Headache Flashcards Preview

Neurology > Headache > Flashcards

Flashcards in Headache Deck (16)
Loading flashcards...
1
Q

EPIDEMIOLOGY:

  1. SAH
  2. Meningitis
  3. Raised ICP
  4. Temporal arteritis
  5. Encephalitis
  6. Tension headache
  7. Migraine
  8. Trigeminal neuralgia
A
  1. 15 per 100k/year
  2. 10 per 100k/year
  3. ≈10 per 100k/year
  4. 5 per 100k/year
  5. 2 per 100k/year
  6. 250 per 100k/year
  7. 250 per 100k/year
  8. 5 per 100k/year
2
Q

HISTORY:

A

SOCRATES

3
Q

EXAMINATION:

A
  1. Look out for fever, rash, neck stiffness
  2. Retinal venous pulsation on fundoscopy
    - absence of this indicates raised ICP
  3. Hypertension
    - headaches can be attributed to severe hypert.
  4. Scalp tenderness in older patients.
4
Q

DANGEROUS HEADACHES:

a) Subarachnoid Haemorrhage
b) Meningitis
c) Temporal arteritis(Giant cell arteritis)
d) Raised ICP

A

a) Sudden, severe headache like being hit by bat, associated LOC, focal neurological signs, neck stiffness.
b) Progressive headache overs days-hours, fever, neck stiffness, rash, impaired consciousness.
c) Insidious onset, usually bilateral but can be unilateral, usually >50y, scalp tenderness, jaw claudication, generalised joint and muscle pains.
d) Onset depends on cause: obstruction of CSF flow, acute onset over days-hours. Over weeks-months if with meningioma. Associated altered consciousness, focal neurological signs, vomiting, worse in mornings, on bending, lying down, coughing, false localizing signs of 3rd or 6th nerve palsy.

5
Q

TEMPORAL ARTERITIS(GIANT CELL ARTERITIS):

  1. Epidemiology
  2. Investigations
  3. Management
A
    • 1 in 100k for >50y, 800 in 100k for >80y
      - Women more commonly affected
    • ESR elevated
      - CRP and blood viscosity also elevated.
      - Temporal artery biopsy: can be negative due to patchy lesions
  1. Steroids for up to 2y, monitor with ESR.
6
Q

OTHER CAUSES:
1. Idiopathic Intracranial Hypertension(IIH)/benign intracranial hypertension/pseudotumour cerebri

  1. Intracranial venous thrombosis
  2. Sinusitis
  3. Arterial dissection
A
  1. Sydrome of raised ICP, machinery noise in ears, usually young, obese women, tetracycline antibiotics as possible cause. Dx. by excluding structural cause for ICP with MR venography, LP to measure ICP(over 30 cm CSF w normal constituents), Tx w LP, acetazolamide, W loss. Measure visual field. May req. lumboperitoneal shunt.
  2. Associated with OCP, dehydration, clotting abn., ear infections. Dx with MR venography, tx with anticoagulation
  3. Frontal and maxillary sinus regions, associated fever and discharge, can be caused by infections, DDx: migraine and cluster headaches, insidious infections may req. ENT imaging
  4. Sudden-onset neck/head pain, ipsilat. Horner’s syndrome, assoc with TIA/strokes
7
Q

SAFE BUT UNPLEASANT HEADACHES:

  1. Migraine and migraine w aura
  2. Tension-type headache
  3. Medication overuse headache
  4. Trigeminal autonomic cephalagia(most commonly cluster headaches. others include paroxysmal hemicrania, hemicrania continua)
  5. Trigeminal neuralgia
A
  1. Associated nausea, photophobia, phonophobia; preceded by aura(most commonly visual) that last 10-30 mins; premonitory Sx ie mood swings, hunger and drowsiness the day before(33%); usually unilat. over temples, bilat.(33%) can affect occipital regions; throbbing; lasts hours-days; worsened by activity, sleep helps, can improve w vomiting; dietary triggers and lying in/relaxation drg weekends associated; hormonal factors in women(COCP, menstruation worsen, pregnancy, menopause improve); FHx
  2. Like pressure of tight band, episodic, poor response to analgesics, related to stress and fatigue; Tx w amitriptyline(widely used although insufficient evidence based on NICE)/relaxation exercises, can coexist with other headaches. Prophylaxis with acupuncture
  3. Headaches from withdrawal of drug; codeine, triptans, paracetamol, caffeine; control headaches with prophylactic agents
  4. Occurs in clusters, severe unilat. pain with lacrimation, red eye and nasal stuffiness, may have ptosis and Horner’s syndrome; last 15 min-3h; patient restless and walks about during headache; alcohol potential trigger; cluster headaches more common in men and smokers; cluster headaches tx acutely w O2/sumatriptan and steroids and verapamil to abort cluster/prophylaxis. Paroxysmal hemicrania and hemicrania continua respond well to indometacin.
  5. Sudden, severe unilat. pain lasting seconds-mins, may be followed by dull aching pain; occurs in bouts; triggered by touch, cold, movement; Tx w carbamazepine, oxcarbazapine, gabapentin, phenytoin, sodium valproate; surgical decompression is definitive; glycerol injection, gamma knife.
8
Q

