Headaches Flashcards
(97 cards)
1
Q
what is a primary headache ?
A
headache with no underlying medical cause
- disturbance in brain function
2
Q
give three examples of primary headaches ?
A
- migraines
- tension type headaches
- cluster head aches
3
Q
what is a secondary headache?
A
a headache with an identifiable structural or biochemical cause
4
Q
give 6 examples of secondary head aches ?
A
- tumours
- meningitis
- vascular disorders
- systemic infection
- head injury
- drug-induced
5
Q
are all secondary headaches sinister ?
A
no
6
Q
what percentage of headaches presenting at GPs are primary ?
A
90%
7
Q
are tension head aches disabling ?
A
no
8
Q
are migraine head aches disabling ?
A
yes
9
Q
are tensions head aches unilateral or bilateral ?
A
bilateral
10
Q
describe the pain of tension head aches
A
Mild, bilateral headache which is often pressing quality
11
Q
what is the treatment for tension headaches
- abortive treatment
- preventative treatment
A
abortive treatment
- NSAIDs
- aspirin
preventative treatment (rare) - tricyclic antidepressants
12
Q
how many people are affected by migraines ?
A
6 million
13
Q
what gender are most effected by migraines ?
A
females
14
Q
what age range is most effected by migraines ?
A
20-50yrs
15
Q
what causes migraines ?
A
complex circuit changes in the brain
16
Q
what symptoms are felt during a migraine ?
A
headache nausea photophobia phonophobia functional disability
17
Q
is a migraine bilateral or unilateral ?
A
unilateral
18
Q
can physical activity trigger a migraine ?
A
yes
19
Q
can physical activity trigger a tension headache ?
A
no
20
Q
state some triggers for migraines ?
A
- dehydration
- diet
- change in oestrogen
- stress
- after stress
- hunger
- sleep disturbance
21
Q
what are the 5 stages of a migraine ?
A
- premonitory
- aura
- early head ache
- advanced head ache
- postdrome
22
Q
what occurs in the premonitory stage of a migraine ?
A
mood change
fatigue
muscle pain
food craving
23
Q
what occurs in the aura stage of a migraine ?
A
visual somatosensory changes
24
Q
what occurs in the early headache stage of a migraine ?
A
dull head ache
nasal congestion
muscle pain
25
what occurs in the advanced headache stage of a migraine ?
```
unilateral
throbbing
nausea
photophobia
phonophobia
osmophobia
```
26
what occurs in the postdrome stage of a migraine ?
fatigue
cognitive changes
muscle pain
27
what percentage of migraineurs have aura?
33%
28
what can aura be confused with?
TIA
29
how many days a month does someone have to have a headache to have chronic migraines ?
>15days for >3months
30
what substances can trigger a headache?
- caffeine
| - over use of analgesias
31
what is the treatment of migraines ?
- abortive
- preventative
abortive
- aspirin
- NSAIDs
preventative
- b blocker
- anti-epileptics
- tricyclic antidepressants
- venlafaxine
32
do migraines get better or worse with pregnancy ?
better
33
what two drugs are women told to avoid if they have migraines ?
Combined OCP
| Anti epileptics
34
whats the treatment of migraines during pregnancy?
- abortive
- preventative
abortive
- paracetamol
preventative
- propranolol
35
what are the four types of trigeminal autonomic cephalalgias ?
cluster headache
paroxysmal hemicrania
SUNCT
SUNA
36
what are the symptoms someone experiences with trigeminal autonomic cephalalgias ?
very severe unilateral head pain
| cranial autonomic symptoms
37
state some cranial autonomic symptoms
- conjunctival infection
- nasal congestion
- eyelid oedema
- forehead sweating
- miosis/ptosis
38
where do patients with cluster head aches feel the pain?
around the eye and temporal area
39
are cluster head aches bi lateral or unilateral?
unilateral
40
do cluster head aches have a gradual on sudden onset?
sudden onset
41
what is the common duration of cluster head aches ?
15mins - 3 hours
42
do patients with cluster head aches want to stay still or move about?
they want to move about
| - whereas people with migraines want to stay still
43
do the autonomic symptoms of cluster head aches happen on the same or opposite side of the pain?
same side of the pain
44
can migraine symptoms be present during a cluster head ache?
yes
45
state some migraine symptoms ?
- tiredness (yawning)
- nausea
- photophobia
- phonophobia
- aura
46
can alcohol trigger a cluster head ache ?
yes
47
what is the typical episodic pattern of cluster head aches ?
1-3 months of attacks followed by 1 month of remission
| attacks typically occur at the same time everyday at the same time of year
48
what would make someone have chronic cluster head aches?
having attacks for over a year without remission
| or remissions last less then 1 month
49
is paroxysmal hemicranial unilateral or bilateral ?
unilateral
50
what is the pain on the head for paroxysmal hemicrania ?
around the eye and temporal area
51
are the autonomic symptoms on the same or opposite side of the pain during a paroxysmal hemicrania attack?
same side
52
how is paroxysmal hemicrania different from cluster head aches ?
paroxysmal hemicrania attacks are short and occur many in one day
53
what quality of pain is experienced with SUNCT?
stabbing pulsating pain
54
how long do SUNCT attacks last?
