Headach Flashcards
Types of headache
1) intracranial
(1ry +2ry)
2ry
-irritatve (meningitis +subarachnoid hge)
-ICP(tumour, hydrocephalus, subdural hge)
2) extracranial
(Local +systemic)
Local (eyes ears and nose)
Systemic (Anemia, hypoglycaemia,depression)
Normal ICP
Term infants: 1.5-6
Young children: 3-7
Older children: 10-15
Red Flags:
Abnormal neurological exam New/ unusual headache Worst headache Immunocompromised Stiff neck and fever Early morning headache Seizure
Triptans
Rizatriptan (6-17)
Almotriptan (adolescent)
Preventive meds indication
has four days or more of disabling headaches per month Beta blocker Calcium channel blocker TCA Valporic acid (sodium channel blocker)
Which headache is related to psychiatric illnesses?
Tension headache
What are complex aura with migraines
hemiparesis, monocular blindness, ophthalmoplegia, vertigo, confusion)
if the headache and associated vomiting are worse when lying down or on first awakening; awaken the child from sleep; remit on arising; or are exacerbated by coughing, Valsalva maneuver, or bending over. Papilledema or focal neurological deficits
Icp
caused by a mass (tumor, vascular malformation) or intrinsic increase in pressure (pseudotumor cerebri).
Contraindications of triptans
patients with focal neurological deficits associated with their migraines or signs consistent with basilar migraine (syncope) because of the risk of stroke.
Types of visual aura
1) negative phenomena, such as hemianopia (loss of half the visual field) or scotoma
2) positive phenomena such as fortification spectra (seeing zigzag lines).
What is the most affected nerve in ICP
The VIth (abducens) cranial nerve has a long intracranial course and is often affected when there is raised pressure, resulting in a squint with diplopia and inability to abduct the eye beyond the midline. It is a false localising sign
Red flags for space occupying lesion
Squint ,torticollis, papilloedema , bradycardia
Forms of migraine
Familial hemiplegic migraine (Ca channel defect) Sporadic hemiplegic migraine Basilar type (vomiting with nystagmus +/ cerebellar signs Periodic syndrome (cyclic vomiting, Abdominal migraine, benign vertigo of childhood)