autonomic features (lacrimation, nasal congestion, ptosis, miosis).
How long does a typical cluster headache last?
15–180 minutes, occurring up to 8 times a day, often at night.
What is the acute treatment of cluster headache?
High-flow oxygen (100% via non-rebreather mask) and subcutaneous sumatriptan.
What are prophylactic options for cluster headache?
Verapamil (first-line), lithium or corticosteroids (short-term bridge), or occipital nerve stimulation in refractory cases.
What is medication overuse headache?
Chronic daily headache due to overuse of acute headache medications (>10–15 days/month for >3 months), particularly triptans, opioids, or NSAIDs.
How does MOH typically present?
Daily or near-daily headache, often worsening after stopping medication and improving after withdrawal, with a history of frequent analgesic use.
