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Headache Flashcards

1
Q

what are the two type so headache

A

primary

secondary

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2
Q

what are more common - primary or secondary headaches

A

90% primary

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3
Q

what are types of primary headaches

A

tension type
migraine (+/- chronic)
cluster headache

medication overuse headache

trigeminal autonomic cephalagias

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4
Q

what are the characteristics of tension type headaches

A

most frequent type of primary headache

NOT disabling

  • mild, bilateral
  • pressing or tension quality
  • no associated features
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5
Q

what makes a tension headache infrequent, frequent or chronic

A

infrequent <1day/month

frequent 1-14 days/month

chronic >15 days/month

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6
Q

what are the treatments for tension type headaches

A

abortive

  • aspirin/paracetamol
  • NSAIDS

preventive
- tricyclic antidepressants

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7
Q

how should abortive treatment of TTH be taken and why

A

Limit to 10 days per month (~2 days per week) to avoid the development of medication overuse headache

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8
Q

what is migraine

A

most frequent DISABLING headache (in the WHO tope 20 disabling conditions)

chronic disorder with episodic attacks - complex brain changes

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9
Q

what is the basic pathology of migraine

A

arises from primary brain dysfunction that leads to activation and sensitisation of the trigeminal system

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10
Q

what are the symptomsfor migraine

A

during:
headache
nausea, photophobia, phonophobia
fucntional disability

inbetween:
enduring predisposition to future attacks

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11
Q

what are some triggers for migraine

A 
sleep disturbance 
hunger
dehydration
diet
stress
environmental stimuli
changes in oestrogen level in women
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12
Q

what are the five stages in a migraine

A

premonition (pre headache)

aura (mild)
early headache (moderate)
advanced headache (severe)

postdrome (post headache)

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13
Q

what are the symptoms seen in the premonition stage

A 
mood changes
fatigue
cognitive changes
muscle pain
food craving
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14
Q

what are the symptoms seen in the aura stage

A

fully reversible

neurological changes: Visual somatosensory

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15
Q

what are the symptoms seen in the early headache stage

A

dull headache
nasal congestion
muscle pain

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16
Q

what are the symptoms seen in the advanced headache stage

A 
unilateral throbbing
nasuea
photophobia
phonophobia
olfactophobia
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17
Q

what are the symptoms seen in the postdrome stage

A

fatigue
cognitive changes
muscle pain

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18
Q

what is aura

A

transient neurological symptoms from cortical/brainstem dysfunction

involves visual, sensory, motor, speech - slow evolution of symptoms from one area to the next

duration - 15-60 mins

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19
Q

how can aura be confused with an ischaemic attack

A

loss of function
sudden onset

symptoms all start at the same time and can be localised to a specific vascular area

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20
Q

what classifies a chronic migraine

A

headache >15 days/month of which >8 days are migraine

for more than 3 months

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21
Q

what is a transformed migraine

A

history of episodic migraine increasing in frequency over weeks/months/years

but migrainous symptoms become less frequent and severe

can occur with or without escalation in medication use

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22
Q

what is classified as a medication overuse headache

A

headache >15 days/month which has developed whilst taking regular symptomatic medication