10-240 seconds
55
what can trigger SUNCT attacks ?
Wind
Cold
Touch
Chewing
56
where is the pain of trigeminal neuralgia?
unilateral maxillary or mandibular division pain
57
what is the main difference between trigeminal neuralgia and trigeminal autonomic cephalalgias ?
trigeminal neuralgia occurs at the lower parts of the face
58
what os the quality of pain with trigeminal neuralgia?
stabbing pain
59
what is the duration of trigeminal neuralgia?
5-10 seconds
60
what are some triggers of trigeminal neuralgia?
wind
cold
touch
chewing
61
are autonomic symptoms present with trigeminal neuralgia?
not present
62
what 3 treatments can be used for cluster head aches?
100%oxygen
subcutaneous sumatriptan
nasal zolmatriptan
63
what drug type own work for cluster head aches?
tablets
64
what four drugs can be used to prevent cluster head aches from occurring ?
verapamil
lithium
methysergide
topiramate
65
is there any abortive treatment for paroxysmal hemicrania ?
no
| - no drugs available
66
which trigeminal autonomic cephalalgias and trigeminal neuralgia conditions don't have any abortive treatment?
SUNCT
Trigeminal Neuralgia
Paroxysmal hemicrania
67
what treatment can be used as prevention for paroxysmal hemicrania ?
indomethacin
68
what treatment can be used as prevention for SUNCT ?
Lamotrigine
Topiramate
Gabapentin
Carbamazepine / Oxcarbazepine
69
what treatment can be used as prevention for trigeminal neuralgia ?
Carbamazepine / Oxcarbazepine
70
what three surgical options are available for trigeminal neuralgia ?
Glycerol ganglion injection
Steriotactic radiosurgery
Decompressive surgery
71
what presentations may indicate a sinister headache ?
- associated with head trauma
- sudden onset
- new daily persistent headache
- change in headache pattern
- returning patient
72
is a headache likely to be sinister if the headaches have a longstanding pattern episode ?
no
73
what are some red flags for head aches ?
new onset
new change in frequency, characteristic, associated symptoms
non-focal/focal neurological symptoms
neck stiffness
74
in what position would a high pressure head ache be worse ?
worse lying down
75
what can trigger a high pressure head ache ?
physical exertion
| valsalva manoeuvre
76
what is a risk factor for high pressure head aches ?
cerebral venous sinous thrombosis
77
in which position would a low pressure head ache be worse ?
sitting or standing up
78
what is the definition of a thunderclap head ache?
A high intensity headache reaching maximum intensity in less than 1 minute
79
what are some differential diagnoses which would have to be ruled out for a thunderclap head ache ?
```
SAH (subarachnoid haemorrhage)
Intracerebral haemorrhage
TIA/Stroke
carotid/ vertebral dissection
cerebral venous sinus thrombosis
meningitis
```
80
what percentage of people die form SAH?
50%
81
what are the two surgical treatments for a cerebral aneurysm ?
coiling
| clipping
82
is examination usually normal with a SAH patient ?
yes
83
what investigations should be done for a SAH?
```
CT scan
Lumbar puncture (>12 hours after headache onset)
Both tests should be done on the same day
```
84
state two types of CSF infections ?
Encephalitis and Meningitis
85
what are the symptoms of meningitis ?
nausea +/- vomiting, photo/phono phobia, stiff neck
86
what are the symptoms of encephalitis ?
altered mental state / consciousness, focal symptoms / signs, seizures
87
what rash is present during a CFS infection ?
rash which doesn't go away when you press on it
88
what could be a cause of intracranial hypotension ?
dural CSF leak
89
what are some warning signs which might indicate that the intracranial pressure is raised ?
head ache is worse
- in the morning
- when lying down
- during valsalva
focal symptoms:
weakness in one arm
non focal symptoms:
personality change, drowsiness
seizures
visual impairment
90
what investigation should be done for intracranial hypertension ?
MRI of brain and spine
91
is intracranial hypotension worse when standing or lying down?
standing up
92
what is the treatment for intracranial hypotension ?
```
bed rest
fluids
analgesia
caffeine
epidural blood patch
```
93
what is the main difference between intracranial hypotension and raised incracranial pressure ?
intracranial hypotension
- worse when standing up
raised incracranial pressure
- worse when lying down
94
what is giant cell arteritis ?
inflammation of large arteries
95
what are the symptoms of giant cell arteritis?
```
headache is diffuse, persistent and severe
systematically unwell
scalp tenderness
visual disturbance
prominent temporal arteries
```
96
what three blood tests should be done for giant cell arteritis?
- elevated ESR (>50)
- raised CRP
- raised platelet count
97
what treatment should be started if giant cell arteritis is suspected ?
high rise prednisolone
