Headache Flashcards
why are cluster headaches named ‘cluster’?
typically occur in clusters lasting several weeks, with the clusters themselves typically once a year
who are most at risk of suffering from cluster headaches?
- men
- smokers
names triggers for cluster headache
- alcohol
- nocturnal sleep
what are the features of cluster headaches?
intense sharp, stabbing pain around **one eye **
* pain typically occurs once or twice a day, each episode lasting 15mins - 2 hours
* patient is restless and agitated during an attack due to the severity
* redness, lacrimation, lid swelling
* nasal stuffiness
* miosis and ptosis
how long do clusters typically last?
1-3 months
what is the imaging of choice in cluster headaches?
MRI with gadolinium contrast
what is the acute management for cluster headaches?
- 100% oxygen
- subcut triptan
what is the prophylaxis treatment for cluster headaches?
verapamil
what are the features of migraine?
- unilateral throbbing headache
- preceded by an aura
- lasts 4-72 hours
- photophobia
- phonophobia
describe aura
- visual (e.g. lines, zigzags)
- sensory (paraesthesia spreading from fingers to face)
name some identifiable triggers for migraine
- oral contraceptives
- chocolate
what symptom confirms the diagnosis of migraine?
aura
what is the diagnostic criteria for a migraine with no aura?
at least 5 headaches lasting 4-72 hours with
* nausea/vomiting
OR
* photo/phonophobia
AND 2 of:
* unilateral headache
* pulsating character
* impaired or worsened by daily activities
what is the management of migraine?
- avoid triggers
- prophylaxis
- managing an acute attack
what is the prophylaxis for migraines?
propranolol or topiramate
how is an acute attack of migraine managed?
- oral triptan (e.g. sumatriptan)
- paracetamol or NSAID
what is the most common cause of chronic recurring head pain?
tension headaches
which sex is more likely to experience tension headaches?
females
what are the features of tension headaches?
- bilateral, non-pulsatile headaches
- tight, like a band around the head
- tenderness of the scalp muscles
what is the management of tension headache?
- paracetamol or NSAID
- associated with stress –> address cause
what are the features of trigeminal neuralgia?
- recurrent short episodes of severe stabbing pain, affecting one side of the face
- pain triggered by touching the face, eating or talking
- aged >50 years old
how is trigeminal neuralgia diagnosed?
- clinical
- MRI to exclude secondary causes
what is the management for trigeminal neuralgia?
- carbamazepine
- microvascular decompression
what are the features of raised intracranial pressure?
- headaches which are worse in the morning and upon bending over
- improve after vomiting and lying down
- associated with neurological deficits
how is raised intracranial pressure diagnosed?
CT head
what is the management of raised intracranial pressure?
treatment of the underlying cause
in what patient should you avoid triptan use?
coronary artery disease
potential to cause coronary vasospasm
what migraine prophyalxis is preferred in women of childbearing age?
propranolol over topiramate
