Week 8: Headache Flashcards

1
Q

What is a secondary headache?

A

something else is causing the headache

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2
Q

Explain the different types of onset of a headache and give examples of each?

A
  • acute (seconds to minutes): SAH/haemorrhage/thunderclap
  • evolving (hours to days): infection/inflammatory/increased ICP
  • chronic - chronic daily headache/increased ICP
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3
Q

what is an episodic headache? give examples

A

at least a few days free between attacks e.g migraine/trigeminal neuralgia

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4
Q

What might be some causes of chronic headache?

A

medication overuse/chronic migraine

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5
Q

What are some associated features of headaches?

A
  • diurnal variation/postural element
  • nausea and vomiting
  • photophobia/phonophobia
  • autonomic features (lacrimation, horners, red eye)
  • premonitory/prodromal
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6
Q

What are the red flag associated features of a headache?

A
  • cognitive effects
  • seizures
  • fever
  • visual disturbance
  • vomiting
  • weight loss
  • sudden onset or older onset
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7
Q

What behaviours can be noticed in a patient with chronic headaches?

A
  • lies down in dark room (migraine)

- agitation/pacing (cluster)

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8
Q

What top disabiling condition is often familial?

A

migraine

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9
Q

What signs should you look for in a patient with headache?

A
fever
rash
neck stiffness
increased BP
organomegaly 
fundal changes (papilloedema - swelling of the optic nerve)
cranial nerve signs/horners syndrome
focal abnormalities e.g right arm being weak
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10
Q

Give 7 primary head ache syndromes

A
  1. migraine
  2. tension headache
  3. cluster headache
  4. paroxysmal hemicrania
  5. exertional headache
  6. ice-pick headache
  7. coital headache
  8. hypnic headache
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11
Q

Give 7 secondary head ache syndromes

A
  1. SAH
  2. intra cerebral haemorrhage/stroke
  3. meningoencephalitis
  4. intracranial venous thrombosis
  5. giant cell arteritis
  6. tumour with raised ICP
  7. cervicogenic headache
  8. benign intracranial hypertension
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12
Q

What does exotropic mean and what is it a sign of?

A

means eyes are looking outward (unable to look medially)

sign of 3rd nerve palsy

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13
Q

When examining a patient, if you can’t see the optic nerve, what might that mean?

A
  • caused by papillary oedema

- suggesting increased ICP

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14
Q

What are the potential causes of raised intracranial pressure?

A
  • mass effect (brain tumour, abscess)
  • brain swelling (hypertensive encephalopathy)
  • increased venous pressure
  • CSF outflow obstruction (hydrocephalus)
  • increased CSF production (meningitis/SAH)
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15
Q

What are the symptoms of raised ICP?

A

Headache
vomiting
seizures

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16
Q

What are the symptoms of temporal arteritis?

A
weight loss
myalgia
transient loss of vision
jaw claudication
tender non-pulsatile temporal artery
17
Q

Who might get temporal arteritis?

A

patients above 50

F>M

18
Q

What are the signs of a migraine?

A

UNILATERAL
nausea
photophobia
dizziness

19
Q

What are thought to be triggers of migraines?

A

sleep deprivation
hunger
stress
oestrogens

20
Q

What are the 3 methods of managing migraines?

A
  1. Brain imaging
  2. Conservative measures
    - avoid caffiene
    - increase water intake
    - avoid tyramine foods (cheese/chocolate/red wine)
    - sleep hygiene and regular meals
  3. Analgesia
    - triptans/naproxen/NSAIDs
21
Q

What substance is released during a migraine?

A

CGRP

22
Q

What is erenumab?

A

first licensed CGRP receptor antagonist specifially designed to prevent migraines

23
Q

How long and often might cluster headaches occur?

A

30-180 mins

1-8 per 24hrs

24
Q

How long and often might paroxysmal hemicrania headaches occur?

A

2-30 minutes

25
Q

What is SUNCT/SUNHA?

A

-short unilateral neuralgiform headache with conjuctival infections and tears (rare, seconds, up to 200 attacks per 24 hrs)

26
Q

How do we manage cluster headaches?

A
  • sumatriptan (class A), high flow 100% oxygen, neurostimulation
  • prevention is predinosolone
27
Q

What is a tension headache?

A
  • non specific description of ‘constricting’ / ‘tight band’

- paracetamol doesn’t resolve

28
Q

What can be some causes of new daily persistent headaches?

A
  • raised ICP / (IIH - idiopathic intracranial hypertension)
  • low ICP
  • chronic meningitis
  • post head injury
29
Q

What is the main treatment for idiopathic intracranial hypertension?

A

loosing weight

30
Q

If headaches change from episodic to chronic, what should you consider?

A

analgesia overuse