Headache Flashcards
tension headache
generated by neurovascular irritation and referred to scalp muscles and soft tissues
pressure / tightness all around the head
no associated features of classic migraine (aura, nausea, photophobia)
rx tension headache
explanation and reassurance
analgesic withdrawal
tricyclic antidepressants in some cases
what is a migraine
recurrent headache associated with visual and GI disturbance
> F
pathogenesis migraine
change in brainstem blood flow
unstable trigem N nucleus and nuclei in basal thalamus
= release of vasoactive neuropeptides incl substance P
= neurogenic inflammation - vasodilation (= pain) and plasma protein extravasation
migraine precipitating factors
chocolate cheese too much / too little sleep noise irritating lights premenstrually
3 types of migraine
migraine with aura (classic migraine) migraine without aura (common migraine) migraine variants (unilateral motor or sensory symptoms resembling stroke)
clinical features migraine
unilateral throbbing headache that builds up nausea, vomiting and photophobia
auras
what are auras
depression of visual cortex function or retinal function & persist for minutes to hours before the headache
may be visual loss, numbness, weakness on one side of the body
most common way a migraine attack resolves
sleep
differential diagnosis migraine
meningitis
subarachnoid haemorrhage
rx migraine - non pharm
avoid dietary precipitating factors
hormonal contraceptives CI in migraine w aura
rx mild migraine
mild: paracetamol / NSAID / antiemetic eg metoclopramide
rx mod-severe migraine
Triptans (eg sumatriptan, almotriptan, eletriptan) are serotonin (5HT) 1B/1D agonists - they inhibit the release of vasoactive peptides, promote vasoconstriction & block pain pathways
who is prophylaxis indicated for
pts w frequent attacks >2/mo or who respond poorly to rx for acute attacks
what prophylaxis is available for migraines
sodium valproate
ßblockers - propanolol
Amitriptyline
symptoms cluster headaches (migrainous neuralgia)
rapid onset, severe, short lived, unilateral headaches with a clustering of painful attacks over weeks or months w periods of remission
rx acute attack cluster headache
subcut or nasal triptans or inhalation of 100% oxygen
verapamil, topiramate, lithium carbonate and / or a short course of steroids helps stop a bout of clusters
who do cluster headaches effect
M > W
peak age 20-50y
what is giant cell arteritis?
granulomatous arteritis affecting extradural arteries
closely related to polymyalgia rheumatica
clinical features giant cell arteritis
headache, scalp tenderness, pain in jaw and mouth worse on eating
blindness - inflammation and occlusion of ciliary and retinal artery
systemic features - weight loss, malaise, fever
investigations giant cell arteritis
ESR always elevated
FBC may = normochromic, normocytic anaemia
temporal artery biopsy confirms diagnosis
management giant cell arteritis
high dose steroids and temp art biopsy asap
LT steroids due to visual loss risk
