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Year 2 - Nervous > Headache > Flashcards

Headache Flashcards

(74 cards)

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1
Q

2 broad categories of headaches

A

Primary

Secondary

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2
Q

What is a primary headache/ cause

A

Headache that is due to the headache condition itself and not due to another cause

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3
Q

What is a secondary headache

A

Headache that is present because of another condition, i.e. a structural or biochemical cause

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4
Q

Name 3 primary headaches

A

Tension type headache
Migraine
Trigeminal autonomic cephalalgias, e.g. cluster headache

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5
Q

Name examples of trigeminal autonomic cephalagias (4) + name the most common one

A

Cluster headache - most common

Paroxysmal hemicranias

SUNCT (Short lasting unilateral headache with conjunctival injection & tearing)

SUNA (Short lasting unilateral headache with autonomic symptoms)

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6
Q

Name causes of secondary headaches (6) + name the secondary headaches that they cause

A

Brain tumour
Meningitis
Cerebrovascular disorders, e.g. aneurysm/haemorrhage
Systemic infection, e.g. sinus headache
Head injury, e.g. post-traumatic headache
Drug-induced, e.g. medication overuse headache, spinal headache (after epidural)

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7
Q

Name conditions that cause secondary headaches (7)

A 
Trigeminal neuralgia
Subarachnoid haemorrhage
Meningitis
Encephalitis
Space occupying lesions/raised ICP
Intracranial hypotension
Giant cell arteritis
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8
Q

What headache does subarachnoid haemorrhage cause

A

Thunderclap headache (secondary)

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9
Q

What is the most frequent non-disabling/ disabling primary headache +

A

Tension type headache

Migraine - disabling

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10
Q

What is a migraine

A

Chronic, genetically determined, episodic neurological disorder that usually presents in early-to-mid life

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11
Q

What is the headache from a migraine thought to be caused by

A

Activation and sensitisation of the trigeminal sensory neurons

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12
Q

Triggers of migraine (4)

RF of migraine (4)

(slightly different things)

A

Stress
Lack of sleep
High caffeine intake
Changes in oestrogen level

Female
FH
Obesity
Overuse of headache medication

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13
Q

People with migraine are … to normal stimuli due to what

A

Hyper-responsive

Enhanced cortical responsiveness

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14
Q

Causes of enhanced cortical responsiveness in people with migraine (2)

A

Insufficient cortical inhibition

Reduced pre-activation of sensory cortices

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15
Q

Name the 4 phases of a migraine + label which 2 of these are pre-headache phases

A

Premonitory phase (pre-headache phase)
Aura phase (also pre-headahce)
Headache phase
Postdrome ( post-headache)

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16
Q

List some pre-monitory symptoms that may be predictors of a migraine attack (4)

A

Mood alteration
Food cravings
Fatigue
Increased irritability to light/sound

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17
Q

Does the aura phase occur in every migraine attack

A

No

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18
Q

What is aura

A

Term used to describe focal reversible neurological symptoms of a migraine that precedes the headache, e.g. visual, sensory, motor or speech symptoms

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19
Q

Name 3 types of aura (focal reversible neurological symptoms of a migraine that precedes the headache) + list symptoms that can occur during the aura phase of a migraine (5)

A

Visual - vision loss, blind spots, hemianopia - VISUAL IS MOST COMMON AURA
Sensory - paraesthesia
Motor - weakness on one side

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20
Q

An aura is not always followed by a headache - name this type of migraine

A

Acephalic migraine (migraine aura without headache)

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21
Q

What can the aura phase of a migraine often be confused with

A

TIAs

because also sudden onset, loss of function

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22
Q

What is the headache phase of a migraine attack subdivided into + describe the clinical features of each (2) (4)

A

Early phase - mild pain, no other symptoms

Advanced phase - moderate to severe pain + other symptoms (nausea, photophobia, functional disability)

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23
Q

Describe the postdrome phase of migraine attack (2)

A

Migraine associated symptoms may still be occurring after headache has resolved

Involves functional disability for 1 or 2 days

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24
Q

Clinical features of a migraine

  • characteristics of the pain (4)
  • migraine associated symptoms (3)

Headache of a migraine must have at least 2 of the pain characteristics and at least 1 of the migraine associated symptoms

A

Unilateral
Pulsating
Moderate or severe pain
Aggravated by routine/simple physical activity

