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Headache Flashcards

1
Q

what is a primary headache?

A

Most common headache

No underlying medical cause

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2
Q

name a few primary headaches

A

Tension Type Headache
Migraine
Cluster Headache

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3
Q

what is a secondary headache?

A

has an identifiable structural or biochemical cause

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4
Q

give some causes of secondary headaches

A 
Tumour
Meningitis
Vascular disorders
Systemic infection
Head injury
Drug-induced
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5
Q

what is a tension-type headache?

A

Most frequent primary headache, but is NOT disabling and rarely presents to doctors
Mild, bilateral headache which is often pressing or tightening in quality, has no significant associated features and is not aggravated by routine physical activity

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6
Q

how often are infrequent ETTH?

A

< 1 day / month

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7
Q

how often are frequent ETTH?

A

1-14 days / month

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8
Q

how often are CTTH?

A

≥15 days/ month

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9
Q

what is the treatment for tension-type headache?

A

Abortive treatment
Aspirin or paracetamol
NSAIDs
Limit to 10 days per month (~2 days per week) to avoid the development of medication overuse headache

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10
Q

what is a migraine?

A

most frequent disabling primary headache
Most sufferers aged 20 to 50
A chronic disorder with episodic attacks
Complex changes in the brain

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11
Q

what are the symptoms during the attacks?

A

Headache
Nausea, photophobia, phonophobia
Functional disability

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12
Q

what are the symptoms in-between attacks?

A

Enduring predisposition to future attacks

Anticipatory anxiety

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13
Q

name some migraine triggers

A 
stress
sleep disturbance
changes in oestrogen level in women 
hunger
dehydration 
environmental stimuli 
diet
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14
Q

what are the 5 phases of a migraine attack?

A 
Premonitory Phase
Aura Phase 
Early headache
Advanced headache
Postdrome
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15
Q

how long do migraine attacks last?

A

4 to 72 hours

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16
Q

what is the Premonitory Phase?

A

predictors of the headache attack

Mood changes, muscle pain, food cravings, cognitive changes, fatigue

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17
Q

what is aura?

A

Affects 33% of migraineurs
Transient neurological symptoms resulting from cortical or brainstem dysfunction
May involve visual, sensory, motor or speech systems
15-60 minutes

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18
Q

what are the symptoms of early headache?

A

Dull headache
Nasal congestion
Muscle pain

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19
Q

what are the symptoms of advanced headache?

A 
Unilateral
Throbbing
Nausea
Photophobia
Phonophobia
Osmophobia
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20
Q

what is the Postdrome phase?

A

migraine-associated symptoms beyond the resolution of the headache
can last 1-2 days

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21
Q

what is a chronic migraine?

A

Headache on ≥ 15 days per month, of which ≥ 8 days have to be migraine, for more than 3 months

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22
Q

what is the treatment for medication overuse headaches?

A

discontinuing the overused medication often (but not always) dramatically improves headache frequency

23
Q

what is a transformed migraine?

A

History of episodic migraine
Increasing frequency of headaches
Migrainous symptoms become less frequent and less severe

24
Q

what is medication overuse headache?

A

Headache present on ≥15 days / month which has developed or worsened whilst taking regular symptomatic medication

