adult with headache Flashcards
what are the red flat symptoms of a headache?
- Progressive headache in days/ weeks.
- Sudden onset. ‘worst ever‘ headache aka thunderclap
- Jaw claudication and scalp tenderness
- Significant fever or systemic upset
- New altered headache in elderly/ immunocompromised/ patient with known malignancy
- any neurological symptoms e.g anosmia, incoordination,, personality change
what are the red flag abnormal examination signs in an adult with a headache?
abnormal - do to screen quickly for neurological abnmorality
- Eye movements
- Fundi e.g. papilledema
- Pupils and pupillary reactions
- Limb and or gait ataxia
- Tendon reflexes / plantar
- level of consciousness
can also check for
- weight loss
- organomegaly
- features of systemic disease
in GP, can do the 3 minute general examination
what are the acute treatment options for a migraine at onset?
at headache onset
Analgesia: NSAIDs e.g Iboprofen 400-600mg or Naproxen 250-500mg
Anti- emetic: e.g Metaclopramide 10mg, Domperidone 10-20mg, Sumatriptan 50-100mg
can also use a triptan
all up to 6 times a month
what are the acute treatment options for tension headaches?
Analgesia - NSAID e.g iboprofen 400mg or Naproxen 250-500mg PRN
avoid opiates and compound analgesia
what are the acute treatment options for cluster headaches?
Subcut injection 6 mg, Sumatriptan as needed for acute episode
Nasal Sumatriptan or Zolmitriptan as needed
Oxygen 100% 10–12 l/min for 10–12 mins
Prednisolone 40–60 mg for 7–10 days
what are the acute treatment options for neuralgia headaches?
Carbamazepine 200-800mg daily on two divided doses
what are the migraine headache prevention options?
Identify / avoid / modify migraine triggers
Propranolol 20–320 mg od
Metoprolol 50–200 mg daily
Topiramate 25–100 mg bd or Amitriptyline 10–150 mg nocte
what are the prevention options for tension headaches?
lifestyle and headache trigger avoidance
consider acupuncture
what is a tension headache?
A tension headache is generally a diffuse, mild to moderate pain in your head that’s often described as feeling like a tight band around your head.
the most common type of headache
usually lasts for 30 minutes to several hours, but can last for several days
what is a migraine?
A migraine is usually a moderate or severe headache felt as a throbbing pain on 1 side of the head.
what is the prevention option for cluster headaches?
Verapamil 240–720 mg / day (with normal ECG)
what are cluster headaches?
Cluster headaches are excruciating attacks of pain in one side of the head, often felt around the eye, temple or face. They are sudden and usually occur on the same side.
Cluster headaches are rare.
The attacks generally last between 15 minutes and 3 hours, and typically occur between 1 and 8 times a day.
what is a trigeminal neuralgia?
Trigeminal neuralgia is sudden, severe facial pain. It’s often described as a sharp shooting pain or like having an electric shock in the jaw, teeth or gums.
It usually happens in short, unpredictable attacks that can last from a few seconds to about 2 minutes. The attacks stop as suddenly as they start.
what can be done to prevent chronic medication over use headaches?
- reduce/ stop analgesia
- monitor with headache diary
- further treatment based upon diagnosis e.g migraine, tension type, etc
how are these headaches managed in the long term?
- monitor and adjust treatment
- consider withdrawing preventative rx after 4-6 months
- avoid increasing analgesic use
