Headache Flashcards
What are the red flags with HA?
new onset headache >55; knownprev malignancy; early morning headache; exacerbation by valsalva or coughing
What is the diagnostic criteria for migraine w/o aura?
2 of : mod/severe; unilateral; throbbing pain; worse on movement and 1 of autonomic features; photo/phonophobia
What is pathophysiology of migraine/
blood vessels constrict and dilate; chemical incl. substance P irritate nerves and blood vessels causing pain
What are the common triggers for migraine?
Chocolate Hangovers Orgasms Cheese/caffeine Oral contraceptives Lie-ins Alchohol Travel Exercise
What is the most common type of aura with migraine?
visual
Where is the migraine centre in the brain?
brainstem
What type of visual aura is most ocmmon?
monochromatic
If the aura is colourful what should be suspected?
an occipital lobe seizure
What is the first treatment fro migraine?
NSAIDs
what advice is given with analgesia and migraine?
take as early as possible
What are triptans?
5HT agonist
What is the problem with triptans in treating migraine?
can get triptan induced headache due to addiction so dont take more than 2x per week
When should migraine prophylaxis be considered?
more than 3 attacks/moth or very severe
How long does eachprophylactic drug for migraine need to be trialled for?
minimum of 4 months
What drugs are used as migraine prophylaxis?
beta-blockers; topiramate; amitriptyline; gabapentin; sodium valproate
What is topiramate?
carbonic anhydrase inhibitor
What are the SE of topiramate?
weight loss; paraesthesia; imparied conc. enzyme inducer
What are the trigeminal autonomic cephalgias?
unilateral trigeminal distribution pain that occurs with prominent ipsilateral crainial autonomic features
What autonomic features are seen with trigeminal autonomic cephalgias?
ptosis; miosis; nasal stuffiness; N and V; tearing; eye lid oedema
What are the 4 main types of trigeminal autonomic cephalgias?
cluster; paroxysmal hemicraina; hemicrania continua; SUNCT
Who gets cluster headaches?
30s and 40s; men
When do cluster headaches tend to arise?
around sleep and with seasonal variation
What are the features of cluster headahces?
severe unilateral headache lasting for 45-90 mins; 1-8 per day
What is the treatment for cluster headahces?
high flow o2; s/c sumatriptan; steroids; verapamil
Who gets paroxysmal hemicrainia?
50s-60s; women
What are the features of paroxysmal hemicrainia?
severe unilateral headahce and autonomic features; 10-30mins duration; 1-40 a day; response to indomethacin
What is the treatment for paroxysmal hemicrainia?
indomethacin
What does SUNCT stand for?
Short lived (15-120s) Unilateral Neuralgiaform HA Conjunctival injections Tearing
What is the treatment for SUNCT HAs?
lamotrigine or gabapentin
What msut be done with new onset unilateral CN autonomic features?
MRI brain and MR angio
Who gets trigeminal neuralgia?
> 60s; women
What are hte features of trigemnial neuralgia?
severe stabbing unilateral pain- usually in V2/3 and triggered by touch; 1s-90s duration; 10-100/day
What is the treatment of trigeminal neuralgia?
carbamazepine; gabapentin; phenytoin; baclofen
What triggers cluster HAs?
alcohol