Nausea
Photophobia
Phonophobia

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25
Define criteria of a chronic migraine (3)
Headache for ≥ 15 days per month, of which ≥ 8 days have to be migraine, for more than 3 months
26
Do associated migraine symptoms improve/worsen in people with chronic migraine (2)
Improve | Become less frequent and less severe
27
Symptoms (3) /signs (3) of a migraine in adults
Prolonged headache - UNILATERAL PULSATILE PAIN Nausea Functional disability Photophobia Photophobia Headache worse with activity
28
Signs of migraine in children (3)
Confusion Ataxia Aphasia
29
What does chronic migraine often cause and ultimately what other type of headache does this lead to
Medication overuse Leads to medication overuse headache (secondary headache)
30
Are migraines unilateral or bilateral | Are tension type headaches unilateral or bilateral
Unilateral Bilateral
31
Clinical features of a tension type headache (5) - pain characteristics (4) - other symptoms
Bilateral Generalised head pain, but often frontal or occipital Non-pulsatile Constricting pain - feels like a tight band Tenderness of head, neck and muscles of mastication
32
Abortive (acute attack) (3) + preventative (ongoing chronic*) (2) treatment of tension type headaches (TTH) *chronic tension headache = >7 a month
Abortive treatment: Aspirin or paracetamol or NSAIDs Preventative: (rarely used) Tricyclic antidepressants -Amitryptiline -Doxepin
33
Abortive (acute attack) (3) + preventative (ongoing) (4) treatment of migraines
Abortive: - Aspirin or NSAIDs - for mild acute attack - Triptans - for severe acute attack Preventative (ongoing): - propanolol - beta blocker - anti-convulsants - topiramate - tricyclic antidepressants - amitryptiline - antidepressant - venlafaxine (if have co-existing depression)
34
How long is abortive treatment for headaches used
10 days a month to prevent medication overuse headache
35
Treatment of migraine in pregnant people (2)
Paracetamol only | Avoid triggers
36
Anti-epileptics (e.g. sodium valproate, lamotrigine, topiramate, carbamazepine, levetericetam) shouldn't be given to what people
Women of child bearing age
37
What are trigeminal autonomic cephalalgias
A group of headache disorders characterised by attacks of unilateral pain in the head or face + associated IPSILATERAL cranial AUTONOMIC features such as eye watering, redness, rhinorrhoea, nasal congestion, and ptosis
38
Cranial autonomic signs (7) of trigeminal autonomic cephalalgias
``` Conjunctival injection Lacrimation Nasal congestion/rhinorrhoea Eyelid oedema Forehead + facial sweating Miosis (constriction of pupil) ptosis ```
39
What division of CN V is involved in trigeminal autonomic cephalalgias
CN V1 - ophthalmic
40
Cluster headaches - duration - frequency - pattern throughout year
Longest and least frequent of all the TACs Last 15 mins - 3 hours Up to 8 attacks a day Last average 3 months then remission of up to a year; could be just a month
41
What do cluster headache attacks correlate with physiologically
Circadian rhythm - attacks usually occur same time each day and the bout occurs same time each year
42
Symptoms /signs of cluster headaches - pain (characteristic, location) - other symptoms (4) - autonomic signs (6)
Excruciating (sharp stabbing, burning) UNILATERAL pain localised to the orbital, supra-orbital, and/or temporal areas Associated symptoms - nausea, vomiting, photophobia, agitation/restless ``` Ipsilateral autonomic signs: • conjunctival injection • Lacrimation • Rhinorrhoea • eyelid oedema/swelling • facial sweating • ptosis ```
43
Treatment of cluster headaches - abortive treatment of an acute attack (2) - acute attack suppression (2) - preventative treatment/ongoing treatment (3)
Abortive treatment of acute attack: • Subcutaneous sumatriptan (triptan) • Supplemental oxygen Acute attack suppression: • Greater occipital nerve (GON) block - mixture of steroid + LA injected into GON on symptomatic side • Prednisolone Preventative: • Verapamil - CCB - 1ST LINE, OR • Lithium OR • Topiramate - anticonvulsant
44
Pain character of: - Cluster headache - Paroxysmal hemicrania - SUNCT
Sharp throbbing Sharp throbbing Stabbing burning, pulsating
45
Symptoms (1) /signs (7) of paroxysmal hemicranias | -pain (characteristic, location)
Excruciating unilateral pain localised to orbital and temporal areas Ipsilateral cranial autonomic signs (7) - see other flashcard
