Headache Flashcards
What type of drugs are the triptans?
5HT1 antagonists
Are migraines more common with or without aura?
Without (70%)
Does pregnancy tend to exacerbate or cause remission from migraines?
Remission
Overuse of which medications can cause headaches?
Triptans
Opioids
Combination analgesics
What medications should be avoid when treating pain in migraine?
Opioids
What are the red flags when taking a headache history?
New onset headache > 55y/o Known/previous malignancy Immuno-suppressed Early morning headache Exacerbation by Valsalva
What is the most common type of migraine?
Without aura = 80%
With aura = 20%
How is migraine diagnosed?
At least 5 attacks
Duration 4-72 hours
2 of (unilateral, moderate/severe, pulsatile, worse on movement)
1 of (Autonomic features, photophobia/phonophobia)
What is the pathophysiology of migraine without aura ?
Stress triggers serotonin release
Blood vessels constrict & dilate
Chemicals irritate nerves and blood vessels causing pain
What is the pathophysiology of migraine with aura?
Cortical spreading depolarization
Activate trigeminal vascular system - dilate cranial blood vessels
Release of substance P, neurokinin A, CGRP
What is the migraine centre in the brain?
Dorsal raphe nucleus
Locus coenucleus
What is an aura?
Fully reversible visual, sensory, motor or language symptom (Visual most common)
What can trigger a migraine?
Sleep Diet Stress Hormonal Physical exertion
What is the treatment of a mild/moderate migraine?
NSAID or aspirin (second line= paracetamol-
What is the treatment of a severe migraine?
Prochlorperazine suppository & diclofenacsuppository
or
SC Sumatriptan
When is migraine prophylaxis indicated?
> 3 attacks a month
What are the options for migraine prophylaxis?
Propranolol
Topiramate
Amitriptyline
What are the side effects of amitrptyline?
Dry mouth
Postural hypotension
Sedation
What type of drug is topiramate?
Carbonic anhydrase inhibitor
What are the side effects of topiramate?
(Start slowly_
Weight loss
Paraesthesia
Impaired concentration
When should propranolol be avoided?
Asthma
PVD
Heart failure
Why is CHC contraindicated in women with migraine with aura?
Both have stroke risk
What is the first line relief for migraine in pregnancy?
Paracetamol
What are the ipsilateral cranial autonomic features that might present in TACs?
Ptosis Miosis Nasal stuffiness Nausea/vomiting Tearing Eye lid oedea
What are the 4 main types of TACs?
Cluster
Paroxysmal hemicranias
Hemicrania continua
SUNCT
What patients tend to get cluster headaches?
Young (30s-40s)
Men > women
What is distinctive about the timings of cluster headaches?
Circadian & seasonal variation
How are cluster headaches diagnosed?
At least 5 attacks
Severe unilateral orbital, supraobrital and or tempora pain lasting 1-10mins if untreated
Accompanied by ipsilateral autonomic dysfunction
Attacks have a frequency of 1-8 a day
What is the acute treatment of a cluster headache?
SC sumatriptan
or
Nasal zolmitriptan
What is the transition treatment for cluster headache?
Steroids (reducing course over 2 weeks)
What is the prophylactic treatment for cluster headaches?
Verapamil (requires ECG monitoring)
What patients tend to get paroxysmal hemicrania?
Elderly (50s-60s)
Women > men
How does paroxysmal hemicrania present?
Severe unilateral headache with unilateral autonomic features
10-30 mins
1 to 40 a day
What is the treatment for paroxysmal hemicrania?
Indomethacin
What does SUNCT stand for?
S = Short lived (15-120 secs) U= Unilateral N= Neuralgia form headache C = Conjunctival injection T = Tearing
What is the treatment for SUNCT?
Lamotrigine
Gabapentin
What individuals are most prone to trigeminal neuralgia?
Elderly (>60)
Women > men
What are the clinical features of trigeminal neuralgia?
Severe stabbing unilateral pain
1-90 secs
10-100 a day
What are the features of a tension headache?
Bilateral Pressing/tightening quality Mild/moderate intensity Not aggravated by physical activity No nausea or vomiting
