headach Flashcards
what is the pattern of tension type headach?
no vomiting + 2 of :
not pulsatile
bilateral
mild-modrate
not exacerbate by activity
what is the dignostic criteria for migrain ?
4-72 hours +2
- pulsating
-unilateral
-disabling
- modrate to sever pain
during attack : +1
N/V
phobia
$no other explanitin
$at least 5 attack fit to criteria
what is the dignostic criteria for migrain ?
4-72 hours +2
- pulsating
-unilateral
-disabling
- modrate to sever pain
during attack : +1
N/V
phobia
$no other explanitin
$at least 5 attack fit to criteria
pattern of cluster type headach ?
unilateral on eye ot around it +1 :
- red eye
-rhinorrhea
-forhead diaphoresis
-ptosis or constrict pupile
how to remember migrain characteristic symptoms ?
POUND mnemonic :
Pulsatile pain for 4-72 HOur Unilateral with nusa
Disabling for Pt .
headach red flag ?
SNNOOP:
-systemic symptom (fever HTN )
-neurological symptome
-neoplasm
-onset suudenly like thunder
-older age > 50
-Post traumatic
-Pregnant
-Papilledema
-Pattern chang / Progressive
headach red flag ?
SNNOOP:
-systemic symptom (fever HTN )
-neurological symptome
-neoplasm
-onset suudenly like thunder
-older age > 50
-Post traumatic
-Pregnant
-Papilledema
-Pattern chang / Progressive
what is the difference between TIA and migrain regarding visual ?
migraine : gradual and it sho aura like zigzag pattern
TIA : sudden visual lose
pharmacological Rx for cluster headach ?
pain : triptan + O2 100%
prophylaxis : verpamile , lithium
next step in PT present with thunderclap headach ?
CT scan during 12 hours maximum
LP follow CT scan result
best modality to investigate secondary cause of headach ?
MRI except in emergency
what is think frame in headach approch ?
start to role out secondary cause and red flag
then assist for primary cause mange regard that
first line treatment for migraine ?
paracetamol + NSAID
+ triptans
which NSAIDs are better and relief pain in migraine?
same no difference
(tip: naproxen slower onset + longer half life)
how to chose from first line ?
many strategies:
1- regarding severity
para+NSAIDs for mild to modret
triptans for moderate to sever
how to chose from first line ?
many strategies:
1- regarding severity
para+NSAIDs for mild to modret
triptans for moderate to sever
best triptan medication to relived pain in 2 hours ?
sumatriptan 6mg subcutaneous injection .
sumatriptan dosing ?
25-50-100 mg formula
u can repete the dose evry 2 hour maximum dose 200mg/day
for subcutaneous injection 6mg u can repete the dose after 1 hour maximum dose 12 mg/day
mangment of acute migrain attack on ER :
-antiemetic (metoclpramide )
-hydration
-oxygen
-triptane injection
refractory migraine
paraintral dihydroergotamine
migrain in pregnant :
only save established is :
paracetamol and metoclopramide
what is the trigger of migrain headach ?
food&drink :
-caffine
-alchole
-chocolate and cheesses
(missing meal)
life style :
Sleep Smoke Stress exerciSe
light , menses
when to start prophylaxis ?
=> 4 attack /month
-non tolrating an acute therapy
-overuse of medication
-deblilting attack despite acute therapy
Pt preference
when to consider prophylaxis mangment good ?
if attack reduced by 50%
(goal)
