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Neurology SOH > Headaches > Flashcards

Headaches Flashcards

(80 cards)

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1
Q

Investigations are required to differentiate between different types of headaches. True or false?

A

False

- investigations are carried out to rule out more sinister conditions

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2
Q

Acute onset - think

A

Haemorrhage

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3
Q

Sub-avute onset - think

A

Migraine

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4
Q

Associated features to ask about

A 
N+V
Photophobia 
Blurred vision
Ptosis 
Nasal stuffiness
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5
Q

Red flag - new onset headache at which age

A

55 and ABOVE

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6
Q

Early morning headache is a red flag. True or false

A

True

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7
Q

A headache that is exacerbated by coughing/sneezing (valsalva) is not a red flag. True or false?

A

False

- it is a red flag

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8
Q

Migraine - most common in young males. True or false?

A

False

- young females

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9
Q

Migraine - triggers

A 
Stress 
Hormonal - menstrual related 
Sleep 
Environment
After exercise 
Dietary: red wine, cheese
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10
Q

Migraine - Trigger factor causes changes in the brain which results in the release of _____

A

Serotonin

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11
Q

Migraine - release of serotonin causes activation of which system, resulting in what?

A

Activation of trigeminal vascular system

Causes cranial blood vessels to constrict and dilate

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12
Q

Give examples of chemicals which irritate nerves and blood vessels to cause pain

A

Substance P
Neurokinin A
CGRP

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13
Q

Which part of the brain is the migraine generating centre found?

A

Brainstem

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14
Q

Migraine with aura - what is aura

A

Fully reversible

Visual, sensory, motor or language symptom which occurs before you get the headache

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15
Q

Migraine with aura - list some common visual symptoms

A

Central fortification spectra
Central scotoma
Hemianopic loss

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16
Q

Migraine with aura - how long does it typically last?

A

20-60 mins

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17
Q

If people have migraine with aura, which medication must they NOT receive

A

Combined OCP

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18
Q

Migraine without aura - criteria needed to diagnose - at least ___ attacks with duration ____ each time

A

at least 5 attacks with a duration between 4-72 hours each time

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19
Q

Migraine without aura - additional criteria needed to diagnose: at least 2 of the following

A

Moderate/severe headache
Unilateral
Throbbing pain
Worst with movement

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20
Q

Migraine without aura - additional criteria needed to diagnose: 1 of the following

A

N+V

Photophobia

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21
Q

Basilar migraine - clinical features

A

Vertigo
N+V
Dizziness

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22
Q

Who are most likely to get abdominal headaches ?

