Headache Flashcards
6 weeks, unilateral headache
Pulsating in nature
Lasting a day at a time, then no headache for a few days
Associated with nausea
Wants to lie down in a darkened room
Triggered by alcohol
Diagnosis?
Migraine
Characteristics of migraine - adults
Headache attack 4-72 hours
With/without preceding aura (focal neurological symptoms)
Unilateral
Pulsating
Mod-severe pain
Aggravation by or causing avoidance of routine physical activity
During - N+V, photophobia, phonophobia
Treating migraine
Diary, avoiding trigger, Triptan/NSAIDs
Chronic vs episodic migraine
Chronic migraine: headache on more than 15 days of each month, 8 of which have features of migraine.
Episodic migraine: less frequency than described in the above definition.
Red flags to watch out for in headaches (with aura)
Motor weakness
Double vision
Visual symptoms affecting only one eye
Poor balance
Decreased level of consciousness
All can indicate TIA/Stroke
Aura without migraine - concerned about?
TIA/Stroke
Severe, sudden onset headache
SAH, venous sinus thrombosis, vertebral artery dissection
Progressive or persistent, acute change during headache
Consider space occupying lesions, subdural haematoma
Tension-type headache characteristics
30 mins to 7 days, bilateral
Pressing or tightening - non-pulsating
Mild-moderate pain intensity
Not aggravated by physical activity
Managing tension headaches
Lifestyle modifications, pain relief
Headache triggered by Valsalva manoeuvre
Consider posterior fossa lesion or chiari 1 malformation
Headache worse on standing?
Consider CSF leak
Headache worse on lying?
Consider causes of raised ICP - space occupying lesions, venous sinus thrombosis
Fever, photophobia and neck stiffness … think
Meningitis, encephalitis
Headache with papilloedema ?
Consider BIH, venous sinus thrombosis, space occupying lesions
Medication overuse headache
Overusing medication can cause chronic headache
Headache occurring on 15 or more days/month in a patient with a pre-existing primary headache and developing as a consequence of regular overuse of acute or symptomatic headache medication (on 10 or more or 15 or more days/month, depending on the medication) for more than 3 months. It usually, but not invariably, resolves after the overuse is stopped’.
Menstrual related migraine - what treatment can be given off-label?
Frovatriptan
Zolmitriptan
These can be taken daily on days migraine is anticipated or from two days before until three days after bleeding starts. All patients should be followed up to review efficacy of treatment.
As discussed elsewhere migraine with aura is a contraindication to the use of the combined oral contraceptive pill due to the increased risk of …
As discussed elsewhere migraine with aura is a contraindication to the use of the combined oral contraceptive pill due to the increased risk of ischaemic stroke. The combined pill should be used with caution in those with migraine without aura, particularly if there are additional risk factors present for vascular events.
Status migrainosus: a debilitating migraine that persists for longer than…
Status migrainosus: a debilitating migraine that persists for longer than 72 hours.
Cluster headaches
Very severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 mins
Very short and very severe
Cluster headaches
Recurrent unilateral headaches centred on the eye or temporal region
They occur in short attacks (15-180 minutes) and are associated with ipsilateral autonomic signs (e.g. conjunctival injection, nasal congestion). It may be episodic (80-90%) with periods of remission or chronic (no periods of remission > 3 months). The severity of the pain should not be underestimated. It is often described as one of the most painful conditions and it can be enormously disruptive to normal life.
SNOOP
Red flags for headache
Cluster headaches - acute episodes are treated with …, and further attacks may be prevented with …
Cluster headaches - acute episodes are treated with triptans/ oxygen therapy and further attacks may be prevented with verapamil
Short burst oxygen therapy in management of acute cluster headaches
Short burst oxygen therapy: in the absence of contraindications 100% oxygen (12-15L/min) can be administered via a non-rebreather face mask for 15-20 minutes. It is possible to set up oxygen at home.
