Headache Flashcards
1
Q
What are primary headache?
A
Headache without underlying cause
2
Q
What are common types of primary headache?
A
Tension
Migraine
Cluster
3
Q
What can cause secondary headaches?
A
Tumours Meningitis Vascular disorders - e.g GCA Systemic infection Head injury - e.g SAH Drug induced
4
Q
Are all secondary headaches sinister?
A
No
5
Q
What is the most frequent headache?
A
Tension
6
Q
Do TTH often present to the doctors?
A
No
7
Q
What are the symptoms of a tension headache?
A
Mild
Bilateral headache
Often pressing or tightening in quality
Band round the head
8
Q
What is classed as an infrequent tension headache?
A
<1 day/month
9
Q
What is classed as a frequent tension headache?
A
1-14 days/month
10
Q
What is classed as a chronic tension type headache (CTTH)?
A
> 15 days/month
11
Q
What is the treatment for TTH?
A
Aspirin or paracetemol
NSAID’s
12
Q
What should be the limit for TTH Rx?
A
Limit to 10 days per month to avoid the development of medication overuse headache
13
Q
What is the most frequent disabling primary headache?
A
Migraines
14
Q
Why are migraines more common in females?
A
Due to their hormone cycle
Change in oestrogen levels
15
Q
What is a migraine?
A
Chronic disabling headache with features
16
Q
What other symptoms can present in a headache?
A
Nausea Vomiting Photophobia Phonophobia Functional disability
17
Q
What are common triggers of migraine?
A
Stress Hunger Sleep disturbance Diet Environmental stimuli Changes in oestrogen in women
18
Q
What is the premonitory phase of a migraine?
A
Prediction of the headache attack
Mood alterations
Muscle pain,
Food cravings
19
Q
What is the aura phase of a migraine?
A
An aura involves focal, reversible neurologic symptoms that often precede the headache
Seeing stars and fuzzy
20
Q
What is aura?
A
Transient neurological symptoms
May involve visual, sensory, motor or speech systems
21
Q
What can aura be confused with?
A
TIA
22
Q
What is the duration of aura?
A
15-60 minutes
23
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
24
Q
What is the abortive treatment for migraine?
A
Triptans
Paracetemoy
NSAIDS
25
What is the prophylactic treatment for migraine?
Propanolol
| Amitriptyline
26
How does migraine without aura change in pregnancy?
Gets better
27
How does migraine with aura change in pregnancy?
Usually does not change
28
What contraceptive is contraindicated in active migraine with aura?
Combined OCP
| Oestrogen and progesterone
29
What is a migraine?
Chronic disorder with episodic attacks
| Due to complex changes in the brain
30
What % of migraineurs ecperience aura?
33%
31
Who are particularly prone to medication overuse headaches?
Migraineurs
32
What is the limit for the use of drugs for migraine?
Limit to 10 days per month to avoid development of MOH
33
When can woman with migraines and aura go on the OCP?
If she hasn't had an attack in 5 years
34
Why should anti-epileptics be avoided in pregnancy?
Because they are teratogenic
35
What should be used in a woman of child bearing age for pain relief?
Paracetemol
36
What is a trigeminal autonomic cephalalgia?
Trigeminal autonomic cephalgia (TAC) is the name for a type of primary headache that occurs with pain on one side of the head in the trigeminal nerve area and symptoms in autonomic systems
37
What are the 3 main TAC?
Cluster headache
Paroxysmal Hemicrania
SUNCT/SUNA
38
What is the pain experienced in TAC?
Predominantly of the area V1 supplies (eye and forehead area)
Very severe and excruciating
With ipsilateral autonomic symptoms
39
What cranial autonomic symptoms are there in TAC?
```
Red eye
Nasal conjection
Lacrimation
Eyelid oedema
Forehead and facial sweating
```
40
Where is the pain in cluster headache?
Mainly orbital and temporal
41
Are cluster attacks bi or unilateral?
Unilateral
42
What is the onset in cluster headaches?
Rapid
| Max onset is 9 minutes
43
What is the duration of a cluster headache?
15mins to 3 hours
44
What are the symptoms of a cluster headache?
Excruciating unilateral pain
Suicide headache
Restlessness and agitation during an attack
Prominent ipsilateral autonomic symptoms
45
What are some assocaited symptoms of cluster headaches?
Tiredness, yawning, nausea, vomiting, photophobia, phonophobia
46
What is a bout in cluster headaches?
Attacks cluster into bouts typically lasting 1-3 months with periods of remission lasting at least 1 month
47
What is the attack frequency in a bout of cluster headaches?
1 every other day
| to 8 per day
48
Can alcohol trigger cluster headaches?
During a bout yes
| During remission no
49
What is cluster headache all about in the history?
Timing
Comes in bouts of daily attacks
Then goes away for months at a time
50
What is chronic cluster headaches defined as?
