Headache Flashcards
Headache red flags
new onset > 55 known/previous malignancy immunosuppressed early morning exacerbated by valsalva
smoking and seasonal variation is assoc with ?? headache
cluster
cluster headache features
unilateral
intense pain around one eye
lacrimation, swelling
typically 1-8 per day, lasting 15 mins - 2 hrs
migrane
risk factors?
more common in which sex?
obesity, patent foramen oval
F > M
what percentage of people with migrane have aura
20
features of migrane
unilateral, throbbing, autonomic feature, photophobia, photophobia
cluster headache tx
high flow O2 - 20 mins
subcut sumatriptan
steroids (no longer than 2 weeks)
verapamil for prophylaxis
migrane acute tx
NSAID +/- anti emetic as soon as possible after onset
or triptans - similar efficacy to NSAIDs
migrane prophylactic tx
when is it given
given if >3 attacks per month or v severe
1st line is propranolol, topiramate
others include valproate, gabapentin
advise to avoid caffeine and hydrate with at least 2L water a day
Trigeminal neuralgia
age group?
triggered by?
elderly
triggered by touch, usually V2/V3
how is the pain described in trigeminal neuralgia and how long does it take to settle
severe stabbing unilateral pain
bouts of pain may last weeks > months before remission
Tx for trigeminal neuralgia
carbamazepine, gabapentin, phenytoin, baclofen …
surgical - ablation, decompression
SUNCT
short lived unilateral neuralgiform conjunctival injections tearing
tx - lamotrigine
Headache in elderly, severe, unilateral, autonomic features, 1-40 per day ..?
paroxysmal hemicrania
Indomethacin is tx for?
paroxysmal hemicrania
when are triptans contraindicated
history of ischaemic heart disease
prophylactic treatment of migrane
who qualifies?
topiramate or propanolol
if patient is experiencing 2 or more migrane attacks per month
