Clinical neuroscience > Headaches > Flashcards

Headaches Flashcards

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1
Q

What is meant by a secondary headache?

A
  • Headache occurs because of another condition
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2
Q

What are the acute causes of headache?

A
  • Vascular
  • Infective/inflammatory
  • Ophthalmic
  • Situational
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3
Q

What are the vascular causes of headache?

A
  • Haemorrhage (subarachnoid, subdural, extradural)
  • Thrombosis (venous sinus thrombosis)
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4
Q

What are the infective/inflammatory causes of headache?

A
  • Meningitis, encephalitis, abscess, temporal arteritis
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5
Q

What are the ophthalmic causes of headache?

A
  • Glaucoma
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6
Q

What are the situational causes of headache?

A
  • Cough
  • Exertion
  • Colitis
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7
Q

What are the causes of chronic headaches?

A
  • Migraine
  • Cluster headaches
  • Drug side effects
  • Tension headaches
  • Trigeminal neuralgia
  • Raised ICP
  • Temporal/giant cell arteritis
  • Systemic
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8
Q

Which drugs can lead to headaches as a side effect?

A
  • Analgesics
  • Caffeine
  • Vasodilators
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9
Q

What are the systemic causes of headaches?

A
  • Hypertension
  • Pre-eclampsia
  • Phaeochromocytoma
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10
Q

What history do we need to take from a patient with a headache?

A
  • Full history of presenting complaint using SQITARS
  • What might be causing/triggering the headache?
  • PMH of headache
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11
Q

What drug history do we need to take from a patient with a headache?

A

-Analgesics
- Side effects causing headache e.g. vasodilators

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12
Q

What family history do we need to take from a patient with a headache?

A
  • E.g. migraine with aura has some heritability
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13
Q

What social history do we need to take from a patient with a headache?

A
  • Stress
  • Diet (some foods can trigger migraine)
  • Hydration
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14
Q

What should we look for when examining a patient with a headache?

A
  • Vital signs/ obs
  • E.g. raised ICP can cause bradycardia/hypotension
  • Hypertension itself can cause headache
  • Neurological examination - full peripheral and cranial nerve
  • Other relevant systems as guided by history
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15
Q

What are the red flag features of headache?

A
  • Systemic signs and disorders e.g. of meningitis or hypertension
  • Neurological symptoms
  • Onset is new or changed and patient is >50 yo (suggestive of malignancy)
  • Onset in thunderclap presentation (suggests vascular cause)
  • Papilledema
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16
Q

Outline the characteristics of a headache caused by a space occupying lesion such as a tumour?

A
  • Gradual onset
  • Progressive
  • Associated neurological features e.g. visual disturbance or focal signs
  • Early morning headache
  • Nausea and vomiting
  • Worse on coughing and bending
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17
Q

What is the epidemiology of migraine?

A
  • 2% of general population
  • Twice as many females as males
  • Most have had first attack when young
  • Severity decreases as age increases
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18
Q

What is the site of a migraine?

A
  • Unilateral, often frontal
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19
Q

What is the quality of migraine?

A
  • Onset can be sudden or gradual
  • Throbbing/pulsating
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20
Q

What is the intensity of migraine like?

A
  • Moderate
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21
Q

What is the timing of migraine like?

A
  • Lasts between 4 and 72 hours, possibly with cyclical character
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22
Q

What are the aggravating factors of migraine?

A
  • Photophobia/phonophobia (dislike of loud noise)
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23
Q

What are the relieving factors of migraine?

A
  • Sleep helps
  • A number of medications are available (e.g. triptans)
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24
Q

What are the secondary symptoms of migraine?

