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Headaches Flashcards

1
Q

What kind of onset may headaches have?

A

Acute
Subacute
Gradual

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2
Q

What kind of exacerbating factors may headaches have? Give examples.

A

Valsalva

e.g coughing, sneezing, straining

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3
Q

Headaches may have …….. variation

A

DIURNAL

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4
Q

Name some associated symptoms of headaches.

A

Photophobia, phonophobia, positive visual symptoms, ptosis, miosis, nasal stuffiness etc

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5
Q

Migraines tend to occur in…..

A

YOUNGER FEMALES

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6
Q

List the 5 red flags of headaches.

A 
New onset in someone >55
Known/previous malignancy
Immuno-suppressed
Early morning headache
Exacerbated by Valsalva
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7
Q

What should you be aware of in someone’s PMH?

A

Previous CA

Predisposition to thrombus

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8
Q

What should be asked about in FHx?

A

Migraines

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9
Q

What should you remember to ask about in drug history?

A

Over the counter medication

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10
Q

Headaches are more common in?

A

WOMEN

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11
Q

On average, how often do most people have an attack?

A

1 per month

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12
Q

What % experience migraine i) with aura ii) without aura?

A

i) 20%

ii) 80%

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13
Q

What is the HIS criteria for a migraine without aura?

A
  • At least 5 attacks.
  • Of duration 4-72hours.
    +
  • 2 of: moderate/severe, unilateral, throbbing pain, worse with movement.
  • 1 of: autonomic features, photophobia/phonophobia
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14
Q

What 2 influences cause an individual to be susceptible to migraines?

A

Neural and vascular

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15
Q

Describe the pathophysiology of a migraine.

A

Stress triggers changes in the brain, and these changes cause SEROTONIN to be released.

Blood vessels constrict and dilate.

Chemicals including SUBSTANCE P irritate nerves and blood vessels, causing pain.

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16
Q

Aura is a …….

A

FULLY REVERSIBLE visual, sensory, motor or language symptom

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17
Q

What does aura duration tend to be?

A

20-60 minutes

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18
Q

When does a headache occur in relation to aura?

A

<1 hour but both can occur simultaneously

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19
Q

What type of aura is most common?

A

VISUAL

positive symptoms usually monochromatic

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20
Q

Suggest factors which may trigger a headache.

A 
Sleep. 
Dietary – cheese, red wine. 
Stress. 
Hormonal – young females in early teens, or females in 40’s.
Physical exertion.
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21
Q

What can be used to help identify triggers?

A

A headache diary

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22
Q

Suggest non-pharmacological methods of treating a migraine.

A
  • Set realistic goals
  • Education – avoid triggers
  • Headache diary
  • Relaxation/Stress management
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23
Q

Pharmacological treatment is either?

A

Acute or Prophylactic

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24
Q

Outline the acute management of a headache.