particularly occurs in migraines

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23
Q

what can cause medication overuse headache and how can it be improved

A 
>10 days/month:
triptans
ergots
opioids
combination analgesics

> 15 days/month:
simple analgesics

caffeine overuse

improvement seen when stopping use

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24
Q

what are the treatments for migraine

A

abortive:
aspirins/NSAIDS
triptans

prophylactic:
propanolol, candesartan
anti-epileptics
tricyclic antidepressants
venalafaxine
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25
how can migraine be affected in pregnancy
first migraine can present in pregnancy migraine without aura gets better during pregnancy treatment more difficult during pregnancy: acute attack - paracetamol preventative - propranolol, amitriptiline
26
what drug is contraindicated for active migraine with aura
combined OCP
27
what migraine treatments must be avoided in women of child bearing age
anti-epileptics - teratogenic
28
what are the different types of trigeminal autonomic cephalagias
cluster headache paroxysmal hemicrania SUNCT - short lasting unilateral neuralgiform headache with conjunctival injection and tearing SUNA - short lasting unilateral neuralgiform headache with autonomic symptoms trigeminal neuralgia
29
what are the characteristics of trigeminal autonomic neuralgia
unilateral head pain very sever/excruciating cranial autonomic symptoms
30
what are some of the cranial autonomic symptoms
Conjunctival injection / lacrimation Nasal congestion / rhinorrhoea Eyelid oedema Forehead & facial sweating Miosis / ptosis (Horner’s syndrome)
31
what are the characteristics of cluster headache
pain - mainly orbital and temporal strictly unilateral rapid onset duration 15mins-3hours rapid cessation of pain "suicide headache"
32
what are the symptoms of cluster headache
prominent ipsilateral autonomic symptoms premonitory - tiredness, yawning associated - nausea, vomiting, photophobia, phonophobia typical aura
33
when can cluster headaches occur
episodic bouts - bouts last 1-3 months - remission for ~1 month - attack frequency - 1 every other day to 8 per day
34
what is the circadian rhythmicity of cluster headaches
attacks occur at the same time each day bouts occur at the same time each year
35
what constitutes a chronic cluster
bouts lasting >1 year without remission remissions lasting <1 month
36
what are the characteristics of paroxysmal hemicranias
pain - mainly orbital and temporal unilateral rapid onset duration - 2-30 mins frequency 2-40 attacks per day (no circadian rhythm) rapid cessation of pain 10% attacks may be precipitated by bending or rotating the head
37
what are the symptoms of paroxysmal hemicranias
no neurological symptoms associated with it prominent ipsilateral autonomic symptoms migraine symptoms
38
what is the treatment for paroxysmal hemicrania
no abortive treatment prophylactic: indometacin
39
what are the characteristics of SUNCT
pain - orbital, supraorbital, temporal unilateral stabbing or pulsating pain - with red eye and lacrimation duration - 10 secs - 4 mins frequency - 3-200/day - no refractory period
40
what are the triggers for SUNCT
cutaneous triggers - wind, cold - touch - chewing
41
what are the characteristics of trigeminal neuralgia
pain - maxillary, mandibular - ophthalmic division unilateral stabbing pain duration 5-10 seconds frequency - 3-200 day - refractory period
42
what are the triggers for trigeminal neuralgia
cutaneous triggers: wind, cold touch chewing
43
what are the treatments for cluster headache
abortive headache: subcutaneous sumatriptan abortive bout: occipital depomedrone injection preventative: verapamil lithium
44
what are the treatments for SUNCT/SUNA
no abortive treatment prophylaxis: gabapentin carbamazepine
45
what are the treatments for trigeminal neuralgia
no abortive treatment prophylaxis: carbamazepine surgical intervention - glycerol ganglion injection - decompressive surgery
46
what features can predict a sinister secondary headache
Associated head trauma First or worst Sudden (thunderclap) onset New daily persistent headache Change in headache pattern or type Returning patient
47
what are some secondary headache red flags
new onset headache new/change in headache (esp >50, immunosuppression, cancer) neck stiffness/fever high pressure - worse when lying down low pressure - worse when sitting up abnormal neurological examination jaw claudication visual disturbance prominent/beaded temporal arteries
48
what is a thunderclap headache
high intensity headache reaching maximum intensity in less than 1 minute can be primary or secondary - no differentiating features
49
what are the differential diagnosis for thunderclap headache
Primary headache (migraine, primary thunderclap headache, primary exertional headache, primary headache associated with sexual activity) Subarachnoid haemorrhage Intracerebral haemorrhage TIA / stroke Carotid / vertebral dissection Cerebral venous sinus thrombosis Meningitis / encephalitis Pituitary apoplexy Spontaneous intracranial hypotension
50
what is a subarachnoid haemorrhage
bleeding into the subarachnoid space
51
how might someone present with a subarachnoid haemorrhage
sudden severe headache that peaks within a few minutes and lasts for at last an hour examination often normal - never consider a patient "too well" for SAH
52
what investigations can diagnose SAH
SAME DAY hospital assessment CT brain LP - must be done >12 hours after headache onset - allows for breakdown of bilirubin CT +/- LP unreliable beyond 2 weeks and angiography required after this time
53
what is the most common cause of subarachnoid haemorrhage
aneurysm - early clipping/coiling can save lives!
54
how might meningism present
nausea +/- vomiting photo/phonophobia stiff neck headache and fever look for non-blanching rash!
55
how might encephalitis
altered mental state/consciousness focal sympotms/signs, seizures headache and fever
56
what are the warning features for a space occupying lesion and /or raised ICP
progressive headache Headache worse in morning or wakes patient from sleep Headache worse lying flat or brought on by valsalva (cough, stooping, straining) Focal symptoms or signs Non-focal symptoms e.g. cognitive or personality change, drowsiness Seizures Visual obscurations and pulsatile tinnitus
57
what can cause intracranial hypotension
dural CSF leak spontaneous iatrogenic (post LP)
58
what are the characteristics of intracranial hypotension headache
clear postural component - develops or worsens soon after assuming an upright posture - resolves when lying down once it becomes chronic - often looses postural component
59
what investigations cane diagnose intracranial hypotension
MRI - brain and spine
60
what is the treatment for intracranial hypotension
bed rest, fluids, analgesia, caffeine IV caffiene epidural blood patch
61
what can cause raised intracranial pressure
cerebral abscess hydrocephalus papilloedema menangioma
62
what is giant cell arteritis and when should it be considered
arteritis of large arteries should be considered in any patient over the age of 50 years presenting with a new headache
63
what are the characteristics of giant cell arteritis
usually diffuse, persistent, cane be severe headache systemically unwell scalp tenderness, jaw claudication, visual disturbance prominent/beaded temporal arteries
64
what can help diagnose GCA
elevated ESR raised CRP raised platelet count
65
what is the treatment for GCA
high dose prednisolone temporal artery biopsy

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