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Neurological System > Headaches > Flashcards

Headaches Flashcards

(49 cards)

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1
Q

define migraines

A

a common primary headache disorder that is characterised by attacks of moderate/severe headaches with associated photophobia, phonophobia, nausea + vomiting

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2
Q

classifications of migraines

A

episodic or chronic, depending on attack frequency

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3
Q

causes of migraines

A

exacts are unknown but precipitated by disturbed sleep, irregular meal patterns, excessive caffeine intake

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4
Q

risk factors of migraines

A

high frequency of episodic migraines
obesity
excessive caffeine intake
overuse of acute migraine medication

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5
Q

clinical features of migraine without aura

A

headache lasting 4-72hrs with at least 2 of

  • unilateral location
  • pulsating quality
  • moderate/severe pain
  • aggravated by/avoidance of routine daily activities
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6
Q

associated symptoms of migraine (without aura)

A

nausea and/or vomiting
phonophobia
photophobia

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7
Q

clinical features of migraine with aura

A

typical migraine presentation WITH typical fully reversible aura 60mins prior to headache that can involve:

  • zigzag lines/scotoma
  • unilateral pins + needles or numbness
  • dysarthria
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8
Q

symptoms of atypical auras

A 
motor weakness
double vision 
unilateral visual symptoms
poor balance 
decreased consciousness
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9
Q

differentials of migraines

A

tension-type headache
trigeminal autonomic cephalgias
sinusitis

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10
Q

investigations for migraines

A

assess BP, HR, RR, temperature and O2 sats
assess extracranial structures (e.g. TMJ, sinuses and temporal arteries)
carry out fundoscopy

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11
Q

conservative management of migraines

A

recommend keeping diary to track triggers and monitor treatment effectiveness
treat any co-morbidities
restrict acute medication use to max 2 days per week
ensure women not using combined contraception
acupuncture

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12
Q

acute medical management of migraines

A

oral or intranasal sumatriptan with analgesia (e.g. paracetamol or NSAID)

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13
Q

when are anti-emetics used in migraines?

A

used if patient experiences vomiting during attacks OR if >2 triptans used and failed

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14
Q

when is prophylaxis treatment considered in migraine patients?

A

if attacks significantly impact QoL and daily function
acute treatments contraindicated or failed
patient at risk of MOH

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15
Q

what medications are utilised in prophylactic treatment of migraines?

A

propanolol
topiramate
amitriptyline

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16
Q

what are contraindications of prophylactic treatment in migraines

A

propanolol not used if patient has asthma

topiramate not used in pregnant women

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17
Q

common complications of migraines

A

reduced QoL
medical overuse headaches (MOH)
status migrainosus
increased risk of ischaemic stroke and mood disorders

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18
Q

medications used in women with menstrual-related migraines that does not respond to usual treatment

A

frovatripan

zolmitriptan

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19
Q

define hemiplegic migraine

A

sudden onset migraines that present with typical migraine symptoms plus hemiplegia, ataxia and changes in consciousness

  • mimic stroke so require fast action to exclude stroke
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20
Q

define tension-type headaches (TTH)

Study These Flashcards
A

a common primary headache disorder that causes generalised headaches

  • described as pressure/tight band around head that spreads/arises from neck
21
Q

classification of TTH

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A

episodic and chronic

  • episodic infrequent - <1 per month
  • episodic frequent - <10 for 1-14 days over month for >3mnths
  • chronic - >15 days affected per month for 3 mnths
22
Q

risk factors of TTH

Study These Flashcards
A 
female sex
middle age
stress and anxiety
dehydration
brightly lit/noisy environments
large amount of screen time
23
Q

clinical features of TTH

Study These Flashcards
A

bilateral and generalised pain described as tight/pressure band around head and neck
no aggravation of pain
no nausea
EITHER photophobia or phonophobia
pericranial tenderness on manual palpation

24
Q

requirements for further investigation in TTH

Study These Flashcards
A

headache develop progressive nature

develop/have associated symptoms (e.g. nausea + vomiting, neck stiffness or neurological changes)

25
differentials of TTH
``` migraine MOH temporal arteritis trigeminal autonomic cephalgias idiopathic cranial hypertension ```
26
management of episodic TTH
offer simple analgesia and advise to take dose ASAP after | identify co-morbidities that may be associated and manage those
27
management of chronic TTH
offer course of <10 acupuncture sessions for 5-8 weeks | provide low-dose amitriptyline as prophylaxis
28
common complications of TTH
overuse of NSAIDs can lead to peptic ulcer disease | overuse of analgesics may cause MOH
29
definition of cluster headaches
a rare and severe primary headache disorder characterised by unilateral periorbital pain attacks with ipsilateral autonomic symptoms for <3hrs
30
characteristics of cluster headaches
attacks occur in series followed by remission periods and are either - episodic - attacks occur in periods of 7 days-year followed but 1 month remission - chronic - attacks occur over 1 year with no remission or remission <1mnth
31
risk factors of cluster headaches
``` male sex age 20-50 smoking alcohol use familial history of CH ```
32
suggested causes of cluster headaches
aetiology is unknown but linked to HCRTR2 gene inheritance low melatonin levels hypothalamic dysfunction and vascular changes
33
clinical features of cluster headaches
unilateral peri-orbital pain - lasts 15-180 mins - sharp and pulsating in nature ipsilateral autonomic symptoms - nasal congestion, eyelid oedema, ptosis/miosis an and conjunctival lacrimation restlessness/agitation
34
differentials of cluster headaches
``` migraine idiopathic intracranial hypertension head/neck trauma neoplasms raised ICP ```
35
investigations of cluster headaches
based on history and neurological examination
36
requirements of cluster headache diagnosis
>5 attacks of characteristic symptoms WITH headaches | occurrence of attacks every other day or 8 per day
37
requirements for further investigations in cluster headaches
``` change in headache pattern new headache in >50s onset of seizures associated symptoms of raised ICP acute onset of 'worst headache ever' ```
38
conservative management of cluster headaches
advise avoiding triggers advise risk of MOH identify and manage co-morbidities provide oral and written info on CH and support groups
39
medical management of cluster headaches
offer subcutaneous or nasal triptans (e.g. sumatriptan) | offer short-burst O2 therapy
40
describe short-burst O2 therapy
patients provided with 100% oxygen at flow rate of 12-15L per min via a non-rebreather face mask for 15-20 mins
41
prophylactic medical management of cluster headaches
offer patients verapamil, sodium valproate or prednisolone
42
common complications of cluster headaches
reduced QoL mood disorders serious underlying 2ndary cause
43
define trigeminal neuralgia
a chronic pain condition characterised by severe shooting or stabbing pain in the distribution of one or more division of CN V
44
risk factors of trigeminal neuralgia
``` MS advanced age (>50yrs) female sex FH of trigeminal neuralgia PMH of hypertension and stroke ```
45
triggers of trigeminal neuralgia
light touch eating wind blowing on persons face
46
clinical features of trigeminal neuralgia
sudden unilateral recurrent 'stabbing' pain in branches of CN V autonomic symptoms
47
red flag signs in trigeminal neuralgia
``` onset < 40yrs pain only in CNV1 FH of MS deafness/ear problems sensory changes ```
48
medical management of trigeminal neuralgia
offer carbamazepine (1st) or phenytoin or gabapentin
49
surgical management of trigeminal neuralgia
microvascular decompression

Neurological System (10 decks)

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