Headache Flashcards
Red flag headache symptoms- as many as possible…
- Compromised immunity
- History of malignancy
- Abrupt onset
- Diurnal or postural variation
- Getting progressively worse
- New onset neurological deficit (focal, generalised e.g. cognition, consciousness)
- triggered by cough, sneeze
- head trauma
- Systemic symptoms/signs (e.g. pyrexia, vomiting)
- Neck stiffness
- Papilloedema
- Tender temporal arteries
Potential investigations in headache (6)
Imaging
CSF (if normal imaging in suspected raised ICP)
FBC, plasma viscosity, CRP
What is papilloedema a sign of?
Raised ICP
Symptoms of idiopathic intracranial hypertension (3)
Headache, nausea and vomiting, visual loss
Typical patient for idiopathic intracranial hypertension
Obese female
Treatment of idiopathic intracranial hypertension (3)
Weight loss
Acetazolamide
Shunt
Symptoms of migraine (5)
Aura or prodrome Pulsating character Nausea and vomiting Photophobia Phonophobia
Possible migraine precipitants (4)
Menstruation
Stress
Cheese, red wine, citrus fruits
Caffeine (may also help)
Treatment of migraine (2)
Aspirin + paracetamol (first-line)
Triptan + paracetamol (second line)
Prophylaxis of migraine (4)
Propanolol
AEDs (topiramate, sodium valproate)
Gabapentin
Amitriptylline
Symptoms of tension headache (2)
Bilateral non pulsatile headache
Lack of aura/nausea and vomiting
Treatment of tension headache (2)
Relaxation therapy
Antidepressants
Symptoms of cluster headache (3)
Severe unilateral pain around eye
Lacrimation
Rhinorrheoa
Management of cluster headache:
a) acute
b) prophylaxis
a) 100% oxygen and nasal/subcut triptan
b) verapamil, prednisolone, topiramate, lithium, lignocaine infusion
Symtpoms suggestive of giant cell arteritis (3)
Tender scalp
Jaw claudication
Associated polymyalgia rheumatica
Main investigations in GCA (2)
Elevated ESR
Temporal artery biopsy
Mechanism of action of triptans
5-HT (serotonin) agonists
Management of GCA (2)
High dose prednisolone
Urgent review by opthalmology
Unilateral facial pain evoked by light touch is a history suggestive of…
Trigeminal neuralgia
Causes of an acute single episode of headache (6)
Meningitis Encephalitis Sinusitis Glaucoma SAH Head injury
Other causes of a chronic headache (3)
Psychological
Chronic raised ICP
Paget’s disease of the skull
“Triptan sensations” (3)
Tinging
Heat
Tightness/heaviness/pressure
Contraindication to triptans
History/significant risk factors for IHD/CVA