A
  • May have aura
  • Nausea and vomiting
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25
What are the triggers of migraines?
- Certain foods - Cheese - Chocolate
26
What is the pathophysiology of migraine?
- Unclear - Often clear family history
27
What is the epidemiology of tension headaches?
- Most common type of headache - Females > men - Young > old - First onset in over 50s is unusual
28
What is the site of tension headaches?
- Bilateral frontal - Can radiate to neck
29
What is the quality of tension headaches?
- Squeezing/band-like constriction - Non-pulsatile
30
What is the intensity of tension headaches like?
- Mild-moderate
31
What is the timing of tension headaches like?
- Worse at end of day (as stress builds up) - Chronic if > 15 times per month - Episodic if <15 times per month
32
What are the aggravating factors of tension headaches?
- Stress - Poor posture - Lack of sleep
33
What are the relieving factors of tension headaches?
- Simple analgesics can help
34
What are the secondary symptoms of tension headaches?
- Mild nausea
35
What is the pathophysiology of tension headaches?
- May be tension in muscles of head and neck (e.g. occipito-frontalisis) - Usually no family history
36
What is the epidemiology of medication overuse headaches?
- 3rd most common type of headache - 1-2% of UK population - 20% of headaches due to medication overuse - 30-40 years old - Females > males
37
What are the clinical features of medication overuse headaches?
- Present on at least 15 days per month - No improvement after OTC medication - Patient is using analgesics on at least 10 days per month - This headache only seems to come about in people who are taking analgesia for headache in the first place - Can get a variety of symptoms - Often co-exists with depression and sleep disturbance
38
How are medication overuse headaches treated?
- Discontinuation of medication (will get worse before it gets better)
39
What is the pathophysiology of medication overuse headaches?
- Related to upregulation of pain receptors in meninges
40
What is the epidemiology of cluster headaches?
- 1/1000 people - Males > females - Usual onset 20-40 years old
41
What is the site of of cluster headaches?
- Around/behind one eye - No radiation
42
What is the quality of cluster headaches?
- Sharp and penetrating
43
What is the intensity of cluster headaches like?
- Very severe - Constant intensity
44
What is the timing of cluster headaches like?
- Rapid onset - Attacks last 15 mins - 3 hours and occur 1-2 times per day - Usually at night - Clusters of attacks last 2-12 weeks - Remissions between clusters can last 3 months to 3 years
45
What are the aggravating factors of cluster headaches?
- Head injury - Alcohol - Smoking
46
What are the relieving factors of cluster headaches?
- Simple analgesics can help
47
What are the secondary symptoms of cluster headaches?
- Features associated with decreased sympathetic activity - Red, watery eye - Nasal congestion - Ptosis
48
What are the triggers of cluster headaches?
- Alcohol - Histamine - GTN - Heat - Exercise - Solvent inhalation - Lack of sleep
49
What is the epidemiology of trigeminal neuralgia?
- Peak incidence 50-60, increasing with age - 25/100 000 UK population - Females > males
50
What is the site of trigeminal neuralgia?
- Unilateral, often over one eye - Radiates to eyes, lips, nose and scalp (think distribution of CN V)
51
What is the quality of trigeminal neuralgia?
- Sharp and stabbing - Electric shock feeling
52
What is the intensity of trigeminal neuralgia?
- Severe
53
What is the timing of trigeminal neuralgia like?
- Sudden onset - Lasts a few seconds to 2 minutes
54
What are the aggravating factors of trigeminal neuralgia?
- Light touch to face - Eating - Cold wind - Vibrations
55
What are the relieving factors of trigeminal neuralgia?
- Can be difficult to alleviate
56
What are the secondary symptoms of trigeminal neuralgia?
- Can have numbness and tingling preceding an attack
57
What is the pathophysiology of trigeminal neuralgia?
- Mostly caused by compression of trigeminal nerve by a vascular malformation - Few cases are caused by tumours, MS, or skull base anomalies - More common in those with a history of chronic pain
58
What are the investigations for headaches?
- Clearly dependent on cause - Headache diary can be useful for chronic headaches - Imaging may be indicated if red flags
59
How are headaches treated?
- Dependent on underlying cause - Simple analgesia - Triptans for migraine - Cluster headaches may respond to high flow oxygen
60
When do headaches need to be referred?
- Suspicion of a tumour - Suspicion of raised ICP - Recent onset seizures - Previous cancer - Unexplained focal deficit - Unexplained cognitive/personality changes
Clinical neuroscience
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