Primary and Secondary Headaches Flashcards Preview

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Flashcards in Primary and Secondary Headaches Deck (65):
1

what are the red flags of a headache?

new onset headache >55

known / previous malignancy

immunosuppressed

early morning headache

exacerbated by valsalva (coughing, sneezing - raises ICP)

2

what should you be aware of in terms of past medical history when someone has headache?

cancer - predisposition to thrombosis

3

what is family history particularly important in?

migraine

4

what gender is migraine more common in?

women

5

on average, most migraine sufferers have how many attacks per month?

1

6

what % of migraines are those with aura (specific warning signs)?

20

80% are without aura

7

how do you diagnose migraine without aura by IHS criteria?

at least 5 attacks (duration 4-72 hours)

2 of: moderate / severe, unilateral, throbbing pain, worst movement

1 of: autonomic features, photophobia / phonophobia

8

what is the pathophysiology of a migraine?

both vascular and neural influences cause migraines in susceptible individuals

stress - serotonin released

blood vessels constrict and dilate

chemicals inc substance P irritate nerves and vessels causing pain

9

what areas in brain are known as migraine centre?

dorsal raphe nucleus

locus coeruleus

10

what is "aura"?

fully reversible visual, sensory, motor or language symptoms

11

what is the duration of aura and when does this occur in relation to headache?

aura duration 20-60 mins

headache follows <1 hour later but aura can occur simultaneously

12

what is most common aura symptom?

visual (positive symptoms usually monochromatic)

eg central scotomata, central fortification, hemianopic loss

13

what tends to trigger a migraine?

sleep
diet
stress
hormonal
physical exertion

14

what may help patient to identify triggers?

headache diary

15

what are types of non-pharmacological management of migraine?

realistic goals
avoid trigger
balanced diet and hydration
avoid caffeine
relaxation / stress management
regular exercise

16

what are two types of pharmacological management of migraine?

acute
prophylaxis

17

what 2 types of medications can be given as abortive treatment of migraine?

NSAIDs

Triptans (5HT agonist)

18

what types of NSAIDs can be given as migraine abortive treatment?

aspirin 900mg
naproxen 250mg
ibuprofen 400mg

19

when should NSAIDs be taken for a migraine?

as early as possible

20

when should anti emetic be considered when giving NSAIDs?

if gastroparesis

21

how can triptans be administered?

oral, sublingual and subcutaneous

consider method of administration in those with N&V

22

when should triptans be given for migraine?

at start of headache

23

what is name of triptans given for migraine?

rizatriptan, eletriptan, sumatriptan

frovatriptan for sustained relief

24

when should you consider prophylaxis for migraine?

more than 3 attacks per month or very severe

25

how long must you trial each prophylaxis drug for?

minimum of 3 months

aim is to titrate drug as tolerated to achieve efficacy at lowest dose possible

26

what non-pharmacological methods of prophylaxis should you consider?

acupuncture
relaxation exercises

27

what are the main medications that can be given for migraine prophylaxis?

amitriptyline
propranolol
topiramate

28

how much amitriptyline should be given for migraine prophylaxis?

10-25mg (max 75mg)

29

what are the adverse effects of amitriptyline?

dry mouth
postural hypotension
sedation

30

how much propranolol should be given for migraine prophylaxis?

80-240mg daily

31

when should propranolol be avoided?

asthma
peripheral vascular disease
heart failure

32

what class of drug is topiramate?

carbonic anhydrase inhibitor

33

how much topiramate should be given for migraine prophylaxis?

25mg - 100mg daily

start slowly due to poor side effect profile

34

what are the adverse effects of topiramate?

weight loss
paraesthesia
impaired concentration
enzyme inducer

35

what types of "fancy" migraine can you get?

acephalgic
basilar
retinal
ophthalmic
hemiplegic (familial / sporadic)
abdominal

36

what is difference in symptoms of tension type headache and migraine?

tension type is bilateral

absence of N&V, photophobia and phonophobia

37

what type of pain is tension type headache?

pressing tingling quality

38

how sore is a tension type headache?

mild to moderate

39

how can tension type headache be treated?

relaxation physiotherapy

reassure

antidepressant - 3 months of dothiepin or amitryptyline

40

what is trigeminal autonomic cephalgias (TACs)?

group of primary headache disorders characterised by unilateral trigeminal distribution pain that occurs in association with prominent ipsilateral cranial autonomic features

41

give examples of ipsilateral cranial autonomic features seen in TACs?

ptosis
miosis
nasal stuffiness
nausea / vomiting
tearing
eye lid oedema

42

what are the 4 main types of trigeminal autonomic cephalgias (TACs)?

cluster
paroxysmal hemicrania
hemicrania continua
SUNCT

43

who gets a cluster headache?

young (30-40s)
men > women

44

when do cluster headaches often occur?

striking circadian (around sleep) and seasonal variation

45

what are the features of a cluster headache?

severe unilateral headache

duration: 45-90 mins

frequency: 1 to 8 per day

cluster bout may last from few weeks to months

46

what is the treatment for a cluster headache?

high flow oxygen 100% for 20 mins

sub cut sumatriptan 6mg

steroids - reducing course over 2 weeks

verapamil for prophylaxis

47

who gets paroxysmal hemicrania?

elderly (50s-60s)
women > men

48

what are the features of paroxysmal hemicrania?

severe unilateral headache, unilateral autonomic features

duration: 10-30 mins

frequency: 1 to 40 per day

ie shorter duration and more frequent than cluster

49

what is treatment of paroxysmal hemicrania?

indomethicin

50

what are features of SUNCT headache?

short lived (15-120 secs)
unilateral
neuralgiaform headache
conjunctival injections
tearing

51

what is treatment of SUNCT headache?

lamotrigine, gabapentin

52

what patients that present with headache require imaging?

those with new onset unilateral cranial autonomic features

53

what imaging is carried out for these patients?

MRI brain and MR angiogram

54

who is more likely to be affected by idiopathic intracranial hypertension?

F > M
obese

55

what are symptoms of IIH?

headache - diurnal variation
morning N & V
visual loss

56

what investigations should take place in IIH?

MRI brain with MRV sequence - normal

CSF - elevated pressure, normal constituents

visual field

57

how should IIH be treated?

weight loss

acetazolamide

ventricular atrial / lumbar peritoneal shunt

monitor visual fields & CSF pressure

58

who gets trigeminal neuralgia?

elderly (>60)
women > men

59

when does trigeminal neuralgia occur?

triggered by touch, usually V2/3

60

what are features of trigeminal neuralgia?

severe stabbing unilateral pain

duration: 1 sec to 90 secs

frequency: 10 per day to 100 per day

bouts pain may last from a few weeks to months before remission

61

what investigation should take place in trigeminal neuralgia?

MRI brain

62

what is medical and surgical treatment options for trigeminal neuralgia?

medical - carbamazepine, gabapentin, phenytoin, baclofen

surgical: ablation or decompression

63

when someone presents with facial pain, you must consider non-neurological structures such as what?

eyes
ears
sinuses
teeth
TMJ etc

64

how is diagnosis of primary headache syndromes (inc TCA) established?

clinically based on demographics, duration, frequency and triggers

65

what is 1st line for uncomplicated migraine?

symptomatic OTC medication