46
Duration/frequency of paroxysmal hemicranias (PH)
2-30 mins - shorter than cluster | 1-40 attacks a day - more frequent than cluster (up to 8)
47
Paroxysmal hemicranias are more often chronic or episodic
Chronic
48
Treatment of paroxysmal hemicranias (2) + what drug does PH respond to very well*
*Indomethacin - eliminates symptoms | Anti-epileptic - topiramate
49
Symptoms (1) /signs of short lasting unilateral headache with conjunctival injection + tearing (SUNCT) (8) + where is pain localised -pain (characteristic, location)
Excruciating unilateral pain located in orbital, supraorbital and temporal area Ipsilateral autonomic signs (8)
50
Duration/frequency of SUNCT
5 secs - 3 mins | 3 - 200 attacks a day
51
Triggers of SUNCT/SUNA (4)
Wind Cold Touch Chewing
52
Name the 3 patterns of attacks in SUNCT
single stab attacks; groups of stabs; saw-tooth pattern - group of stabs occurring in quick succession such that the pain does not return to baseline between stabs
53
Abortive/preventative (4) treatment of SUNCT/SUNA
No abortive treatment ``` Preventative with anti-convulsants/epileptics: Lamotrigine, Topiramate gabapentin Carbamazepine ```
54
What is trigeminal neuralgia
Facial pain syndrome of the areas innervated by the trigeminal nerve
55
2 causes of trigeminal neuralgia
Compression of CN V often due nearby blood vessel | MS - loss of myelin of CN V
56
What divisions of CN V are involved in trigeminal neuralgia
CN V2 & V3
57
Symptoms of trigeminal neuralgia | -pain (characteristic + location)
Severe sharp stabbing FACIAL PAIN in the lower face - jaw, teeth and gums NO AUTONOMIC SYMPTOMS/SIGNS
58
Duration/frequency of trigeminal neuralgia
5 secs - 10 secs | 3 - 200 attacks a day
59
Treatment of trigeminal neuralgia - abortive treatment - preventative (ongoing) treatment (2) - surgical treatment if medication unresponsive (2)
No abortive treatment - just prescribed with anticonvulsants when diagnosed Prophylaxis with anti-convulsants: • carbamazepine OR oxcarbazepine Surgical intervention: • Microvascular decompression • Ablative surgery - e.g. steriotactic radiosurgery
60
Triggers of trigeminal neuralgia (4) - same as SUNCT triggers
Touching your face Wind Chewing Cold
61
List some red flags of secondary headaches (6)
``` New onset headache Change in headache frequency or character Focal neurological symptoms Neck stiffness/fever Hypotension Giant cell arteritis ```
62
Symptoms/signs of a thunderclap headache caused by subarachnoid haemorrhage + duration of headache
High intensity headache reaching max intensity in less than a min and lasts for at least an hour
63
Differentials of a thunderclap headache (subarachnoid haemorrhage isn't the only cause) (4)
Primary headache - migraine, primary exertion headache Subarachnoid haemorrhage TIA/stroke Carotid/vertebral dissection
64
Treatment of thunderclap headache caused by subarachnoid haemorrhage (4)
Surgical clipping of aneurysm or endovascular coil embolisation CCBs Anticonvulsants
65
Causes of a headache due to raised ICP/space occupying lesion (4)
Tumour - e.g. GBM, meningioma Haemorrhage Cerebral abscess Hydrocephalus
66
Clinical features of a headache caused by raised ICP/space occupying lesion (4)
Headache worse in morning Headache worse lying flat or brought on by valsalva (cough, strain) Focal symptoms/signs Seizures
67
Cause of intracranial hypotension
Dural CSF leak either spontaneous or iatrogenic (e..g post LP)
68
What improves/worsens a low pressure headache (i.e. a headache caused by intracranial hypotension)
Improves when lying down | Worsens when upright
69
Treatment of a headache caused by intracranial hypotension (5)
``` Bed rest IV fluids Analgesia IV caffeine - to raise CSF pressure Epidural blood patch - injecting a sample of your own blood into the epidural space; clotting factors of the blood close the hole in the dura ```
70
Where is the headache localised in giant cell arteritis
Temporal areas
71
What condition is giant cell arteritis associated with
Polymyalgia rheumatica
72
Symptoms of polymyalgia rheumatic (2)
Aching and stiffness in the neck, shoulders, hips, and proximal extremities
73
Treatment of a headache caused by giant cell arteritis
High dose prednisolone
74
Investigations of giant cell arteritis (4)
ESR - raised CRP - raised FBC Temporal artery biopsy - definitive diagnosis

Year 2 - Nervous (39 decks)

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