Headache Flashcards
What headache symptoms would be regarded as ‘red flags’?
Abrupt or 'spilt second' headache Diurnal/postural variation Progressively worsening, insidious onset Neurological signs/symptoms Systemic signs/symtpoms Secondary risk factors eg sinusitis, cancer, head injury
What signs would be regarded as red flags?
pyrexia neck stiffness papilloedema Focal neurological signs Tender temporal arteries
What is papilloedma
Blurring of the optic disc due to raised intracranial pressure
There is absence of venous pulsation
What is pseudopapilloedema
Calcification of the optic disc due to globules of mucoproteins and mucopolysacrarides build up- knows as an optic disc drusen
Can look like papilloedema
What is a migraine
a neurological disease characterized by recurrent moderate to severe headaches often in association with a number of autonomic nervous system symptoms with or without aura
What is associated with migraines?
Nausea and vomiting
Photophobia
phonophobia
How is a migraine headache described
pulsating
often unilateral but can be bilateral
aggravated by movement
What can be the ‘trigger’ factors for a migraine be
premenstrual
stress
lack of sleep
missing meals
what is a migraine ‘aura’?
focal cerebral cortical and/brain dysfunction
gradually progressing
resolves over about one hour
visual/percetual disturbances common
How are migraines treated
avoid preceipitating factors
simple analgesia +/- anti emetic
Specific anti migraine agent - triptan
What can result due to overuse of triptans
rebound headache
what migraines may benefiti from preventative measures
frequent sever migraines with more than three per month
what can be used to prevent migraines
beta blockers -1/2 Inderal LA antidepressants- dothiepin or amytriptilyn gabapentin up to 600mg PO BD topiramate up to 100mg PO OD acupuncture
take for 10-12 weeks then review
what is a tension headache
most common primary headache what most of us think of as a 'standard' head ache usually bilateral and mild to moderate Has a pressing tingling quality no N and V Absence of photophobia or phonophobia
What is used to prevent tension headaches
dothiepin
amitriptyline
3 months then review
what is a cluster headache?
unilateral head ache severe
often around the eye or supra orbital
lasts 30-180 minutes and is recurrent
associated autonomic features
what are the autonomic features assocatied with a cluster headache
Typically eye watering, nasal congestion and swelling around the eye, typically confined to the side of the head with the pain.
What drugs can be given to help treat cluster headaches
triptan prednisolone oxygen verapamil lithium
name some other types of primary heachache
hypnic
hemicranias continua
trigeminal autonomi cephalgia
Name a type of vasculitis which often presents with a headache
giant cell arteritis
What condition Is giant cell arteritis associated with
polymyalgia rheumatica
What is elevevated in the blood in GCA
ESR
plasma viscosity
What is the main risk of GCA
vision loss
