Headache Flashcards
What are the red flags in headache?
new onset in over 55 known/previous malignancy immune-supressed early morning headache exacerbation by valsalva
Are headaches more common in men or women?
women 2.5:1
What is the criteria for migraine without aura?
at least 5 attacks of 4-72 hour duration
2 0f : moderate/severe, unilateral, throbbing pain, worse on movement
1 Of: autonomic features, photophobia, photophobia
What is the pathophysiology behind migraines?
Susceptible individual stress causes changes in the brain serotonin released blood vessels constrict and dilate chemicals (substance P) irritate nerves and blood vessels pain
Where is the migraine centre?
dorsal ralphe nucleus
lock coeruleus
What is aura?
reversible visual, sensory, motor or language symptom
How long do aura last?
20-60 minutes
What is the most common kind of aura?
visual
Name some migraine triggers
sleep dietary stress hormonal physical exertion
What tool can be used to help identify triggers?
headache diary
What non-pharmacological treatment of headaches is there?
education - avoid triggers
headache diary
relaxation
What is the first line abortive treatment for migraine?
NSAID
aspiring 900mg
naproxen 250mg
ibuprofen 400mg
What are triptans?
serotonin agonists
When should triptans be given?
at the start of a headache
Name some commonly used triptans
rizatriptan
eletriptan
sumatriptan (less effective)
When should prophylaxis be considered?
More than 3 attacks per month
very severe
What is the aim with drug dosage?
achieve effect at the lowest dose possible
How long should each drug be trialled for?
4 months
Propranolol can be used in migraine prophylaxis, which conditions should contraindicate it?
asthma
PVD
CCF
What is topiramate?
carbonic anhydrase inhibitor
What is the problem with topiramate?
poor side effect profile - start slowly!
what are some possible side-effects of topiramate?
weight loss
paraesthesia
impaired concentration
enemy inducer
What are some side-effects of amitriptyline?
dry mouth
postural hypotension
sedation
What dietary triggers are there for migraines?
caffeine
chocolate
dehydration
What is acephalgic migraine?
migraine with no headache
What are trigeminal autonomic cephalgias?
group of primary headaches characterised by unilateral trigeminal distribution of pain that occurs in association with cranial autonomic features
What are cranial autonomic features?
ptosis miosis nasal stuffiness nausea + vomiting tearing eye lid oedema
What are the 4 main TCA’s?
cluster headache
paroxysmal hemicrania
hemicrania continua
SUNCT
What are the common features of cluster headache?
30s-40s
circadian and seasonal variation
severe unilateral headache
45-90mins
1-8/day
cluster may last from weeks to months
How do you treat cluster headaches?
high flow oxygen 20 mins
subcut sumatriptan
steroids for 2 weeks
verapamil prophylaxis
What drug is used in cluster headache prophylaxis?
verapamil
Describe paroxysmal hemicrania?
50s-60s
unilateral headache and autonomic features
10-30mins
1-40/day
What drugs are used to treat paroxysmal hemicranial?
INDOMETHICIN
What is SUNCT?
short lived unilateral neuralgiform headache conjunctival injections tearing
What drugs are used to treat SUNCT?
lamotrigine
gabapentin
What investigation must be done in a new onset unilateral cranial autonomic features?
MRI brain and MR angiogram
Describe trigeminal neuralgia?
elderly women>men
triggered by touch - V2/3
severe stabbing unilateral pain
1-90seconds
10-100/day
bouts may last weeks to months before remission
What is the medical treatment for TN?
carbamazepine
gabapentin
phenytoin
baclofen
What can be injected in TN?
glycerol
What surgical options are there for treatment in TN?
ablation
decompression
What is 1st line in treatment for uncomplicated migraine?
OTC medication