A

Aspirin 900mg
Naproxen 250mg
Ibuprofen 400mg
+ anti-emetic

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25
What kind of drug are triptans?
5 HT agonist
26
When are triptans taken?
At the start of the headache
27
What should be considered when deciding the route of triptans?
If patient has nausea and vomiting then don't give oral
28
When should prophylaxis for headaches be considered?
If person is having more than 3 attacks per month, or very severe attacks
29
How long should a prophylactic drug be trialled for?
At least 3 months
30
What non-pharmacological methods should be tested for prophylaxis?
Acupuncture | Relaxation exercises
31
Name 2 prophylactic drugs.
Propanolol | Topiramate
32
What does propranolol do?
Reduction in migraine frequency in around 60-80% of patients.
33
What is the range of suitable doses of propanolol?
80-240mg
34
When should propranolol be avoided?
Asthma and PVD (heart failure)
35
What type of drug is topiramate?
A carbonic anhydrase inhibitor
36
What range of doses can be given for topiramate?
25-100mg
37
What are the side effects of topiramate? What should you therefore do?
``` Weight loss. Paraesthesia. Impaired concentration. Enzyme inducer START LOW, GO SLOW ```
38
What are the side effects of amitriptyline?
Dry mouth, postural hypotension, sedation
39
What dietary advice should you give?
Ensure regular intake Avoid triggers Maintain a healthy balanced diet
40
In terms of hydration, what should you tell patients?
At least 2 litres per day | Decrease caffeine
41
For a typical migraine, what investigations are required?
NONE
42
When should imaging for a migraine be considered?
If late onset - > 55. Known malignancy. Acephalgic (ie. no headaches) migraine
43
Migraine is?
A common UNILATERAL headache of the young
44
Consider prophylaxis for those who have more than 3 attacks per month
TRUE
45
Tension headaches can be either ........ or ......?
Episodic OR Chronic
46
Describe the main features of a tension headache.
Pressing/Tingling quality Mild to moderate Bilateral
47
What features sometimes associated with headache are absent in a tension-type headache?
Nausea Vomiting Photophobia Phonophobia
48
How are tension headaches managed?
* Relaxation physio * Anti-depressant for 3 months - dothiepin or amitriptyline * Reassurance is often enough
49
What are the Trigeminal Autonomic Cephalgias (TACs)?
A group of primary headache disorders, characterised by unilateral trigeminal distribution pain that occurs in association with prominent ipsilateral cranial autonomic features
50
What are ipsilateral cranial autonomic features?
``` Ptosis. Miosis. Nasal stuffiness. Nausea/vomiting. Tearing. Eye lid oedema ```
51
Name the 4 main types of TAC.
* Cluster. * Paroxysmal hemicrania. * Hemicrania continua. * SUNCT
52
Who tends to get cluster headaches?
young 30's - 40's | men > women
53
When do cluster headaches occur?
* Striking circadian (around sleep). | * Seasonal variation.
54
Describe features of a cluster headache.
* Severe UNILATERAL headache. |  unlike people with migraine, these people struggle to stay still.
55
What is the duration of cluster headaches?
45-90 minutes
56
What is the frequency of cluster headaches?
1 to 8 days
57
How long may cluster bouts last?
From a few weeks to months
58
Outline the treatment of cluster headaches.
* High flow oxygen, 100% for 20 mins. * Subcutaneous sumatriptan 6mg. * Steroids – begin at start of cluster, then reduce course over 2 weeks.
59
What is given as prophylaxis of cluster headaches?
Verapamil
60
Who gets paroxysmal hemicrania?
Elderly people – 50s-60s. | Women > men
61
Outline the features of paroxysmal hemicrania.
* SEVERE UNILATERAL headache, with UNILATERAL AUTONOMIC features
62
What is the duration of paroxysmal hemicrania headaches?
10-30 mins
63
What is the frequency of paroxysmal hemicrania headaches?
1-40 days
64
Paroxysmal hemicrania headaches are SHORTER in duration, and more FREQUENT than cluster
TRUE
65
What is the treatment of paroxysmal hemicrania/hemicrania continua?
ABSOLUTE response to INDOMETHICIN
66
Explain what SUNCT is.
``` S = Short lived (15-120secs). U = Unilateral. N = Neuralgiaform headache. C = Conjunctival injections. T = Tearing ```
67
What is SUNCT treated with?
Lamotrigine. | Gabapentin
68
When is investigations needed?
Those with new onset unilateral cranial autonomic features require imaging.
69
What imaging is done?
MRI brain | MR angiogram
70
Who is affected by IIH?
F>M | Obese people - almost never see people with normal BMI with this
71
Outline the features of IIH.
Headache that has diurnal variation. Morning n + v. Visual loss.
72
What investigations should be done for IIH? What are the expected results of each of these?
Fundoscopy. * papilloedema, absence of venous pulsation MRI brain with MRV sequence. * normal Lumbar Puncture. * CSF – elevated pressure, normal constituents Visual fields
73
***These are the one group of pts where you can do a lumbar puncture even if they have papilloedema. First, ensure MRI is normal.***
TRUE
74
How is IIH managed?
* Weight loss. * Acetazolamide. * Ventricular atrial/lumbar peritoneal shunt. * Monitor visual fields and CSF pressure.
75
Who gets trigeminal neuralgia?
* Elderly people, >60y/o. | * Women > Men
76
What triggers trigeminal neuralgia?
Touch, usually in the CN V2/3 distribution
77
* Severe STABBING unilateral pain
TRIGEMINAL NEURALGIA
78
* What is the duration of trigeminal neuralgia?
1-90 seconds
79
What is the frequency of trigeminal neuralgia?
10-100 days
80
How long may bouts of pain last before remission in trigeminal neuralgia?
From a few weeks to months
81
What investigations are done for trigeminal neuralgia? Why?
MRI brain. IF there are any signs on examination, atypical features, poor response to medical treatment or if surgical treatment is being considered
82
What drugs may be used in the medical tx of trigeminal neuralgia?
Carbamazepine. Gabapentin. Phenytoin. Baclofen.
83
What are the 2 main surgical options in the treatment of trigeminal neuralgia?
Ablation OR Decompression

Neurology (42 decks)

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