L19 - headaches

Question 1

acute pain in headaches (seconds to minutes)

Answer 1

SAH/Intra-cerebral haemorrhage/coital/thunderclap

Question 2

evolving pain in headaches (hours to days)

Answer 2

infection/inflammatory/ increased ICP

Question 3

chronic pain in headaches (weeks to months)

Answer 3

increased ICP

Question 4

episodic headaches (at least a few days between each attack)

Answer 4

migraine / cluster headache ‘ trigeminal neuralgia

Question 5

chronic headaches (most days)

Answer 5

medication overuse / chronic migrine

Question 6

associated features of headaches

Answer 6

• Nausea and vomiting
• Photophobia/ phonophobia
• Autonomic features (lacrimation/Horner’s/red eye)

Question 7

red flags for headaches

Answer 7

• Cognitive effects
• seizures
• fever
• visual disturbance
• vomiting
• weight loss

Question 8

how to check for red flags

Answer 8

SNOOP4

Question 9

SNOOP4

Answer 9

• Systemic symptoms/signs
• Neurologic symptoms/signs
• Onset sudden
• Older onset
• Pattern change

Question 10

S in SNOOP4

Answer 10

Systemic symptoms/signs

• fever
• rash
• chills / sweats
• weight loss
• myalgia

Question 11

myalgia

Answer 11

muscle pain

Question 12

N in SNOOP4

Answer 12

Neurologic symptoms/signs
- weakness
- change in level of consciousness
- diplopia
tinnitus
- ataxia
- seizure / collapse

Question 13

O1 in SNOOP4

Answer 13

Onset sudden

- thunderclap headache

Question 14

thunderclap headache

Answer 14

pain reaches maximal intensity instantly after onset

Question 15

O2 in SNOOP4

Answer 15

Older onset

- after 50 years of age

Question 16

P in SNOOP4

Answer 16

Pattern change

- progressive heacache

Question 17

questions to ask

Answer 17

• pattern of pain (onset and periodicity)
• associated features
• SNOOP4
• behaviour of the headache
• family history
• medication

Question 18

analgesia

Answer 18

medication which acts to relieve pain

Question 19

what type of headache is it when the patient wants to lie down in a dark room

Answer 19

migraine

Question 20

what type of headache is it when the person is agitated / pacing

Answer 20

cluster

Question 21

cluster headache

Answer 21

• occurs in cluster patterns
• commonly awakens you in the middle of the night
• intense pain in or around one eye on one side of your head.

Question 22

causes of raised ICP

Answer 22

• Mass Effect (brain tumour, abscess)
• Brain swelling (Hypertensive encephalopathy)
• Increased venous pressure
• CSF outflow obstruction (hydrocephalus)
• Increased CSF production (meningitis/SAH)

Question 23

causes of papilloedema

Answer 23

raised ICP

Question 24

symptoms of raised ICP

Answer 24

headache (worse on lying or awakening)
vomiting
seizures

Question 25

acute management for patients with raised ICP

Answer 25

- Resuscitation - Broad spectrum IV antibiotics - neurological consultation - steroids in patients with strep. pneumoniae meningitis - neurosurgical consultation

Question 26

temporal arteritis

Answer 26

large vessel vasculitis affecting external and internal carotid artery

Question 27

signs and symptoms of temporal arteritis

Answer 27

- weight loos - myalgia - transient loss of vision - jaw claudication - tender non-pulsatile temporal artery

Question 28

ESR - erythrocyte sedimentation rate

Answer 28

measures how quickly cells in the blood sink

Question 29

increased ESR

Answer 29

related to inflammatory conditions

Question 30

management of temporal arteritis

Answer 30

- high dose steroids (prednisolone 60mg for 1 week) | - temporal biopsy

Question 31

aura

Answer 31

often occurs before a migraine or seizure - may consist of flashing lights, a gleam of light, blurred vision, an odour, the feeling of a breeze, numbness, weakness, or difficulty in speaking

Question 32

occurrence of migraines

Answer 32

10% population | F>M

Question 33

why are females more likely to get migraines than males

Answer 33

oestrogen

Question 34

symptoms of migraines

Answer 34

- unilateral headache - nausea - photophobia - dizziness

Question 35

triggers for migraines

Answer 35

- sleep deprivation - hunger - stress - oestrogens

Question 36

subtypes of migraines

Answer 36

basilar hemiplegic Acephalgic

Question 37

basilar migraines

Answer 37

Cranial neuropathies/cerebellar signs (with aura or without aura)

Question 38

hemiplegic migraines

Answer 38

<0.15 | weakness on one side of body

Question 39

Acephalgic migraines

Answer 39

aura but no headache

Question 40

CGRP

Answer 40

calcitonin gene related peptide | - released during migraine attack

Question 41

management of migraines

Answer 41

brain imagine

Question 42

conservative measures to manage migraines

Answer 42

- Avoid caffeine/ increase water intake - Avoid tyramine foods (cheese/chocolate/red wine) - Sleep hygiene and regular meals

Question 43

analgesia for migraines

Answer 43

triptans / naproxen / NSAIDS

Question 44

preventative treatment for migraines

Answer 44

``` antihypertensives antidepressants anti-epileptic medications nerve blocks botox ```

Question 45

who is more likely to get cluster headaches

Answer 45

men

Question 46

types of cluster headache

Answer 46

- Cluster (attacks last 30-180 minutes; 1-8 per 24hrs) - Paroxysmal hemicrania (2-30) - SUNCT/SUNHA – short unilateral Neuralgiform Headache with Conjunctival injection and tears

Question 47

pain releief for cluster headache

Answer 47

sumatriptan high flow oxygen vagal nerve stimulation

Question 48

prevention for cluster headache

Answer 48

- prednisolone - GON bocks - verapamil - indomethacin

Question 49

tension headche

Answer 49

- bilateral - described as a tight band around head - unrelieved by paracetamol