Headaches

Question 1

what are primary headaches?

what are secondary headahces

Answer 1

Primary headaches- 90%- headache is the main issue, episodic and benign

Question 2

types or primary headahces?

Question 3

types of less worrying secondary headaches

Question 4

Immediately more worrying headaches

Question 5

describe Tension type headache

Answer 5

• Primary
• most commong
• young adults
• stress and depression
• epsiodic (<15 days month) chronic
• Featureless headahce (no other symptoms, normal neuro exam)
• mild- moderate bilateral pain
• tight band squeezing (may also have neck pain)
• duration 30 mins - 7 hours

Question 6

Describe migraine generally

Answer 6

• affecst 1 in 7
• disabling0 large efect on QoL
• childhood/ young adulthood onset
• more common in females
• not fully understood- though to have triggers

Question 7

describe the pahses of migraines

Answer 7

• prodrome
• aura (focal neurological symptoms)
• headache
• prodrome

Question 8

describe clinical presentation of migraine

Answer 8

• Featureful headache
• lasts 4 hours- 3 days
• seevre unilateral- throbbing/pulsating
• patient want to lie ind ark rooma dn go to slee
• for diagnosis need headache +
  
  • nausa/vommiting or Photophobia/phonophobia

Question 9

what are the 3 main types of migraine

Question 10

treatment for migraines

Answer 10

simpel analgesia

anti-inflammatories

anti-sickness drugs

triptans

Question 11

triggers for mirgaine

Answer 11

• lack of sleep/too much
• premenstrual
• chocolate
• cheese
• dehydration
• missed meals
• stress

Question 12

desrribe cluster headache generall- occurence ?

Question 13

triggers for cluster headaches

Question 14

Clinical features of cluster headaches?

Answer 14

• severe, unilateral pain around the eye
• ipsilateral autonomic symptoms (same side as headache,m eye watering, nasal congestion, facial sweating)
• excrutiating sharp pain (not pulsatile)- behind the eye
• alos knowna s suicide headahce
• last 15 mins to 3 hours
• typically occurs at night and wakes the patient

Question 15

Treatment for cliuster headaches

Answer 15

simple analgesia NOT recommended by nice

oxygen- administered at start of attack can lesses

triptans

preventer therpoay ( verapamil tablkets)

Question 16

Describe the causes of a Vascular headahce?

Answer 16

subarchnoid haemorrhage- SAH- bleeding increases intracnial pressure- irirtant effect opn brain by the blood

commest cause of non-trauamric SAH- rupture berry aneurysm (tends to grwon in circle or willis (associated with polycystic kidney disease)

• causes
  
  • genetic
  • arteriovenous malformation
  • trauam
  • infections (cuase weakness
  • smoking, hypertension, alcohol excess

Question 17

Clinical presentation of Vascular headache

Answer 17

• Explosive or thundercalp headache
• wrost ever
• peak intensity within 3 seconds
• may have signs of meningism
  
  • jheadache, neck stiffness, photophobia
• nausa vomiting
• high mortality and mobdidiyt

Question 18

What is Giant cell arteritis (GCA)

Question 19

symptoms of GCA

Answer 19

• headache- usually oveer the site of arteries affeceted
• scalp tenderness (coimbing hair)
• jaw claudication
• amaurosis fugax ( temporary visual loss)
• generally unwell, stiff joints ( polymylagia rheumatica)- association -n shoudler or pelvic girdle

Question 20

Treatment of GCA

Answer 20

urgent assessment by rheumatolgoists

visual loss needs same day assessment by opthalmost

once suspected need immeidate high dose oral steriod (prednisolone)

Question 21

Causes of Raised intracranila pressure

Question 22

Clinical presentation of Raised intracranial pressure

Answer 22

triad of

headache

vomiting

papilledema (sweleling ot the optic disc on fundoscopy

Question 23

describe late stage raised intrcranial pressure

Answer 23

Raised BP, wide pulse pressure, bradycardia

cushing triad

caused by compression of the medulla

Question 24

what is a space occupying lesion
?

Question 25

what are the mechanism behind which space occupying lesions cause signs and symptoms

Question 26

what are red flags that indicat a high risk SOL

Answer 26

New headache in a patient with PHO cancer and immunosuppression Headache and focal neurology Worsening headache- growing Headaches associated with seizures

Question 27

types of intracranial infections? and cause (which is more severe bacterial or viral)

Answer 27

Meningitis encephaltiis meningoencephaltiis bacterial is more severe

Question 28

what are Meningism a tirad of

Answer 28

headache, stiffness of neck, photphobia. also fevr, altered mental state, focal neurology, petechial rash (non blanching)

Question 29

Causes of Encephaltiis and triad of symtpoms seen

Answer 29

usually viral- HSV common at extreems of age presnetation - triad of- hgih fever, headahce, personality chnage (noticed by friend/family) range from mild to serious

Question 30

what is Medication overuse headache

Answer 30

obverurse headache medication using medication 10-15 per month for period of 3 months

Question 31

describe the use of antimigraine therpay

Question 32

describe acute management of migraine

Answer 32

oral triptan+ NSAID ( most effective) OR oral triptan + paracetmol Or monotherpay if patient prefers Consider antiemetic

Question 33

Descirbe prophylaxis of migraine

Answer 33

if significant impact, treatment resistant or at risk of MOH ## Footnote **topiramate or propranolol**

Question 34

Describe thow Triptains work- give examples

Question 35

give examples of Anti-emetics used in combination with analgesics for migraine management

Question 36

contraindictaes for Topiramate (anti-epileptic medication)- used in prophyalxis for migraines?

Question 37

treatment if the migraine fails to respond to pahramcological prophylaxis?

Answer 37

botulinum toxin Type A (specialist teatment)