Headache Flashcards

1
Q

What are the red flags with HA?

A

new onset headache >55; knownprev malignancy; early morning headache; exacerbation by valsalva or coughing

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2
Q

What is the diagnostic criteria for migraine w/o aura?

A

2 of : mod/severe; unilateral; throbbing pain; worse on movement and 1 of autonomic features; photo/phonophobia

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3
Q

What is pathophysiology of migraine/

A

blood vessels constrict and dilate; chemical incl. substance P irritate nerves and blood vessels causing pain

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4
Q

What are the common triggers for migraine?

A
Chocolate
Hangovers
Orgasms
Cheese/caffeine
Oral contraceptives
Lie-ins
Alchohol
Travel
Exercise
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5
Q

What is the most common type of aura with migraine?

A

visual

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6
Q

Where is the migraine centre in the brain?

A

brainstem

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7
Q

What type of visual aura is most ocmmon?

A

monochromatic

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8
Q

If the aura is colourful what should be suspected?

A

an occipital lobe seizure

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9
Q

What is the first treatment fro migraine?

A

NSAIDs

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10
Q

what advice is given with analgesia and migraine?

A

take as early as possible

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11
Q

What are triptans?

A

5HT agonist

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12
Q

What is the problem with triptans in treating migraine?

A

can get triptan induced headache due to addiction so dont take more than 2x per week

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13
Q

When should migraine prophylaxis be considered?

A

more than 3 attacks/moth or very severe

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14
Q

How long does eachprophylactic drug for migraine need to be trialled for?

A

minimum of 4 months

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15
Q

What drugs are used as migraine prophylaxis?

A

beta-blockers; topiramate; amitriptyline; gabapentin; sodium valproate

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16
Q

What is topiramate?

A

carbonic anhydrase inhibitor

17
Q

What are the SE of topiramate?

A

weight loss; paraesthesia; imparied conc. enzyme inducer

18
Q

What are the trigeminal autonomic cephalgias?

A

unilateral trigeminal distribution pain that occurs with prominent ipsilateral crainial autonomic features

19
Q

What autonomic features are seen with trigeminal autonomic cephalgias?

A

ptosis; miosis; nasal stuffiness; N and V; tearing; eye lid oedema

20
Q

What are the 4 main types of trigeminal autonomic cephalgias?

A

cluster; paroxysmal hemicraina; hemicrania continua; SUNCT

21
Q

Who gets cluster headaches?

A

30s and 40s; men

22
Q

When do cluster headaches tend to arise?

A

around sleep and with seasonal variation

23
Q

What are the features of cluster headahces?

A

severe unilateral headache lasting for 45-90 mins; 1-8 per day

24
Q

What is the treatment for cluster headahces?

A

high flow o2; s/c sumatriptan; steroids; verapamil

25
Q

Who gets paroxysmal hemicrainia?

A

50s-60s; women

26
Q

What are the features of paroxysmal hemicrainia?

A

severe unilateral headahce and autonomic features; 10-30mins duration; 1-40 a day; response to indomethacin

27
Q

What is the treatment for paroxysmal hemicrainia?

A

indomethacin

28
Q

What does SUNCT stand for?

A
Short lived (15-120s)
Unilateral
Neuralgiaform HA
Conjunctival injections
Tearing
29
Q

What is the treatment for SUNCT HAs?

A

lamotrigine or gabapentin

30
Q

What msut be done with new onset unilateral CN autonomic features?

A

MRI brain and MR angio

31
Q

Who gets trigeminal neuralgia?

A

> 60s; women

32
Q

What are hte features of trigemnial neuralgia?

A

severe stabbing unilateral pain- usually in V2/3 and triggered by touch; 1s-90s duration; 10-100/day

33
Q

What is the treatment of trigeminal neuralgia?

A

carbamazepine; gabapentin; phenytoin; baclofen

34
Q

What triggers cluster HAs?

A

alcohol