headache Flashcards
what is a primary headache
no underlying structural or biochemical causes
what is a secondary headache
identifiable structural or biochemical cause
what is a tenstion type eheadache
treated with NSAIDS and can carry on with their day
what is a migrane
gradually builds up
what is aura
can be confused with TIA. loss of vision, speech, sensory
how do you classify a chronic migraine
headache more than 15 days a month and more than 8 days has to be a migraine for more than 3 months
how do you manage migraines
modify lifestyle triggers (stress, diet, hunger, sleep disturbance)
abortive treatment
preventative treatment
what is a medication overuse headache
> 15 days a month which is worse when taking regular symptomatic medication
acute treatment of a migraine
aspirins, triptans, CGRP antagonist
name some prophylactic (prevent) treatment for migraines
propranolol, tricyclic antidepressants
topiramate
what is cranial neuralgias
an intense or stabbing pain
pain is brief but severe
pain extends along the affected nerve
what nerves are involved in cranial neuralgias
trigeminal, glossopharyngeal and vagus
nervus intermedius
occipital
what is trigeminal neuralgia
unilateral maxilliary or mandibular pain
triggers of trigeminal neuraligia
wind, cold, touch, chewing
what are the common causes of trigeminal neuralgia
vascular compression of trigeminal nerve
uncommon: MS, intracranial tumour
medical treatment for trigeminal neuraliga
carbamazepine, oxcarbazepine, lamotrigine
surgical treatment of trigeminal neuraliga
glycerol ganglion injection
stereotactic radiosurgery
microvascualr decompression
describe the cluster headache
pain in orbital or temporal region
attacks striclty unilateral
15mins to 3 hrs
abortive treatments for cluster headaches
sumatriptan
nasal zolmatripan
transitional treatment for cluster headache
oral prednisolone taper
greater occipital nerve block
preventative treatment for cluster headache
verapamil
ECG monitoring
lithium
melatonin
surgical- occipital nerve stimulation or deep brain stimulation
what is paroxysmal hemicrania
rapid onset which lasts 2-30mins
what headache responds to indometacin
paroxysmal hemicrania
what features predict a sinsiter headache
head injury, sudden thunderclap headache, change in headache pattern
red flags for headaches
new onset headache over 50
neck stiffness or fever
headache worse lying down
treatment of a subarachnoid haemorrhage
early treatment of aneurysm
nimodipine (calcium channel blocker for vasospasm)
HHH therphy (hydration, hyperoxia, hypertension)
features of a high pressure headache
headache when patient wakes up
cough or other valsalva headache
seizures
investigations for subarchnoid haemorrhage
CT as soon as possibel
LP>12 hrs after headache onset
CT angiogram if SAH is confirmed
what is giant cell arteritis
inflamation of large arteries
features of giant cell arteritis
headache is non specific
scalp tenderness, jaw claudication, visual disturbance
treatment for giant cell arteritis
high dose prednisolone
temporal artery biopsy arranged
what investigations support diagnosis of giant cell arteritis
elevated ESR (blood test)
raised CRP and platelet count
treatment for intracranial hypotension
bed rest, fluids, analgesia
i.v caffeine
epidural blood patch
