⚕️ FREE MSRA PODCAST – Tension Headache

🎧 A clear, high-yield breakdown of this common,pressure-like primary headache – perfect for exam prep and real-life clinicalscenarios.

🧠 Key Learning Points

📌 Definition

• The most commonprimary headache, characterised by a dull, bilateral, pressure-like sensationaround the head or neck.

• Typically notassociated with nausea, vomiting, or focal neurological symptoms.

📌 Causes & Risk Factors

•Stress and anxiety 😰

• Poorposture 🪑

•Fatigue and sleep disturbances 😴

•Bruxism (teeth grinding) 😬

•Female gender 🚺

• Family history

•Excessive screen time or neck strain 💻

🧠 Mnemonic: “SLEEP” – Stress, Lifestyle, Emotion,Ergonomics, Posture

📌 Pathophysiology

• Multifactorial –involves increased pericranial muscle tension.

•Central sensitisation may play a role 🧠

• Potentialserotonin imbalance

📌 Symptoms

•Bilateral dull ache or pressure 🔁

• Feels like a tightband around the head

• No photophobia,phonophobia or nausea (or only mild)

• May have scalp orneck tenderness

🧠 Mnemonic: “BAND” – Bilateral, Aching,Non-throbbing, Dull

📌 Differential Diagnosis

• Migraine

• Cluster headache

• Cervicogenicheadache

• Sinus headache

•Raised ICP or red-flag secondary causes ⚠️

📌 Diagnosis

• Clinical diagnosisbased on history

• No imaging orbloods unless red flags present

• Red flags:thunderclap onset, focal neurology, altered consciousness, trauma, fever, orimmunosuppression

📌 Management

• 🧘 Lifestyle: stress reduction, posture correction, hydration, regularsleep

• 💊 Medication: Paracetamol or NSAIDs for acute episodes

• 🧠 Chronic: low-dose amitriptyline may be considered

• 🧠 CBT, mindfulness, headache diary

• ❌Avoid codeine or routine opioid use – risk of medication-overuse headaches

📌 Complications

• Medication overuseheadaches (rebound)

•Chronic tension-type headache 😖

• Reduced quality oflife if unmanaged

📌 Prognosis

•Episodic types resolve easily with self-care 🟢

•Chronic types may impair functioning and require longer-term management 🟠

• Avoid analgesicoveruse to prevent rebound headaches

📎 More MSRA Resources for Tension Headache

📝 Revision Notes: https://www.passthemsra.com/topic/tension-headache-revision-notes/

🧠 Flashcards: https://www.passthemsra.com/topic/tension-headache-flashcards/

💬 Accordion Q&A Notes: https://www.passthemsra.com/topic/tension-headache-accordion-qa-notes/

🚀 Rapid Quiz: https://www.passthemsra.com/topic/tension-headache-rapid-quiz/

🎓 Full Course: https://www.passthemsra.com/courses/neurology-for-the-msra/

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#MSRA #MSRARevision#MSRATextbook #MSRAQuiz #MSRAQuestionBank #MSRAFlashcards #MSRAQANotes#MSRAAccordions #MultiSpecialityRecruitmentAssessment #MSRAOnlineRevision#MSRARevisionWebsite #TensionHeadache #Neurology

🧬FREE MSRA PODCAST –Friedreich’s Ataxia: From Genes to Gait and Beyond

🎧 In this episode, we untangle Friedreich’s Ataxia (FA)—the most common early-onset inherited ataxia.We’ll break down the genetics, the mitochondrial link, clinical features,complications, and management—everything you need for the MSRA and clinical practice. Quick, focused, and high-yield!

🧠Key Learning Points

📌 Definition

• Friedreich’s Ataxia is a progressive,hereditary neurodegenerative disorder—caused by autosomalrecessive mutations in the FXN gene(chromosome 9) resulting in deficient frataxinprotein.

• Hallmarks:Progressive ataxia (loss of coordination), muscle weakness, and reduced/absentreflexes.

📌 Genetics & Pathophysiology

• Trinucleotide GAA repeat expansion in the FXNgene → reduced frataxin → mitochondrial dysfunction, iron accumulation,oxidative stress, and cell damage (especially nerves & heart).

• No “anticipation”(unlike some other repeat disorders).

• Most common inindividuals of European descent.

• Onset: Usuallyages 10–15.

📌 Symptoms & Clinical Features

• Progressive limb/gait ataxia (balance/walkingdifficulties)

• Dysarthria (slurred speech)

• Reduced proprioception & vibration sense

• Muscle weakness (limbs)

• Areflexia (absent ankle/knee jerks)

• Babinski sign (upgoing plantars)

• Cerebellar ataxia, optic atrophy

• Scoliosis, pes cavus (high-arched feet), high-archedpalate (may appear early)

• Cardiomyopathy (90%: hypertrophic, often amajor cause of death)

• Diabetes mellitus (10–20%)

• Other: Bladder dysfunction, cold peripheries(cyanosis), respiratory issues in late disease

📌 Diagnosis

• Genetic testing (GAA repeat in FXN gene = goldstandard)

• Clinical exam: Progressive ataxia, areflexia,cerebellar/cord signs

• Nerve conduction studies: Absent/reducedsensory potentials

• ECG/echo: Cardiac hypertrophy, arrhythmias

• MRI: Spinal cord atrophy

• Bloods: Glucose (diabetes), vitamin E (excludedeficiency)

📌 Differentials

• Other inheritedataxias (spinocerebellar ataxias)

• Vitamin Edeficiency (treatable mimic!)

• Multiplesclerosis, toxins, metabolic, immune, or structural causes

• Early cognitiveimpairment or marked cerebellar atrophy suggest alternatives

📌 Management

• No cure—focus is on symptom & complicationmanagement

• Multidisciplinary care: Neuro, cardio, physio,OT, speech & language, social support

• Physiotherapy: Mobility, manage spasticity

• Speech therapy: Speech & swallow support

• Cardiac management: Standard treatment forcardiomyopathy/arrhythmias

• Diabetes: Standard diabetic management

• Orthopaedics: Surgery for scoliosis/footdeformity if needed

• Genetic counselling is essential forpatients/families

• Research ongoing: Antioxidants, ironchelation, gene therapy (none proven effective yet)

📌 Complications & Prognosis

• Progressive disability: Wheelchair use ~15years post-diagnosis

• Cardiac complications: Main cause of mortality(mean life expectancy 40–50 years, some live longer)

• Diabetes & respiratory complications alsoreduce quality & length of life

📎More MSRA Resourcesfor Friedreich’s Ataxia:

📝 Revision Notes: https://www.passthemsra.com/topic/friedreichs-ataxia-revision-notes/

🧠 Flashcards: https://www.passthemsra.com/topic/friedreichs-ataxia-flashcards/

💬 Accordion Q&A: https://www.passthemsra.com/topic/friedreichs-ataxia-accordion-qa-notes/

🚀 Rapid Quiz: https://www.passthemsra.com/topic/friedreichs-ataxia-rapid-quiz/

🎓 Neurology Course: https://www.passthemsra.com/courses/neurology-for-the-msra/

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