T1 L24: Headaches and migraines, 04/12/23, JG

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Questions and Answers

What percentage of the UK population is estimated to have migraine?

15%

What is the estimated lifetime prevalence of headaches in the adult population?

96%

What percentage of all outpatient department referrals go to Neurology for headaches?

25%

What is the percentage of adult population that has had at least one headache over the past year?

50% Signup and view all the answers

What is the third highest cause of disability?

Headaches Signup and view all the answers

What percentage of all admissions to the emergency department are due to headaches?

2% Signup and view all the answers

What is the focus of this lecture module?

Diagnosis and treatment of headaches Signup and view all the answers

What is the primary focus when distinguishing primary vs secondary headaches?

Underlying cause of headache Signup and view all the answers

What type of symptoms are listed within the criteria for diagnosing migraines?

Both physical and psychological symptoms Signup and view all the answers

Which structures within the brain are described as pain sensitive in this lecture module?

Both cerebral cortex and meninges Signup and view all the answers

What is the imaging of choice for atypical features of a primary headache with red flags?

Plain CT scan Signup and view all the answers

What test is recommended for diagnosing idiopathic intracranial hypertension?

Therapeutic LP Signup and view all the answers

Which condition presents with headache worse on sitting/standing up and relieved by lying down?

Idiopathic intracranial hypertension Signup and view all the answers

What is the recommended initial imaging for Thunderclap headaches?

Urgent CT Signup and view all the answers

Which test may show abnormal cells present in tumours?

Lumbar puncture: Cytology Signup and view all the answers

What is the mean age for Temporal Arteritis (GCA)?

>80 years Signup and view all the answers

Which neurotransmitters and neuromodulators play a role in pain modulation?

Oxytocin, noradrenaline, neuropeptides Signup and view all the answers

What structures are involved in modulating pain within the central nervous system?

Brainstem nuclei and peripheral ganglia Signup and view all the answers

What are the red flags indicating secondary headaches in clinical assessment?

Age over 50 years, thunderclap onset Signup and view all the answers

How are headaches classified?

Primary and secondary categories Signup and view all the answers

What percentage of cases do primary headaches account for?

99.9 Signup and view all the answers

What is used to differentiate between primary and secondary headaches?

Assessing the presence of red flags and fulfilling the criteria for specific headache types such as migraines. Signup and view all the answers

What is used to diagnose migraines?

Specific characteristics of headache attacks. Signup and view all the answers

How are migraine types differentiated?

Based on presence of migrainous features, duration, and associated symptoms. Signup and view all the answers

Who is more affected by migraines?

Females than males. Signup and view all the answers

What are some treatment options for migraines?

Lifestyle adjustments, abortive treatments such as triptans and NSAIDs, preventative medications, injectables like Botox and CGRP antagonists. Signup and view all the answers

Study Notes

Cranial Pain Sensitivity and Clinical Assessment

Cranial structures have varying pain sensitivity, with pain-sensitive structures including cranial venous sinuses, arteries at the base of the brain, dura near the base of the brain, and extracranial nerves.
Neurotransmitters and neuromodulators such as serotonin, dopamine, glutamate, oxytocin, noradrenaline, and neuropeptides play a role in pain modulation.
The central nervous system structures involved in modulating pain include brainstem nuclei and peripheral ganglia.
Clinical assessment of headaches involves phenotyping the headache, considering its site, load, character, precipitating factors, and previous history of headaches.
Headaches are classified into primary and secondary categories, with primary headaches accounting for 99% of cases and being further subcategorized in the ICHD classification.
Differentiating between primary and secondary headaches involves assessing the presence of red flags and fulfilling the criteria for specific headache types such as migraines.
Red flags in clinical assessment indicating secondary headaches include age over 50 years, thunderclap onset, severity, rapid progression, specific triggers, systemic symptoms, and neurological signs.
The absence of red flags provides confidence in diagnosing a primary headache.
Diagnostic criteria for migraines include specific characteristics of headache attacks, duration, and associated symptoms like nausea, vomiting, photophobia, and phonophobia.
Migraine types are differentiated based on the presence of migrainous features, duration, and associated symptoms.
Migraines affect over 10 million people in the UK and are more prevalent in females than males.
Treatment options for migraines include lifestyle adjustments, abortive treatments such as triptans and NSAIDs, preventative medications, and injectables like Botox and CGRP antagonists.

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