A

Children

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23
Q

Migraine - how often do people get them

A

Average is 1 attack per month

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24
Q

Migraine - clinical features

A 
Moderate/severe pain 
Unilateral
Throbbing/pounding sensation
N+V
Photophobia 
Phonophobia
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25
When patients have a migraine where do they often want to rest?
Lie down in a dark room
26
Migraine - acute pharmacological management
NSAIDS - aspirin 900mg - naproxen 250mg - ibuprofen 400mg +/- anti-emetics Triptans
27
Migraine - acute pharmacological management - triptans - examples
5-HT agonist Examples - rizatriptan - frovatriptan
28
Migraine - acute pharmacological management - these medications should be taken as early as possible. true or false?
True
29
Acute management of an uncomplicated migraine
Over the counter medication is first line
30
Migraine - non pharmacological management
Avoid triggers | Relaxation/stress management
31
When would you consider prophylaxis management
When the patient has more than 3 attacks per month | When the patient has very severe migraines
32
Migraine - prophylaxis management - must trial a drug for how long before giving up
4 months
33
Migraine - examples of drugs used for prophylactic management
``` Propranolol Atopiramate Amitryptiline Gabapentin Sodium Valproate ```
34
Migraine - drugs used for prophylactic management - side effects of propranolol
Avoid in asthmatics | Heart failure
35
Tension headache is always stress related. True or false?
True
36
Tension headache is more debilitating than a migraine. True or false?
False | - less debilitating
37
Tension headache is unilateral. True or false?
False | - bilateral
38
Tension headache - clinical features
Bilateral headache | Tingling sensation
39
Tension headache - what are they NOT associated with
No N+V No photophobia No phonophobia
40
Tension headache - management
Relaxation physiotherapy | Anti-depressant (amitryptiline)
41
Trigeminal autonomic cephalgia (TAC) - definition
Group of primary headache disorders that affect the trigeminal vascular system
42
TAC - general clinical features
``` Unilateral trigeminal (CNV) distribution of pain + Prominent ipsilateral cranial autonomic features - ptosis - miosis - nasal stuffiness - N+V - tearing - eye lid oedema ```
43
TAC - what are the 4 types
Cluster headache Paroxysmal hemicrania Hemicrania continua SUNCT
44
Patient with new onset unilateral cranial autonomic features require which type of investigation?
Imaging
45
TAC - cluster headache - more common in men/women?
Men
46
TAC - cluster headache - average age range
30-40
47
TAC - cluster headaches - triggers
Sleep | Seasonal variation
48
TAC - cluster headaches - unilatera/bilateral
Unilateral
49
TAC - cluster headaches - clinical features
Severe unilateral headache Patient wants to walk about Patient can't sit still
50
TAC -cluster headache - the pain is worse than a migraine. True or false?
True
51
TAC - cluster headache - duration
Short | - 30 mins -> 2 hrs
52
TAC - cluster headache - how often do they occur
Around 1-8 per day
53
TAC - cluster headache - acute management
High flow oxygen for 20 mins | Subcutaneous sumitriptan 6mg
54
TAC - cluster headache - management to treat a cluster bout
Steroids for 2 weeks
55
TAC - cluster headache - prophylaxis mangement
Verapamil
56
TAC - paroxysmal hemicrania - who gets it
Elderly (50-60s)
57
TAC - paroxysmal hemicrania is more common in males/females?
Females
58
TAC - paroxysmal hemicrania - - clinical features
Severe unilateral headache Unilateral autonomic features Pain comes and goes
59
TAC - paroxysmal hemicrania - duration
Short duration | 10-30 mins
60
TAC - paroxysmal hemicrania - how often do they occur
1-40 per day
61
TAC - paroxysmal hemicranias are SHORTER/LONGER duration and MORE/LESS frequent than cluster headaches
Shorter duration | More frequent
62
TAC - paroxysmal hemicrania - management
Indomethacin
63
TAC - paroxysmal hemicrania - if the headache doesn't respond to indomethacin then what happens?
You have made the wrong diagnosis
64
TAC - SUNCT - clinical features
``` Short lived (15-120 secs) Unilateral Neuralgiform headache Conjunctibal injections Tearing ```
65
TAC - SUNCT - management
Lamotrigine | Gabapentin
66
Idiopathic intracranial hypertension - more common in males/females?
Females
67
Idiopathic intracranial hypertension - more common in skinny/obese people?
Obese
68
Idiopathic intracranial hypertension - clinical features
``` Headache Papilloedema Diurnal vriation Morning N+V Visual loss ```
69
Idiopathic intracranial hypertension - investigations
MRI scan - should be normal Lumbar puncture
70
Idiopathic intracranial hypertension - why is an MRI scan necessary?
If there is headache + papilloedema it may be a brain tumour so it is necessary to do imaging investigations to check
71
Idiopathic intracranial hypertension - what are the rules about lumbar puncture here
Only perform lumbar puncture once you are sure that MRI scan is normal
72
Idiopathic intracranial hypertension - management
Weight loss can resolve the issue | Acetazolamide
73
Trigeminal neuralgia - pathogenesis
Due to blood vessel touching CNV
74
Trigeminal neuralgia - who gets it?
Elderly patients
75
Trigeminal neuralgia - more common in men/women ?
Women
76
Trigeminal neuralgia - clinical features
Severe, stabbing pain Unilateral Very short duration (1-90 secs) Bouts of pain which may last weeks/months before remission
77
Trigeminal neuralgia - investigations
MRI brain
78
Trigeminal neuralgia - management (pharmacological)
Carbamazepine Gabapentin Phenytoin Baclofen
79
Trigeminal neuralgia management (surgical)
Ablation of CN V nerve root | Decompression if blood vessel is touching CN V
80
What is the first line pharmacological management for trigeminal neuralgia?
Carbamazepine

Neurology SOH (31 decks)

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