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Neuro week 3 > Primary & Secondary headache syndrome > Flashcards

Primary & Secondary headache syndrome Flashcards

1
Q

How does subarachnoid hemorrhage present

A

Instant peak in pain

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2
Q

What are some red flags for headache?

A
  • New onset >55 y/o
  • Known/previous malignancy
  • Immunosuppressed
  • Early morning headache
  • Exacerbated by valsava
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3
Q

How often do migraine attacks generally occur?

A

once a month

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4
Q

Is a migraine with aura effecting both or one eye?

A

Both

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5
Q

How likely is it that a migraine has ‘aura’ (visual involvement)?

A

20%

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6
Q

What is the criteria for a migraine with aura?

A
  • At least 5 attacks
  • Last 4-72hrs
  • 2 of: Moderate/severe, unilateral, throbbing pain, worse movement
  • 1of: autonomic features, photophobia/phonophobia
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7
Q

What is the biggest trigger for migraines?

A

Stress

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8
Q

How does stress cause migraine?

A
  • Stress triggers changes in the brain leading to serotonin release
  • Blood vessels constrict and dilate
  • Chemicals including substance P irritate nerves and blood vessels causing pain
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9
Q

Where is the migraine center?

A

Dorsal raphe nuclei & Locus coeruleus

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10
Q

How is migraine treated non-pharmacologically?

A
  • setting goals
  • avoid triggers
  • headache diary
  • Relaxation/stress management
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11
Q

How is migraine treated pharmacologically?

A

Acute
- NSAID (aspirin, naproxen, ibuprofen) +/- Anti-emetic
- Triptans (rizatriptan, fovatriptan)
Prophylaxis
- Amitriptyline (10-25mg normally)
- Propranolol (80-240mg)
- Topiramate (25-100mg)

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12
Q

When is prophylaxis considered for migraine?

A

> 3 attacks a month
OR
Very severe attack

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13
Q

How long does each method of prophylaxis need to be trialed for in migraine?

A

at least 3 months

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14
Q

What are some contraindications to propranolol use in migraine?

A

Asthma
PVD
Heart failure

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15
Q

What are adverse effects of amitriptyline?

A
  • Dry mouth
  • Postural hypotension
  • Sedation
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16
Q

What are some adverse effects of topiramate?

A
  • Weight loss
  • Paresthesia
  • Impaired concentration
  • Enzyme inducer
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17
Q

What does CGRP do?

A

Triggers receptors which open up pain pathways to start migraine attacks

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18
Q

When can anti-CGRP be given to a patient?

A

After three prior prophylactics

19
Q

Name some ‘Atypical’ migraines

A

Acephalgic
Basilar
Retinal
Ophthalmic
Hemiplegic (familial/sporadic)
Abdominal

20
Q

When are abdominal migraines common?

A

Kids

21
Q

Are migraines unilateral or bilateral headaches?

A

Unilateral

22
Q

Are tension type headaches unilateral or bilateral?

A

Bilateral

23
Q

How are tension headaches managed?

A

Relaxation physio
Anti-depressants
- Dothiepin or Amitriptyline
- 3 months

24
Q

What are trigeminal autonomic cephalgia’s (TACs)?

A

Primary headache disorders characterized by unilateral trigeminal distribution of pain with ipsilateral autonomic features

25
Q

What are the types of trigeminal autonomic cephalgia’s?

A

Cluster headache
Hemicrania

26
Q

What age do cluster headaches usually occur?

A

30-40

27
Q

When do cluster headaches occur?

A

Around sleep
Tends to be seasonal

28
Q

How does cluster headache present?

A

Severe unilateral headache
Lasts 45-90 mins
Every 1-8 days

29
Q

How are cluster headaches treated?

A

High flow oxygen
Sub cut sumatriptan 6mg
Steroids
Verapamil (prophylaxis)

30
Q

What age do hemicrania normally present at?

A

50-60s

31
Q

How does hemicrania present

A

Severe unilateral headache
Unilateral autonomic features
10-30 mins

32
Q

How often do hemicrania happen?

A

Every 1 to 40 days

33
Q

How is hemicrania treated?

A

Indomethacin

34
Q

How does idiopathic intracranial hypertension present?

A
  • Obese
  • Headache
  • Visual loss
35
Q

What investigations are there for idiopathic itracranial hypertension?

A

MRI brain with MRV sequence
CSF
- Increased pressure
Visual field

36
Q

How is idiopathic intracranial hypertension managed?

A
  • Weight loss
  • Acetazolamide
  • Ventricular atrial / Lumbar peritoneal shunt
  • Monitor visual field & CSF pressure
37
Q

What age does trigeminal neuralgia present at?

A

> 60

38
Q

How does trigeminal neuralgia present?

A

Severe stabbing unilateral pai in distribution of trigeminal nerve

39
Q

How is trigeminal neuralgia treated medically?

A
  • Carbamazepine
  • Gabapentin
  • Phenytoin
  • Baclofen
40
Q

How is trigeminal neuralgia treated surgically?

A

Ablation decompression

41
Q

Is giant cell arteritis a secondary or primary headache?

A

Secondary

42
Q

How does GCA present?

A
  • Temporal headache
  • Jaw claudication
  • Elevated CRP/Plasma viscosity
43
Q

How is GCA treated?

A

Steroids

Neuro week 3 (8 decks)

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