Headache Flashcards
What are the four phases of a migraine?
Prodrome
Aura
Headache
Resolution
Irritability, hyperactivity, depression, food cravings are characteristic for which phase of the migraine?
First phase - occurs in the 24h period before headaches
Reversible neurological symptoms tha develops gradually over 5-20 min, lasting 1h.
Which phase of migraine is this characteristic for?
Aura visual, sensory, motor, or speech disturbances
85% of migraines presents without aura
What is the typical location and character of a migraine headache?
unilateral/bilateral - pulsating
usually starts around orbit
What can aggrevate a migraine?
Light, noise, physical activity. Nausea is common
What symptoms can appear in the resolution phase of a migraine? (5)
Tiredness depression malaise irritabillity impaired concentration
What is the treatment of an acute migraine?
Paracet(+caffeine?), NSAIDS, triptans
(remember to rule out SAH first time)
- Metocloperamide etc for nausea
What is the prophylactic treatment of migraine? (more than 2 attacks/month)
- CCB (Verapamil, Flunarazine)
Valporate, Topiramate, Propranolol, Amitryptiline
and many other drugs
What is the location and character of the pain in tension-headaches?
Band-like, pressing/tightening constant pain
Lasts 30m - 7 days
How is acute and chronic tension headache distinguished?
more than 15 days /month is chronic
less is episodic
What is the treatment of episodic tension-headaches?
aspirin, acetaminophen(+-caffein), NSAIDS
What is the prophylactic treatment for chronic tension headaches?
TCAs: Amitriptyline, Nortriptyline,
SSRIs: (citalopram, fluoxetine, sertralin etc)
In which sex is the prevalence of cluster headaches highest?
men (M:F ,9:1)
What is the location and character of the pain in cluster headaches?
Severe sharpe retro-orbital headache
regular (i.e every night at 2 a.m)
What neurologic symptoms usually accompany cluster headaches?
Autonomic symptoms: (rhinorhea conjunctival injection Horner syndrome eylid edema)
What is the treatmen of cluster headaches?
100% O2, steriods, TRIPTANS, lidocaine, ergotamine
Prophylaxi: Verapamil, Lithium
What are the presentation of headache associated with temporal arteritis?
localized headache
localized tenderness
systemic symptoms: fever, w. loss, polymyalgia,fatigue
(elevated ESR, CRP)
What is the treatment of temporal arteritis headaches?
steroids
What can be the cause of pseudotumor cerebri (benings intracranial hypertension) ? (4)
ypung obese women with hormonal imbalance
tetracyclin therapy
hypervitaminoses A
steroids withdrawal
what is the clinical presentation of pseudotumor cerebri? (3)
severe, global constant headache
papilledema and visual loss
6th nerve palsy with diplopia
What is the treatment of pseudotumor cerebri?
Repeated LPS weight loss Acetazolamide/Furosemide Steroids Mannitol Topiramate Surgery
What is the clinical presentation of trigeminal neuralgia?
Paroxysmal, sharp/stabbing/electric/ pain
lasting up to 2m
trigeminal distribution
(presence of trigger zones)
What is the treatment of trigeminal neuralgia?
Carbamazepine, Gabapentin
Surgical peripheral denervation
What is the order of severity for cluster, neuralgias, migraines and tension headaches?
worst: neuralgias >cluster>migraine>tension
