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3 Neurology > Headaches > Flashcards

Headaches Flashcards

1
Q

most important part of SOCRATES for headaches?

A

onset ie acute/subacute/chronic
exacerbating/relieving factors
associated symptoms

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2
Q

what can exacerbate a headache?

A

posture
sneezing
coughing

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3
Q

what symptoms can accompany a headache that you should ask about?

A 
nausea and vomiting
photophobia
phonophobia
visual disturbance
nasal stuffiness
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4
Q

headache red flags?

A 
>55 new onset
known/previous malignancy
immunosuppressed
worse in early morning
worse on coughing/sneezing
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5
Q

why should you ask if a cough/sneeze exacerbates a headache?

A

they raise intracranial pressure

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6
Q

PMH should look for…

A

previous cancer

are they thrombolytic?

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7
Q

FH should explore…

A

migraines

cancers

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8
Q

migraines are commoner in who?

A

young women

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9
Q

on average people have _ migraine attack(s) per month

A

1

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10
Q

migraine with aura is more common than without T or F

A

F, without aura is more common (80%_

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11
Q

timescale for migraine without aura?

A

4-72hrs

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12
Q

presentation of a migraine without aura

A

moderate-severe, throbbing

unilateral headache that is worse on movement WITH associated N&V or photo/phonophobia

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13
Q

pathophysiology of a migraine

A

stress triggers changes in the brain causing release of serotonin -> dilates BVs; substance P release causes pain

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14
Q

how long does an aura last?

A

20-60 mins

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15
Q

presentation of migraine with aura?

A

aura for up to an hour followed by a headache (can also happen at the same time)

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16
Q

name the different kinds of aura; what is the most common?

A

visual eg lights, odd smell, hallucinations

visual is most common

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17
Q

a central scotomata type of visual aura looks like…

A

a blurred dark circle in the middle of the visual field

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18
Q

a central fortification type of visual aura looks like…

A

a zigzagged circle in the middle of the visual field

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19
Q

hemianopic loss in a visual aura looks like…

A

half of the visual field is lost

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20
Q

migraine triggers

A 
sleep
diet
stress
hormones
physical exertions
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21
Q

name a way of finding what triggers a patient’s migraines

A

getting them to fill out a headache diary

22
Q

Tx of migraines

A

avoid triggers
headache diary
relaxation/stress management
NSAID +/- antiemetic ASAP

23
Q

when would you consider prophylactic treatment for migraines?

A

if theyve had >3 attacks a month or are very severe

24
Q

prophylactic drugs for migraines?

A

propranolol
topiramate (carbonic anhydrase inhibitor)
amitryptiline

25
Q

side effects of topiramate

A

wight loss
paresthesia
impaired concentration

26
Q

amitryptiline side effects?

A

dry mouth
postural ht
sedation

27
Q

presentation of a tension headache?

A

mild-moderate pressing/tingling headache that is bilateral

28
Q

associated symptoms are absent in tension headaches T or F

A

T

29
Q

Tx of tension headache?

A

relaxation physio
reassure
antidepressant eg amitryptiline for 3 months

30
Q

what are the trigeminal autonomic cephalgias?

A

group of primary headache disorders characterised by UNIlateral trigeminal distribution pain PLUS ipsilateral cranial autonomic features

31
Q

name the ipsilateral cranial autonomic features that appear with TACs?

A 
ptosis
miosis
nasal stuffiness
N+V
crying
eyelid oedema
32
Q

4 main types of TAC?

A

cluster
paroxsymal hemicrania
hemicrania continua
SUNCT

33
Q

who gets cluster headaches?

A

young adult men (30s)

34
Q

when do cluster headaches appear?

A

striking pain around sleep tme

35
Q

presentation of cluster headache?

A

SEVERE unilateral headache lasting around an hour that appears up to 8 times a day

36
Q

Tx of cluster headache

A

high flow O2 for 20 mins
sumatriptan SC
steroids (decrease over 2 weeks)

37
Q

prophylactic treatment of cluster headaches?

A

verapamil

38
Q

who gets paroxysmal hemicrania

A

elderly women (50-60s)

39
Q

clinical presentation of paroxysmal hemicrania

A

severe unilateral headache with ipsilateral autonomic features lasting about 30 mins

40
Q

how many can headaches can you get a day in paroxysmal hemicrania?

A

up to 40

41
Q

Tx of paroxysmal hemicrania

A

indomethicin

42
Q

what does SUNCT stand for?

A 
short lived (up to 2 mins)
unilateral
neuralgiform headache
conjunctival injections
tearing (Crying)
43
Q

Tx of SUNCT

A

lamotrigine

gabapentin

44
Q

Ix of new onset unilateral cranial autonomic features

A

all need MRI brain and MR angiogram

45
Q

what is the headache like in idiopathic intracranial hypertension

A

diurnal variation

morning N+V

46
Q

MRI of IIH would show…

A

nothing

47
Q

Tx of IIH

A

weight loss
acetazolamide
ventricular shunt

48
Q

who gets trigeminal neuralgia?

A

elderly women

49
Q

what triggers trigeminal neuralgia?

A

touch over CNV2 and 3

50
Q

presentation of trigeminal neuralgia?

A

severe stabbing unilateral pain lasting around a minute multiple times throughout the day

51
Q

Tx of trigeminal neuralgia

A 
carbamazepine
gabapentin
phenytpim
baclofen
Sx = ablation/decompression
52
Q

Ix of trigeminal neuralgia

A

MRI brain

3 Neurology (41 decks)

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