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Year 2 Neuro (JK) > Headache > Flashcards

Headache Flashcards

(60 cards)

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1
Q

Is most headache primary or secondary?

A

primary

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2
Q

What does primary headache mean and give 3 examples

A

no underlying cause

migraine, cluster headaches and tension type headaches

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3
Q

What does secondary headache mean?

A

identifiable structure or biochemical cause

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4
Q

Give some causes of secondary headache

A

tumour, meningitis, raised IC, head injury, vascular disease, drugs, medication, systemic infection

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5
Q

Which is the most frequent primary headache?

A

tension type

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6
Q

Describe a tension type headache

A

Mild, bilateral headache which is pressing/tightening with no significant features and not precipitated by activity

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7
Q

How many days a month does tension type headache occur to be chronic?

A

> 15

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8
Q

Absorptive treatment of tension type headache (how often is too often to give these and why?)

A

paracetomol or aspirin
NSAIDS
>10 days/month - do not want to cause medication overuse headache

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9
Q

Which is the most frequent disabling primary headache?

A

migraine

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10
Q

What is migraine?

A

A chronic disorder with episodic attacks and complex changes in the brain

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11
Q

Migraine: during attacks

A

nausea, photophobia, phonophobia, headache, functional disability

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12
Q

Migraine: in between attacks

A

fatigue, anticipatory anxiety

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13
Q

Triggers for migraine

A

diet, stress, oestrogen changes, hunger, sleep disturbance, environmental stimuli

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14
Q

What is aura?

A

Transient neurological symptoms resulting from cortical or brainstem dysfunction

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15
Q

What systems can be affected in aura?

A

visual, sensory, motor or speech

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16
Q

What can aura be confused with and why?

A

TIA

15-60 minutes, sudden onset, loss of function

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17
Q

Criteria for a chronic migraine

A

> 15 days a month and 8 have to be migraine and this for more than 3 months

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18
Q

Transformed migraine changes

A

history of episodic migraine

increasing frequency of headaches over time and migrainous symptoms become less

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19
Q

How is medication overuse headache treated?

A

stopping the medication

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20
Q

What is medication overuse headache?

A

> 15 days a month which has developed or worsened since starting regular symptomatic medication

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21
Q

What can cause medication overuse headache?

A

analgesics and caffeine

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22
Q

Migraine - absorptive treatment

A

NSAIDS, aspirin

triptans

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23
Q

Tension type headache - prophylactic treatment

A

Rarely needed - tricyclic antidepressants eg amytriptiline

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24
Q

Migraine - prophylactic treatment

A

propranolol
anti epileptics eg valproate
tricyclic antidepressants

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25
Does migraine with or without aura get better in pregnancy?
without aura
26
Treatment in pregnant women for migraine
paracetomol | propranolol/amytriptiline
27
4 trigeminal autonomic cephalalgias
cluster headache paroxysmal hemicranias SUNCT SUNA
28
What are the cranial autonomic symptoms?
lacrimation, sweating on forehead, eyelid oedema, miosis/ptosis, nasal congestion
29
In trigeminal autonomic cephalalgius where is the pain?
unilateral - usually V1 - very severe
30
Do autonomic symptoms occur on the contralateral or ipsilateral side?
ipsilateral
31
Where is pain mostly in cluster headaches?
temporal and orbital
32
3 cycles of cluster headache
episodic circadian chronic
33
Cluster headaches - pain description
unilateral, rapid onset, 15mins-3hours, rapid cessation
34
How often do paroxysmal hemicranias last?
2-30minutes
35
What can paroxysmal hemicranias be precipitated by?
turning or rotating head
36
Treatment for paroxysmal hemicranias
nitric oxide
37
SUNCT - pain and duration
unilateral, supraorbital, orbital and temporal | 10-240s
38
cutaneous triggers of SUNCT and trigeminal neuralgia
cold, wind, chewing, touch
39
Are autonomic features common in SUNCT or trigeminal neuralgia?
SUNCT
40
What type of headaches do tablets not work quick enough?
cluster
41
Secondary headaches - sinister if..
recent onset, recent head trauma, change in character or pattern, sudden onset and new headache
42
What groups would you be particularly aware of secondary headaches in?
over 50s | immunosuppression and cancer
43
Neck stiffness/fever red flag of?
meningitis, subarachnoid haemorrhage
44
High pressure headaches worse when?
lying down, valsava manoeuvre
45
Causes of low pressure headaches
epidural | lumbar puncture
46
When are low pressure headaches worst?
standing up
47
Giant cell arteritis - 3 signs/symptoms
visual disturbance prominent temporal artery jaw claudication
48
What is thunderclap headache?
A high intensity headache running at maximal intensity in less than a minute and is a whole head headache which can be primary or secondary
49
Differential diagnosis of thunderclap headache
primary eg migraine, cluster haemorrhage TIA/stroke meningitis
50
Main cause of subarachnoid haemorrhage?
aneurysm
51
Investigation of subarachnoid haemorrhage?
CT brain, lumbar puncture, angiography
52
Meningism symptoms
Nausea with or without vomiting, photo/phonophobia, stiff neck
53
Encephalitis symptoms
Altered consciousness/mental state, focal symptoms, signs, seizures
54
Always look for what in suspected CNS infection?
rash, fever, headache
55
Causes for raised ICP
glioblastoma multiforme, abscess, venous infarct, haemorrhage, hydrocephalus, meningioma, papilloedema
56
Space occupying lesion features
Progressive headache with associated symptoms and signs
57
Warning symptoms of raised ICP
worse in morning and awakens from sleep worse lying flat seizures
58
What can cause intracranial hypotension (with examples)
dural CSF leak | idiopathic or iatrogenic eg lumbar puncture
59
Intracranial hypotension investigation and treatment
MRI brain and spine | bed rest, fluids, caffeine, epidural blood patch, analgesia
60
GCA - blood findings and investigations/treatment
ESR and CRP | temporal artery biopsy and prednisolone

Year 2 Neuro (JK) (50 decks)

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