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The Nervous System: Pathology > Primary Headache > Flashcards

Primary Headache Flashcards

1
Q

What is the two categories of headaches

A

Primary headache - No underlying medical cause

Secondary headache - has an identifiable structural or biochemical cause

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2
Q

What is the mot frequent primary headache

A

Tension headache

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3
Q

What is the clinical presentation of tension type headaches

A

Mild, bilateral headache which is often pressing or tightening in quality

No significant associated features

Not aggravated by routine physical activity

Not disabling

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4
Q

What is the usual time frame for a episodic tension type headache, and when is it chronic

A

Infrequent: less than 1 day a month

Frequent: 1-14 days a month

Chronic:>15days a month

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5
Q

What is the abortive treatment for Tension type headaches

A

Aspirin

Paracetamol

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6
Q

What is the preventative treatment used in tension type headaches

A

Tricyclic antidepressants used in low dose

  • amitriptyline,
  • dothiepin,
  • nortriptyline
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7
Q

What is the most frequent and disabling primary headache

A

Migraine

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8
Q

Define Migraine

A

Migraine is a neurologic chronic disorder with episodic manifestation characterized by recurrent and reversible attacks of pain and associated symptoms

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9
Q

What is the pathology of a a migraine

A

Primary brain dysfunction that leads to the activation and sensitisation of the trigeminal system

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10
Q

What further central nervous system structures are involved in the pain pathway of a migraine, and what do these determine

A

-Brainstem

-Meninges and other
peripheral structures

-Cortical events

The activation of these then determine how we feel

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11
Q

In a migraine what are the additional features experienced during an attack

A

Phono-phobia
Photophobia
Nausea

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12
Q

What are triggers of migraines

A 
Sleep disturbance 
Dehydration 
Diet 
Environmental stimuli 
Changes in oestrogen level in woman 
Stress 
Hunger
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13
Q

Why is migraines more common for women between puberty and menopause

A

Due to periods changing oestrogen levels, as the female hormone cycle acts as a trigger

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14
Q

What is the requirements for a migraine to be diagnosed

A

A head attack to occur with or without an aura

Lasting between 4-72 hours

With the following 2 features:

  • unilateral location,
  • pulsating quality,
  • moderate or severe pain intensity,
  • causing avoidance of routine physical activity
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15
Q

What is the premonitory phase of a migraine

A

Mood changes

Fatigue

Cognitive changes

Muscle pain

Food craving

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16
Q

What is the features of Aura phase in a migraine

A

Fully reversible

Neurological changes

Slow evolution of symptoms: from vision - sensory - motor - speech

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17
Q

What are the features of an early headache in a migraine

A

Dull headache
Nasal congestion
Muscle pain

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18
Q

What are the signs of an advanced headache in a migraine

A

Unilateral

Throbbing

Nausea

Photophobia

Phonophobia

Osmophobia

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19
Q

What is the postdrome features of a headache

A

Fatigue

Cognitive changes

Muscle pain

significant disability can last 1 or 2 days

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20
Q

In an aura what causes the neurological symptoms

A

Cortical or brainstem dysfunction

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21
Q

What is the duration of an aura phase

A

15-60 minutes

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22
Q

What is pathologically occuring in an aura phase

A

Electrical disturbance called Cortical spreading depression

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23
Q

What features of an aura causes it to be confused with an transit ischameic attack

A

Loss of function
Sudden onset
Symptoms all start at same time and can be localised to a specific vascular area

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24
Q

Not all acres are followed by headache pain, what is this called

A

acephalgic migraine or migraine aura without headache.

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25
Q

What is the most common aura symptoms

A

Visual somatosensory - visual disturbance starts in the periphery and spreads in

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26
Q

What is the clinical definition of a chronic migraine

A

Headache on ≥ 15 days per month, of which ≥ 8 days have to be migraine, for more than 3 months

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27
Q

How do you treat patients with migraines induced by medication overdue

A

Discontinuing the overused medication often (but not always) dramatically improves headache frequency

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28
Q

Define medication overuse headache

A

Headache present on ≥15 days / month which has developed or worsened whilst taking regular symptomatic medication

29
Q

What is the abortic migraine treatment

A

Aspirin or NSAIDs

Triptans

30
Q

What is the prophylactic migraine treatment

A

Propranolol,
Candesartan

Anti-epileptics
-Topiramate, -Valproate, -Gabapentin

Tricyclic antidepressants

  • amitriptyline,
  • dothiepin,
  • nortriptyline

Venlafaxine

31
Q

What is the problem with the combined OCP and migraines in woman

A

The combined OCP is contraindicated in active migraine with aura

32
Q

When is it okay for migraine patients to take the OCP

A

ok if no attacks for > 5 years, but stop if aura recurrs

33
Q

Why should anti-epileptics be avoided in women of child bearing age

A

There is a risk of tetratogenecity if fall pregnant

34
Q

What medication should be avoided in the treatment of migraines in pregnant woman

A

Acute attack: Paracetamol

Preventative: Propranolol or Amitriptyline

35
Q

What is the symptoms experienced in children and elderly with migraines

A

Children - confusion, ataxia, aphasia

Elderly - may experience aura without headache

36
Q

What is the different types of trigeminal autonomic cephalalgias

A

Cluster headache

Paraoxysmal Hemicrania

SUNCT

SUNA

37
Q

Trigeminal autonomic cephalalgias is a group dog headache disorders characterised by

