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Neurology > Headache > Flashcards

Flashcards in Headache Deck (53):
1

what aspects of headache should be covered in a history

SOCRATES
unilateral/bilateral
timing - morning
duration
associated with autonomic symptoms, N+V, photophobia
worsens with valsalva manoeuvres
PMH of cancer

2

what are red flags to look out for in someone with a headache

>55 yo
immunosuppressed
previous/current known malignancy
worse in the morning
associated with N+V, worsens with valsalva

3

what can headaches be categorised as

primary and secondary headache complexes

4

list the primary headache complexes

migraine
tension type headache
autonomic cephalgias: cluster headache, paroxysmal hemicrania, SUNCT

5

list the secondary headache complexes

idiopathic intracranial hypertension
trigeminal neuralgia

6

sore head upon standing is intracranial hypo/hyper tension

HYPO tension

7

sore head upon lying down is intracranial hypo/hyper tension

HYPER tension

8

migraine with/without aura is more common

without aura is more common

9

IHS criteria is for defining migraine with/without aura

without aura

10

what is the criteria for defining migraine without aura

at least 5 attacks
each lasting 4-72 hours
2 of: mod/severe, unilateral, throbbing pain, worse with movement
1 of: autonomic features, photo/phonophobia

11

who gets migraines

females
teens / 40-50s menopausal
menstrually related

12

what is the pathophysiology of migraines

neurovascular problem in susceptible individuals
serotonin release causes vasoconstriction and dilatation
substance P irritates nerves and vessels causing pain

13

describe aura associated with migraines

fully reversible symptoms - visual, sensory, motor or language
lasts 20-60 minutes

14

triggers of migraine

stress
sleep
diet - dark chocolate, cheese, alcohol
hormonal
physical exertion

15

what can be used to help identify triggers of migraine

headache diary

16

what are the main groups of management in migraine

pharmacological and non-pharmacological

17

list non-pharmacological Mx of migraine

avoid triggers
stress avoidance
headache diary
hydration - 2L water daily
reduce caffiene
regular exercise

18

what is acute management of migraine

NSAIDs +- anti emetic
Triptans

19

why would you give an anti-emetic with NSAID in acute migraine

if there is gastroparesis

20

what are triptans and how do they work

serotonin (5HT) agonists
cause vasoconstriction of dilated vessels

21

how can triptans be administered

PO
SC
sublingual

22

when would you give someone migraine prophylaxis

if they have had more than 3 attacks per month
or very severe migraines

23

what prophylaxis can be given for migraines

amitriptyline (tricyclic antidepressant)
propranolol (B blocker)
topiramate (anti-convulsant/carbonic anhydrase inhibitor)

24

side effects of amitriptyline

postural hypotension
dizziness
sleepiness
dry mouth

25

side effects of propranolol

bronchoconstriction
cold peripheries
bradycardia
sleep disturbance
GI upset
tiredness

26

when is propranolol contraindicated

asthma/COPD
heart failure
peripheral vascular disease

27

topiramate is teratogenic, true or false

TRUE

28

side effects of topiramate

weight loss
parasthesia
poor cognition
enzyme inducer

29

other treatments of migraine

gabapentin
pizotifen
sodium valproate (teratogenic)
botox scalp injection
anti CGRP Ab

30

list some "fancy" types of migraine

acephalgic
basilar
retinal
ophthalmic
hemiplegic (familial)
abdominal (children)

31

describe symptoms of tension type headache

bilateral
pressing/tingling pain
absence of autonomic features

32

management of tension type headache

relaxation physiotherapy
anti-depressants: dothiepin, amitriptyline
reassurance

33

what are trigeminal autonomic cephalgias (TACs)

group of primary headache complexes with unilateral trigeminal distribution pain along with ipsilateral cranial autonomic features

34

list cranial autonomic features

nasal stuffiness
eye tearing
ptosis
miosis
N+V
eyelid oedema

35

what are the 4 main types of autonomic cephalgias

cluster headache
paroxysmal hemicrania
hemicrania continuum
SUNCT

36

who gets cluster headaches

men
30-40s

37

symptoms of cluster headahces

severe unilateral pain
45-90 min
cluster bout
moving makes it better

38

management of cluster headaches

high flow oxygen 100% for 2 min
SC sumitriptan
steroids reduced over 2 weeks

39

prophylaxis for cluster headaches

verapamil

40

who gets paroxysmal hemicrania

females
50-60s

41

symptoms of paroxysmal hemicrania

severe unilateral headache
10-30 min
more frequent episodes

42

management of paroxysmal hemicrania

very sensitive to indomethicin

43

what is SUNCT

Short lived 15-120 sec
Unilateral
Neuralgiaform headache
Conjuctival injections
Tearing

44

management of SUNCT

lamotrigine, gabapentin

45

what investigations do those with new onset unilateral cranial autonomic features get

MRI brain
MR angiogram

46

what is idiopathic intracranial hypertension IIH and who gets it

^ICP
females
obese BMI>30

47

symptoms of IIH

headaches worse in the morning
N+V
visual loss (papilloedema needs to be checked for)

48

LP is indicated in all cases of IIH, true or false

FALSE
LP is only done if scan is normal
contraindicated in ^ICP

49

management of IIH

MRI, CSF, visual fields
Weight loss!!!
acetazolamide (carbonic anhydrase inhibitor)
ventricular-peritoneal shunt

50

who gets trigeminal neuralgia

females
>60 yo

51

triggers of trigeminal neuralgia

touch
chewing
swallowing
talking
eating

52

symptoms of trigeminal neuralgia

sharp stabbing unilateral pain lasting 1-90 seconds

53

management of trigeminal neuralgia

MRI - rules out compression
carbamazepine, gabapentin, phenytoin, baclofen
surgery - ablation, decompression