MIGRAINE TX

A
  1. Identify and remove triggers
  2. Tx acute attacks
    - simple analgesia eg paracetamol 1g/aspirin 900 mg/ibuprofen 400 mg
    - antiemetic(PO/PR) eg metoclopramide 10 mg
    - selective serotonin agonists ie triptans(PO/SC/intranasal)
  3. Prophylaxis
    - Propanolol/topiramate are first choice
    - amitriptyline, sodium valproate
    * valproate and topiramate cause teratogenicity
    - start w low dose and increase to therapeutic dose every 1-2w. Give tx adequate trial of ≥6w of maximaly tolerated dose.
    - Indications:
    a) Recurrent migraine affecting QOL despite acute treatment
    b) Freq of migraine 1/week
    c) Freq of medication use 2d/week
    d) Failure/CI/not tolerating acute medication
    e) Presence of atypical migraine conditions
9
Q

IHS CRITERIA(CLUSTER HEADACHE):

A

A. ≥5 attacks fulfilling B-D
B. Severe/very severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 mins if untreated.
C. Headache with ≥1 of:
- ipsilateral conjunctival injection/lacrimation
- ipsilateral nasal congestion and/or rhinorrhoea
- ipsilateral eyelid oedema
- ipsilateral forehead and facial sweating
- ipsilateral miosis and/or ptosis
- sense of restlessness/agitation
D. Frequency of attack from 1 every 2d to 8 per d.
E. Not attributed to anoter disorder

10
Q

IHS CRITERIA(MIGRAINE WITHOUT AURA)

A

A. ≥5 attacks fulfilling B-D

B. Headaches last 4-72h

C. Headaches have ≥2 of:

  • unilateral location
  • pulsating quality
  • moderate/severe pain
  • aggravation by/causing avoidance of routine physical activity

D. ≥1 of:

  • nausea and/or vomiting
  • photophobia and phonophobia

E. Not attributed to another disorder.

11
Q

QUICK SCREENER FOR MIGRAINE

  1. Nausea
  2. Disability
  3. Photophobia

2/3 Symptoms 93% predictive. 3/3 Symptoms 98% predictive

A
  1. Are you nauseated or sick to your stomach when you have a headache?
  2. Has a headache limited your activities for ≥1 day in the last 3 months?
  3. Does light bother you when you have a headache?
12
Q

IHS CRITERIA(EPISODIC TENSION HEADACHE)

A

A. ≥10 episodes on 1-14d per month for ≥3months(12-179d per year) and fulfills B-D
B. Headaches last 30 mins-7d
C. ≥2 of:
- bilateral location
- pressing/tightening(non-pulsating) quality
- mild/moderate intensity
- Not aggravated by routine physical activity
D. Both of:
- no nausea or vomiting
- not >1 of photophobia or phonophobia
E. Not attributed to another disorder.

13
Q

RED FLAGS:

A
  1. Explosive and severe onset
  2. Recent significant change in pattern, frequency and severity
  3. Altered mental status
  4. Onset with exertion/cough/sexual activity
  5. > 50y
  6. Immunosuppression
  7. Neurological abn ie pappiloedema
  8. Decreased consciousness
  9. Meningismus, fever
  10. History of HIV
  11. Visual disturbance, jaw claudication
  12. Patients w risk f for cerebral venous sinus thrombosis
  13. <20y and Hx of malignancy
  14. Hx of malignancy that is known to metastasise to brain
  15. Recent(typically within 3 months) trauma/head injury
14
Q

MEDICATION OVERUSE HEADACHE CRITERIA:

A

All 3 of:

  1. Headache ≥15d per month(chronic headache)
  2. Regular overuse for ≥3 months of ≥1 acute/symptomatc treatment drugs as defined:
    a) ergotamin/triptans/opioid/combination analgesics for ≥10d per month on regular basis for >3 months.

b) Simple analgesics ≥15d/month on regular basis for 3 months
3. Headache has developed or worsened markedly during medication overuse.

15
Q

IHS CRITERIA(TYPICAL AURA WITH MIGRAINE)

A

A. Aura with ≥1 of:

  1. fully reversible visual symptoms. can be positive/negative features
  2. fully reversible sensory symptoms. can be positive/negative
  3. fully reversible dysphasic speech disturbance.

B. ≥2 of:

  1. Homonymous visual symptoms and/or unilateral sensory symptoms
  2. ≥1 aura symptom that gradually develops ≥5 mins and/or different aura symptoms occur in succession over ≥5 mins.
  3. each symptom lasts 5-60 mins.
16
Q

COMMON MIGRAINE TRIGGERS:

A
  1. Tiredness, stress
  2. Bright lights
  3. Menstruation
  4. Cheese, chocolate, red wines, citrus fruits.
  5. Lack of food or dehydration
  6. Alcohol
  7. COCP