A

Excruciatingly severe Unilateral pain in the head or face, with associated ipsilateral cranial autonomic features

38
Q

What differentiate the trigemnial autonomic cephalagias

A

Attacks frequency and duration

39
Q

What is the cranial autonomic symptoms of a trigeminal autonomic cephalagias

A

Conjunctival injection / lacrimation

Nasal congestion / rhinorrhoea

Eyelid oedema

Forehead & facial sweating

Miosis / ptosis (Horner’s syndrome)

40
Q

What is the clinical presentation of a cluster headache

A

Pain - located mainly orbital and temporal
Attacks are strictly unilateral
Rapid onset

Duration: 15 mins to 3 hours

Rapid cessation of pain

excruciatingly severe

patients are restless and agitated during an attack

Prominent ipsilateral autonomic symptoms

Migranious symptoms

41
Q

What are the premonitory and associated Migrainous symptoms often present with trigeminal autonomic cephalagias headache disorders

A

Premonitory:
Tiredness
Yawning

Associated:
Vomiting 
Nausea 
Photophobia 
Phonophobia
42
Q

What is usually present in a cluster headache

A

Typical aura

43
Q

What is the 3 different bout patterns a cluster headache can present

A

Episodic

Striking circadian rhythmicity

Chronic cluster

44
Q

What is the definition of episodic cluster headache

A

Attacks “cluster” into bouts typically lasting 1-3 months with periods of remission lasting at least 1 month

Background pain in remission

45
Q

What is the frequency of episodic cluster headaches

A

1 every other day to 8 per days

46
Q

What is the features of striking circadian rhythmicity cluster headaches

A

Attacks occur at the same time each day

bouts occur at the same time each year

47
Q

What is the features of chronic cluster

A

Bouts last >1 year without remission or

Remissions last <1 month

48
Q

What is the clinical presentation of paroxysmal hemicrania

A

Pain: mainly orbital and temporal

Attacks are strictly unilateral

Rapid onset

Duration: 2-30 mins

Rapid cessation of pain

Excruciatingly severe

50% are restless and agitated during an attack

Prominent ipsilateral autonomic symptoms

Migrainous symptoms may be present

Background continuous pain present

49
Q

How do cluster headaches and paroxysmal hemicrania differ

A

Paraoxysmal hemicrania is shorter and more frequent

paraoxysmal hemicrania is more likely to be chronic

50
Q

What is a precipitated sign isn some paroxysmal hemicranial

A

Bending or rotating the head

51
Q

What is the clinical presentation of SUNCT

Short-lasting Unilateral Neuralgiform headache with Conjunctival injection and Tearing

A

Unilateral, orbital, supraorbital or temporal pain

Stabbing or pulsating pain (burning)

Duration 10-240seconds

occurs frequently

52
Q

What is the frequency of SUNCT

A

Attack frequency from 3-200/day, no refractory period

53
Q

What signs accompany pain in SUNCT/SUNA

A

Conjuctivial injection - red eye

Lacrimation - recreation of tear

54
Q

What is the cutaneous triggers of SUNCT/SUNA

A

Wind
Cold
Touch
Chewing

55
Q

Where does the unilateral head pain preliminary occur in trigeminal autonomic cephalagias

A

Affects predominantly trigeminal nerve ophthalmic division

56
Q

What trigeminal autonomic cephalagias is circadian periodicity absent

A

SUNCT

57
Q

What is the clinical presentation of Trigeminal neuralgia

A

Unilateral maxillary or mandibular division pain

Stabbing pain

duration 5-10seconds

Occurs frequently with refractory period

(autonomic features are uncommon)

58
Q

How is trigemnial neuralgia not considered under Trigeminal Autonomic Cephalagias’ Headache disorders

A

maxillary or mandibular division pain > ophthalmic division

59
Q

What is the cutaneous triggers of trigeminal neuralgia

A

Wind
Cold
Touch
Chewing

60
Q

Why is SUNCT and trigeminal neuralgia triggered by cutaneous sensation

A

Due to blod vessel touching a nerve

61
Q

What is the abortive treatment of a cluster headache

A

Subcutaneous injection sumatriptan 6mg

Nasal zolmatriptan 5mg

100% oxygen 7-12 l/min via a tight fitting non-rebreathing max is effective and safe

62
Q

What is the over all treament of a cluster headache episodic bout

A

Occipital depomedrone injection (same side as the headache)

Tapering course of oral prednisone

63
Q

What is the preventative medication of

A

Verapamil
(high doses may be required)

Lithium

Methysergide

Topiramate

64
Q

What is the side effect of methysergide

A

Risk of retroperitoneal fibrosis

65
Q

What is the abortive treatment for paroxysmal hemicranial and
SUNCT/SUNA

A

There is none

66
Q

What is the prophylaxis treatment for paroxysmal hemicranial

A

Indometacin

COX-II-inhibitors

Topiramate

67
Q

What is the prophylaxis treatment for SUNCT/SUNA

A

Lamotrigine

Topiramate

Gabapentin

Carbamazepine

Oxcarbazepine

68
Q

What is the prophylaxis treatment for trigeminal neuralgia

A

Carbamazepine

Oxcarbazepine

69
Q

What is the surgical intervention treatment in trigeminal neuralgia

A

Glycerol ganglion injection (nerve damged to stop pain)

Steriotactic radiosurgery

Decompressive surgery

The Nervous System: Pathology (25 decks)

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