25
when does medication overuse headache occur?
Migraineurs are particularly prone | Migraineurs taking pain medication for another reason can develop chronic headache
26
what causes medication overuse headache?
triptans, ergots, opiods and combination analgesics >10 days / month simple analgesics > 15 days per month Caffeine overuse: coffee, tea, cola, irn brew
27
what is abortive migraine treatment?
Aspirin or NSAIDs Triptans Limit to 10 days per month (~2 days per week) to avoid the development of medication overuse headache
28
what is prophylactic migraine treatment?
Propranolol, Candesartan Anti-epileptics Tricyclic antidepressants Venlafaxine
29
how does pregnancy affect migraine frequency?
Migraine without aura gets better in pregnancy | Migraine with aura usually does not change
30
what is Trigeminal Autonomic Cephalalgias?
type of primary headache that occurs with unilateral head pain in the trigeminal nerve area
31
describe a cluster headache attack
Pain: mainly orbital and temporal Attacks unilateral Rapid onset 15 mins to 3 hours Rapid cessation of pain Excruciatingly severe (“suicide headache”) Prominent ipsilateral autonomic symptoms Migrainous symptoms often present
32
describe the cluster headache bout
Episodic in 80-90% Attacks “cluster” into bouts typically lasting 1-3 months with periods of remission lasting at least 1 month Attack frequency: 1 every other day to 8 per day Striking circadian rhythmicity-same time every day 10-20% have chronic cluster
33
what is chronic cluster?
Bouts last >1 year without remission or | Remissions last <1 month
34
describe a Paroxysmal Hemicrania attack
``` Pain: mainly orbital and temporal Attacks unilateral Rapid onset 2-30 mins Rapid cessation of pain Excruciatingly severe Prominent ipsilateral autonomic symptoms Migrainous symptoms may be present Background continuous pain can be present Absolute response to indometacin ```
35
describe the Paroxysmal Hemicrania frequency
80% have chronic PH, 20% have episodic PH Frequency: 2-40 attacks per day (no circadian rhythm) Absolute response to indometacin
36
describe a SUNCT attack
Unilateral orbital, supraorbital or temporal pain Stabbing or pulsating pain 10-240 seconds duration Cutaneous triggers eg Wind Pain is accompanied by conjunctival injection and lacrimation
37
describe SUNCT frequency
3-200/day, no refractory period
38
describe Trigeminal Neuralgia attack
``` Unilateral maxillary or mandibular division pain > ophthalmic division Stabbing pain 5 - 10 seconds duration Cutaneous triggers eg cold Autonomic features are uncommon ```
39
describe Trigeminal Neuralgia frequency
3-200/day-similar to SUNCT, has a refractory period
40
What features predict sinister headache?
Serious intracranial pathology is very unlikely in longstanding episodic headache Presentations more likely to have a sinister cause Associated head trauma First or worst Sudden (thunderclap) onset New daily persistent headache Change in headache pattern or type
41
what are red flags of a sinister headache?
``` new onset headache new or change in headache aged over 50 abnormal neurological examination neck stiffness / fever high/low pressure GCA ```
42
what indicates high pressure headache
headache worse lying down headache wakening the patient up headache precipitated by physical exertion headache precipitated by valsalva manoeuvre risk factors for cerebral venous sinus thrombosis
43
what indicates low pressure headache
headache precipitated by sitting / standing up
44
what indicates Giant Cell Arteritis headache
``` Headache is usually diffuse, persistent and may be severe systemically unwell scalp tenderness jaw claudication visual disturbance beaded temporal arteries ```
45
what is a thunderclap headache?
A high intensity headache reaching maximum intensity in less than 1 minute Majority peak instantaneously
46
what must be tested for in patients with a thunderclap headache?
Subarachnoid Haemorrhage 1 in 10 patients with thunderclap headache will have a SAH 85% aneurysmal 50% mortality, 20% of survivors remain dependant Early coiling (or clipping) of the aneurysm saves lives
47
how is thunderclap headache investigated?
SAME DAY hospital assessment Does the patient have SAH or another secondary cause CT brain (3% negative at 12 hrs, 7% negative at 24 hrs) LP (must be done >12hrs after headache onset) CT +/- LP is unreliable beyond 2 weeks and angiography is required beyond this time
48
what should be considered in any patient presenting with headache and fever?
CNS infection Meningitis and Encephalitis Look for a rash!
49
what are the symptoms of Meningitis?
nausea +/- vomiting, photo/phono phobia, stiff neck
50
what are the symptoms of Encephalitis?
altered mental state / consciousness, focal symptoms / signs, seizures
51
what features suggest a space occupying lesion and/or raised intracranial pressure?
Progressive headache with associated symptoms and signs Headache worse in morning/lying flat or brought on by valsalva Focal symptoms or signs Non-focal symptoms e.g. cognitive or personality change, drowsiness Seizures- due to underlying structural causes Visual obscurations and pulsatile tinnitus
52
what causes Intracranial hypotension?
Dural CSF leak | Spontaneous or iatrogenic (post lumbar puncture)
53
what features suggest Intracranial hypotension?
headache precipitated by sitting / standing up | Once the headache becomes chronic it often loses its postural component
54
what supports the diagnosis of Giant cell arteritis?
An elevated ESR (usually >50, often much higher, rarely normal) Raised CRP and platelet count are other useful markers

Nervous System (37 decks)

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