Headache Flashcards
How does migraine present?
Moderate to severe throbbing pain Unilateral Worse on movement Decreased ability to function Associated symptoms: nausea, vomiting, photo/phonophobia
How long do migraines usually last?
4-72 hours if untreated
What is migraine with aura?
Migraine + fully reversible visual, sensory or motor symptom
What can happen in migraine with aura?
Visual: Central scotoma, hemianopia loss, centra fortification
Sensory: deficit e.g. hands and feet
Flashing lights, geometric shapes, funny smells
What can trigger a migraine?
sleep hormonal (pregnancy, premenstrual) physical exertion dietary stress
How is migraine diagnosed?
Usually clinical
What are some non pharmacological treatments of migraine?
Avoid triggers
Headache diary
What is the pharmacological treatment of acute migraine?
NSAIDs, triptans e.g. rizatriptan
What can be used as migraine prophylaxis?
propranolol
topiramate
amitryptiline
What is the headache like in cluster headache?
Rapid onset of severe unilateral pain
Orbital, supraorbital, temporal
Lasts 15 mins to 3 hours
Can occur e.g. once every 2 days, 8 times a day for that cluster period
How long can a cluster bout last?
weeks to months - headaches occur at the same time for this period
What are the associated symptoms of a cluster headache?
N&V
lacrimation
rhinorrhea
partial Horners syndrome
How is cluster headache diagnosed?
Clinical
CT (looking for secondary cause)
What is the treatment of cluster headache?
high flow oxygen
sumatriptan
steroids
What is the prophylaxis for cluster headache?
verapamil
What is the most common type of primary headache?
Tension headache
Describe a tension headache
Generalised, non pulsatile headache
No associated nausea or vomiting, sensitivity to head movements
What can cause a tension headache?
Stress Alcohol Caffeine Hormones Dehydration
How is tension headache diagnosed?
Clinical diagnosis
How are tension headaches treated?
Reduce cause e.g. caffeine, stress
Simple analgesia
What is trigeminal neuralgia?
Facial pain syndrome
Distribution of 1 or more divisions of trigeminal nerve (typically V2/3)
What are the symptoms of trigeminal neuralgia?
Very severe stabbing unilateral pain
Lasting 1-90 seconds
What can trigger trigeminal neuralgia?
Touch - shaving, talking, eating
What are some causes of trigeminal neuralgia?
Compression of trigeminal nerve: MS, chronic meningeal inflammation, skull base malformation, trauma, anomalous/aneurysmal intracranial vessels or tumour
How is trigeminal neuralgia diagnosed?
Clinical
MRI
How is trigeminal neuralgia treated?
carbamazepine gabapentin baclofen phenytoin lamotrigine surgery: decompression, ablation
What causes idiopathic intracranial hypertension?
Increased CSF pressure
Who typically gets IIH?
Young women, recently gained lots of weight, pregnant
How does IIH present?
Headache
Whooshing noises/tinnitus
Worse lying down and in the morning
Nausea, visual field loss
What are the investigations for IIH?
Visual field testing
Fundoscopy
LP at L3/4
MRI brain?
What is the treatment for IIH?
Weight loss
LP
Acetazolamide, furosemide (to decrease ICP)
Analgesia
What are the key risk factors for trigeminal neuralgia?
Age
MS