Remissions < 1 month or
| Bouts last > 1 year without remission
51
Where is pain felt in paroxysmal hemicrania?
Mainly orbital and temporal
52
Is paroxysmal pain usually bi or uni later?
Unilateral
53
What is the duration of paraoxysmal hemicrania?
2-30 mins
54
What is the pain intensity for paroxysmal hemicrania?
Very severe
55
Does cluster headache have circadian rhythm?
Yes Frequently
56
Does SUNCT have circadian rhythm?
Absent
57
Does circadian rhythm occur in paroxysmal hemicrania?
Not typically
58
What is SUNCT?
Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT syndrome), is a rare headache disorder that belongs to the group of headaches called trigeminal autonomic cephalalgia (TACs).
59
What autonomic symptoms are experienced with SUNCT?
```
Lacrimation
Ptsosis
Eyelid oedema
Nasal conjestion
Conjunctival injection
```
60
What is the character of pain in SUNCT?
Stabbing or pulsating pain
61
What is the duration of SUCNT?
2-240 seconds
62
What is trigeminal neuralgia?
Trigeminal neuralgia (TN or TGN) is a chronic pain disorder that affects the trigeminal nerve
63
Which branches are usually affected in trigeminal neuralgia?
V2/V3 >V1
64
What is the character of pain in trigeminal neuralgia?
Stabbing
65
What is the duration of pain in trigeminal neuralgia?
5-10 seconds
66
Are autonomic features common in trigeminal neuralgia?
No
67
What is the difference between SUNCT and trigeminal neuralgia?
TN- no autonomic features
Predominantly over eye area
SUNCT- autonomic features
Predominant over maxillary and mandibular area
68
What triggers trigeminal neuralgia?
Wind
Cold
Touch
Chewing
69
What presentations of secondary headache are more likely to have a sinister cause?
```
Associated head trauma
First or worst
Progression in headache
Sudden thunderclap headache
New daily persistent headache
Changes in pattern or type
Returning patient
```
70
What are red flags for headaches?
```
New onset
New or change
>50
on immunosuppresion
have cancer
changes in headache frequency, characteristics or associated symptoms
Focal neurological symptoms
Abnormal examination
Neck stiffness or fever, photophobia
```
71
What is a thunderclap headache?
A high intensity headache reaching maximum intensity in less than minutes
Starts mainly at back of head
72
What is the main worry with thunderclap headaches?
SAH
73
What is the main cause of subarachnoid haemorrhage?
85% aneurysmal
| Berry aneurysms
74
What is the mortality for subarachnoid haemorrhage?
50%
75
What is the presentation of SAH?
All patients presenting with a sudden severe headache that peaks within a few minutes and lasts for at least 1 hour need to be assessed
Examination is often normal!
Never consider a patient ‘too well’ for SAH
76
When should LP be done for SAH?
>12 hours
77
What are the symptoms of meningitis?
Meningism: nausea +/- vomiting, photo/phono phobia, stiff neck
Non blancing rash
78
What are the warning features for a headache that could be due to space occupying lesion or raised ICP?
```
Headache:
Worse in morning
Worse lying down
Brought on by valsalva
Focal symptoms or signs
Seizures
Visual obscurations
Pulsatile tinnitus
```
79
What is pulsatile tinnitus?
Ear noise that is heard in time with heartbeat
80
What is ICP hypotension due to?
Dural CSF leak
81
What causes iatrogenic ICP hypotension?
Post lumbar puncture
82
What is distinguishing about headaches with low ICP?
Headache develops or worsens soon after assuming an upright posture and lessens or resolves shortly after lying down
83
What investigations should be done for low ICP?
MRI brain and spine
84
What is the treatment for low ICP?
```
Bed rest
Analgesia
Caffeine
IV caffeine
Epidural blood patch
```
85
What is an epidural blood patch?
Using the patients own blood to seal the hole
86
What causes the pain in low ICP headaches?
Due to low pressure the brain sinks
| Pulls on the vessels and the meninges causing pain
87
What is giant cell arteritis?
Arteritis of large arteries
| Temporal arteritis
88
What type of headache is experience with giant cell arteritis?
Diffuse, persistent and may be severe
89
What supports the diagnosis of giant cell arteritis?
Raised ESR
90
What are the special clinical features of giant cell arteritis?
Scalp tenderness,
Jaw claudication
- pain when eating or chewing
Visual disturbance
91
What are other useful markers for giant cell arteritis?
Raised CRP
| Raised platelet count
92
Rx for giant cell arteritis?
High dose prednisolone
93
What investigation should be done to confirm the diagnosis of giant cell arteritis?
Temporal artery biopsy
94
What is giant cell arteritis?
Giant-cell arteritis (GCA), also called temporal arteritis, is an inflammatory disease of blood vessels.
Inflammation of the temporal artery
