MD4001 Pathology > Headache > Flashcards

Headache Flashcards

(35 cards)

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1
Q

What percentage of primary care symptoms involve headache?

A

> 4% GP consultations

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2
Q

What percentage of neurology referals involve headache?

A

30%

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3
Q

What percentage of headache in primary care are not given a diagnostic label?

A

70%

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4
Q

WHat percentage of the population have a tension headache at any time?

A

40%

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5
Q

What are common headache types?

A
  • Tension / muscular
  • Migraine
  • Analgesia overuse
  • Systemic illness
  • Cervicogenic
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6
Q

What are the different types of serious headaches?

A
  • Subarachnoid haemorrhage
  • Meningitis
  • Tumours
  • Other SOL
  • Temporal arterititis
  • Stroke (including CV sinus thrombosis)
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7
Q

What should be included in a history headache history?

A

SOCRATES as aide memoire

  • How long?
  • Position on head?
  • Character (not intensity)?
  • Frequency When?
  • Diurnal variation?
  • Change in character
  • Nausea / vomitting
  • Radiation
  • Other neurological symtpms
  • PMH, FH
  • Medicines
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8
Q

What does a tension headache history usually present with?

A
  • Over weeks, months, years
  • Tightness, pressure
  • Constant, or worse towards evening
  • Rarely with nausea
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9
Q

What are the treatments for tension headaches?

A
  • Reassurance
  • Explain the muscles around the head
  • Reduce analgesia
  • Use relaxation exercises
  • Low dose amitriptyline
  • Won’t go away overnight
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10
Q

How many people in the UK are off work every day due to a migraine?

A

> 100,000

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11
Q

What are the symptoms of a migraine?

A
  • Headache with nausea
  • With or without aura, spreads over minutes
  • Unilateral or bilateral, usually hours-days
  • Photophobia, phonophobia, gut symptoms
  • Pulsating, sharp
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12
Q

What gender are migrains more common in?

A

Women - especially mid-cycle, at period and menopause (oestrogen)

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13
Q

What is thought to cause migraines?

A
  • Mechanism unclear, vascular and neural theories
  • Certain triggers (take diary) - foods, alcohol, beginning or end of working week, periods
  • May be exacerbated by physical activity
  • Often family history
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14
Q

What are the acute migraine treatments?

A
  • Triptans - agonsists at 5HT- 1b and 5HT-1d receptors (sumatriptan, rizatriptan, naratriptan, zolmitriptan etc)
  • Aspirin, paracetamol
  • Anti-nausea (prochlorperazine, metoclopramide)
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15
Q

What are the prophylactic treatments of migraines?

A
  • Beta blockers (propranolol)
  • Amitriptyline (low dose)
  • Pizotifen (5HT-2a and 2c antagonist, antihistamine, anticholenergic)
  • Topiramate
  • Sodium valproate
  • Candesartan
  • Flunarazine
  • Lisinopril
  • Methysergide (retroperitoneal fibrosis)
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16
Q

What are other migraine treatments that are not usually prescribed in primary care?

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A
  • Botulinum toxin injection (usually every 90 days)
  • Anti-CGRP monoclonal antibodies, erenumab, liscensed in 2018 for >4 migraines / month UK, subcutaneous monthly injection, must have tried at least 3 other prophylactics
  • Acupuncture
17
Q

What category of people should not be prescribed the combined oral contraceptive pill?

Study These Flashcards
A

Women with migraine and aura due to increased risk of stroke

18
Q

What are the symptoms of trigeminal neuralgia?

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A
  • Shooting pain in one or more division of V

- Extremely painful, maybe triggered by cold or eating

19
Q

What is considered the cause of trigeminal neuralgia?

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A
  • Young people consider demyelination

- Older people, often abberant blood vessel touching V

20
Q

What are the treatments for trigeminal neuralgia?

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A
  • Carbamazepine
  • Gabapentin
  • Injection
  • Surgery
21
Q

What is trigeminal autonomic cephalagia (TAC)?

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A
  • Recurrent pain in trigeminal distribution with autonomic features (eye watering, nasal congestion, redness eye)
  • Commonest of these is cluster headache: unilateral (striking circadian rhythm, dame time of day, clustering in periods usually few weeks, around one eye, runny)
  • Paroxysmal hemicranias (women>men), shorter, more frequent attacks, response to indomethacin
22
Q

What is the treatment of Trigeminal Autonomic cephalgia?

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A
  • Triptans
  • Oxygen
  • High dose verapamil (up to 960 mg/day)
  • Indomethacin for P Hemicrania
23
Q

What is a medication overuse headache?

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A
  • Present for > 15 days / month
  • Worsened while analgesia has been used
  • If using simple analgesia > 15 days/month, or > 10 days for other acute e.g. triptans
  • No evidence of another type of headache
  • Uncertain whether abrupt cessation of gradual stopping is better for treatment
24
Q

What is a thunderclap headache? How is it treated?

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A
  • Instant or rapidly appearing (< 60 seconds)
  • Must consider SAH, but can be exertional (coital cephalgia)
  • Requires urgent investigation, CT head, LP after 12 hours, look for bilirubin and oxyhaemaglobin
25
What is associated with raised intracranial pressure?
- Headache usually mild - Diurnal variation - worse in morning, often gone by lunchtime - "headache wakes me up in morning" - May be worse with cough, straining - Often mild nausea - Neurological features - look for papilloedema - Tumours, absess, CSF blockage - Urgent referral and scan
26
What are the classic clinical signs of meningitis?
- Fever - Photohobia - Neck stiffness - Altered conscioussness - Petechial rash - Most meningitis is viral, but cannot distinguish clinically, so treat with ceftriaxone/cefotaxime or benzyl penicillin
27
What are the symptoms / signs of temporal arteritis?
- Never < 50 years of age - May be features of polymyalgia (proximal myopathy) - Jaw claudication - Tendor temporal arteries - Raised ESR (strong marker of inflammation)
28
How is temporal arterietis diagnosed / treated?
- Ultrasound or temporal artery biopsy (sample error) | - Danger of blindness, use steroids early - Prednisolone
29
What group is most likely affected by cerebral venous sinus thrombosis?
Female - oral contraceptive pill
30
What is associated with cerebral venous sinus thrombosis?
- Headaches, often severe | - May be bilateral, haem
31
What is used to investigate / diagnose cerebral venous sinus thrombosis?
MRI/MRV
32
What is a low ICP caused by and what does it involve?
- After lumbar puncture - Headache on standing, eased with lying - Can occur spontaneously
33
How can low ICP be treated?
- May resolve spontaneously | - Blood patch for post lumbar puncture headache
34
What can cause early morning headaches?
- Raised ICP - Obesity - History snoring - COPD - Sleep apnoea
35
What is Transient Global Amnesia?
- Variant of migraine - Often during stress/exposure to cold - Period of amnesia, unable to lay down any new memory, keep repeating the same question - Few minutes to hours - Usually solitary event that does not reoccur, can be similar to stroke - Clinical diagnosis
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