headache Flashcards
RF headache
immuno // history of mets // vomitting unknown cause // + fever // neuro or cognitive or personality or consiousness // trauma // triggered by cough or valsava
symptoms migraine
severe, unilateral, throbbing, nausea, photophobia, aura
triggers migraine
stress, tired, alcohol, COCP, dehydration, cheese, chocolate, red wine, menstruation, bright lights
migraine diagnostic criteria
5 attacks of: headache lasting 4-72 hours // 2 of - unilateral, pulsating, severe pain, aggregated by activity // N+V or photo+phonophobia // no secondary disorder
symptoms hemiplegic migraines
aura of motor weakness, strong FH history
1st line acute mx migraine
oral triptan + NSAID or paracetamol
2nd line mx acute migraine
metoclopramide or prochlorperazine
when should prophylactic migraine treatment be started
2 or more a month
1st line prophylaxis migraines
topirimate or propanolol // toperimate should be avoided in child bearing women
prophylaxis mx menstrual migraines
frovatriptan (2.5mg BD) // zolmitriptan (2.5mg TD) // mx with mefanfemic acid, paracetamol, triptan
1st line migraine mx during pregnancy
paracematol
2nd line migraine mx during pregnancy + when can it be used
NSAIDs = 2nd + 3rd trimester // avoid opioids
what contraception is contraindicated in migrane with aura and what UKMEC is it
COCP - UKMEC 4
can you prescribe HRT with migraines
yes - may make them worse
mechanism of triptans
spececifc serotonin (B+D) agonists
administration triptans
oral, oraldisersile, nasal spray, sub/cut
SE triptans
tingling, heat, tightness, heavy chest
containdications triptans
IHD or cerebrovascular disease
symptoms tension headache
tight band around head, bilatera // lower pain that migraine, no N+V, no photophobia or phonophobia
what is chronic tension headaches
headaches occur 15+ days a month
acute mx tension headaches
aspirin, paracetamol, NSAIDs
2nd line mx migraines + tension headaches
acupuncture over 5-8 weeks
what conditions are Trigeminal Autonomic Cephalgia’s (TACs) + what general symptoms
cluster headaches, paroxysmal hemicrania, SUNCT // unilateral pain + trigeminal nerve symptoms
who gets cluster headaches + what can trigger them
men, smoking, alcohol
symptoms (not frequency + length) cluster headache
intense pain around one eye // agitated and restless patient // redness and lacrimiation around lid // nasal congestion // common at night
frequency and duration cluster headaches
need 5 attacks for diagnosis // usually 1-2 times a day // last 15mins - 2 hours // clusters last 4 - 12 weeks
invx cluster headache
MRI + gadolium contrast
acute mx cluster headache
100% O2, subcut triptan
prophylaxis cluster
1 = verapamil (maybe some pred) 2 = topimerate
symptoms, duration, frequency SUNCT
unilateral, stabbing heading with conjunctival injection + tearing // attacks last seconds, can occur 300 times a day
mx SUNCT
gabapentin or lamotrigene
symptoms paroxysmal hemicrania + who usually gets it
unilateral headache around orbital or temporal area, tears or conjunctival injection common, women in their 60s
duration and frequency paroxysmal hemicrania
last 10-30 mins but happen lots in a day
mx paroxysmal hemicrania
indomethacin
what causes trigeminal neuralgia
vascular, demyelination, neoplasms
symptoms trigeminal neuralgia
unilateral, sudden pain in trigeminal distribution // pain evoked by touch eg washing, shaving // nasolabial fold or chin v sore // lasts minutes
RF trigeminal neuralgia
sensory change, deaf, skin legions, opthalamic division, optic neurits // onset <40
what is trigem neuralgia assoc with
MS
mx trigem neuralgia
carbamazepine (if does not response refer)
what is the most common type of chronic headache
medication overuse
how many days a month for medication overuse headache
15 days a month
which medications cause overuse headaches
opioids and triptans
mx for withdrawing meds in overuse headache
simple analgesia + triptans stop immediately // wean opioids
causes secondary headaches
drugs, cough, exercise, post-coital
how common is post LP headache and who gets them
1/3, young females, low BMI
features post LP headache
develop 24-48 hours after, lasts a few days, worse upright
mx LP headache
initally conservative, after 72 hours –> blood patch, epidural saline, IV caffeine
what can post LP headaches lead too
subdural haematoma
what causes spontaneous intracranial hypotension
CSF leak from thoracic nerve root sleeves
RF spontaneous intracranial hypotension
marfans
symptoms spontaneous intracranial hypotension
headache worse upright
invx spontaneous intracranial hypotension
MRI + gadolium
