Headache Flashcards
What is the diagnostic criteria for migraines?
SULTANS
- severe
- unilateral
- light sensitivity
- throbbing
- aura
- nausea/vomiting
How are migraines treated?
ABORTIVES
- nap
- fluids
- NSAIDs
- triptan
PREVENTIVE
- antihypertensives -> BB (propranolol), CCB (verapamil)
- antidepressants -> amitriptyline
- antiepileptics -> topiramate
- botox
- anti-CGRP monoclonal antibodies
What triggers migraines?
- sleep disturbances
- dehydration
- stress
- irregular meals
What is the diagnostic criteria of tension-type headaches?
- headache lasting for hours
- bilateral
- tightening or squeezing pain
- mild to moderate intensity
- not aggravated by routine physical activity
- photophobia or phonophobia or mild nausea
- NO vomiting
How are tension-type headaches treated?
- abortives -> paracetamol or NSAIDS
- prophylactic -> amitriptyline
- PT -> neck massage or stretching exercise
- behavioral therapy
What are the characteristics of cluster type headaches?
- common in young men
- comes in many very severe but short attacks
- unilateral orbital, supraorbital, or temporal pain lasting 15 - 180mins
- accompanied by ipsilateral conjunctival injection/lacrimation, ipsilateral nasal congestion, rhinorrhea, eyelid edema, sweating, mitosis/ptosis, and restlessness or agitation
- 1-8 attacks per day
How are cluster headaches treated?
first line -> OXYGEN or -triptans
prophylaxis -> verapamil
how is trigeminal neuralgia recognized?
- paroxysmal attacks lasting seconds to 2 mins affecting divisions of trigeminal nerve
- pain is intense, sharp, superficial, or stabbing (electricity)
How is trigeminal neuralgia managed?
carbamazepine
What are the red flags for headaches?
- new onset
- progressive worsening
- worst pain ever -> subarachnoid hemorrhage until proven otherwise
- > 50
- abrupt onset
- initiated by exertion or valsava -> aneurysm
- head trauma
- neurological signs & symptoms
- systemic signs & symptoms
What are the worrisome physical examination signs in headaches?
- abnormal vital signs -> fever or severe hypertension
- toxic appearance
- localizing neurological finding
- decreased level of consciousness
- meningeal signs -> Kernig’s or Brudzinski’s sign
- ophthalmic findings -> papilledema
- traumatic finding
- abnormalities in temporal arteries
What are the features of temporal arteritis?
- Absent temporal pulse bilaterally
- tenderness
- age above 50 or equal to it
- ESR > 50
What is the most feared complication in temporal arteritis?
blindness
URGENT TREATMENT -> systemic corticosteroids
a ruptured intracranial aneurysm will lead to what type of headache?
THUNDERCLAP headache -> subarachnoid hemorrhage
how is subarachnoid hemorrhage diagnosed?
1- CT
2- lumbar puncture if CT is negative -> xanthochromia
2- CTangio if CT is positive
3- if CTangio is negative -> catheter angio
