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2a neuro > Headaches > Flashcards

Headaches Flashcards

1
Q

What are the types of primary headache?

A
  • Migraine
  • Cluster
  • Tension
  • Drug overdose
  • (Trigeminal neuralgia)
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2
Q

Define migraines

A

Unilateral, throbbing usually with a specific trigger, with or without aura

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3
Q

What is an aura?

A

neurological changes that accompany or precede the headache; FULLY REVERSIBLE visual, sensory or other CNS symptoms

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4
Q

What are some symptoms of migraines?

A

2 of
- unilateral pain
- throbbing
- motion sickness
- mod-severely intense
1 of
- nausea and vomiting
- photophobia/ phonophobia

WITH NORMAL NEURO EXAM

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5
Q

Describe the pathophysiology of migraines

A
  1. Prodrome (days before the attack) mood change
  2. Aura (part of attack, minutes before headache) visual changes, zig zag lines
  3. Throbbing headache lasting 4-72 hrs
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6
Q

What are some triggers of migraines?

A

CHOCOLATE

Chocolate
Hangover
Orgasms
Cheese
Oral contraceptives
Lie ins
Alcohol
Tumult (noise)/ travel
Exercise

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7
Q

How do you diagnose migraines?

A

Clinical unless other pathology suspected

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8
Q

How do you treat migraines?

A
  • At onset of headache - Triptans, 1st line is oral sumatriptan (or aspirin 900mg)
  • Simple analgesia first and foremost; paracetamol or NSAIDs
  • Prophylaxis - BB: Propranolol or Amitriptyline
  • Antiemetic treatment includes buccal prochlorperazine
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9
Q

What medication should you avoid in migraines?

A
  • Opiates: risk of dependence + worsens nausea
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10
Q

Define cluster headaches

A

Recurrent, unilateral headaches
centred around eye or temporal
region.

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11
Q

What are risk factors of cluster headaches?

A
  • Male
  • Smoking
  • Genetics
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12
Q

How long are cluster headaches?

A

Short attacks (15-180 mins)

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13
Q

What are the signs of a cluster headache?

A

ipsilateral autonomic signs:
- lacrimation + conjunctival infection (watery bloodshot eyes)
- rhinorrhoea (runny nose)
- miosis (dilated unilateral pupil)
- ptosis (droopy eyelid)
- sweating

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14
Q

What are symptoms of cluster headaches?

A
  • crescendo (rising in severity) unilateral periorbital moderate/excruciating pain and
    restlessness or agitation
  • most disabling primary headache
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15
Q

How do you diagnose cluster headaches?

A

Clinically
5 or more similar attacks confirms

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16
Q

What investigations do you do for cluster headaches?

A

Investigations are often to exclude more severe pathologies
- CT head and MRI.

17
Q

How do you treat cluster headaches?

A
  • First line management is sumatriptan and short burst oxygen therapy
  • verapamil (CCB) prophylactically
  • Avoiding potential triggers
    identified by the patient works too
18
Q

Define tension headaches

A

Bilateral generalised headache, radiates to neck

19
Q

Describe the pathophysiology of tension headaches

A
  • Most common primary headache
  • Bilateral, mild/moderate
    intensity, not worsened by
    routine physical activity
20
Q

What are the symptoms of tension headaches

A
  • Rubber band tight around the head presentation
  • Bilateral
  • NO nausea, NO photophobia or
    phonophobia
21
Q

What is a trigger of tension headaches?

A

Stress

22
Q

What are red flags that may accompany tension headaches?

A
  • Fever (Meningitis)
    -Neoplasm history (Metastatic disease)
    -Neurological deficit (Tumour)
  • Pregnancy (Pre-eclampsia)
    -Sudden onset (Haemorrhage/injury)
  • Older onset (GCA)
  • Reduced or loss in consciousness (Haemorrhage)
  • Papilloedema (Idiopathic Intracranial Hypertension)
    -Painful eye; autonomic features (Cluster headache)
  • Worsened by sitting or standing (CSF leak)
23
Q

How do you treat tension headaches?

A

Simple analgesia
- Aspirin or paracetamol
Avoid opiates (dependence)

24
Q

Define trigeminal neuralgia

A

Episodes of acute, severe facial
pain; electric shock in nature

25
Q

Describe the pathophysiology of trigeminal neuralgia

A
  • Unilateral pain in 1 or more trigeminal branch
  • Can be either due to vascular
    compression (primary),
    compression due to lesion
    (secondary) or idiopathic
26
Q

What are risk factors of trigeminal neuralgia?

A
  • MS (20x more likely)
  • Increasing age
  • Female
  • Family history
27
Q

What are triggers of trigeminal neuralgia?

A
  • Eating
  • Shaving
  • Talking
  • Brushing teeth
28
Q

How do you diagnose trigeminal neuralgia?

A
  • Pain should be from a fraction of
    a second to 3 minutes.
    -Severe intensity
  • 3 or more attacks with symptoms
29
Q

What are the symptoms of trigeminal neuralgia?

A

Electric shock pain, shooting, stabbing

30
Q

How do you treat trigeminal neuralgia?

A

Carbamazepine (anticonvulsant)
If that doesn’t work, lamotrigine or gabapentin.

31
Q

What are concerning features of a headache that need further investigation?

A

● Constant
● Nocturnal
● Worse on waking
● Worse on coughing, straining or bending forward
● Vomiting

2a neuro (33 decks)

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