headache Flashcards
which headache involves the eye ? intense pain around one eye? lacrimal swelling. recurrent attack which ‘always attacks one side?
cluster headache
how many times a day do you get cluster headaches?
once or twice a day (clusters)
how long do the clusters last ?
typically 4-12 weeks
what is raised in temporal arteritis?
ESR
Recurrent, severe headache which is usually unilateral and throbbing in nature
May be be associated with aura, nausea and photosensitivity
Aggravated by, or causes avoidance of, routine activities of daily living. Patients often describe ‘going to bed’.
In women may be associated with menstruation
migraine
Recurrent, non-disabling, bilateral headache, often described as a ‘tight-band’
Not aggravated by routine activities of daily living?
tension headache
who is typical patient to have a migraine ?
young female
how often typically would people have migraines
once a month
pain in migraine?
unilateral throbbing pain
autonomic features of a migraine?
photophobia/phonophobia
what kind of aura can you get in migraine?
visual, seonsory, motor or language
triggers for migraine ?
Sleep • Dietary • Stress • Hormonal • Physical exertion
management of migraine?
offer combination therapy with an oral triptan and an NSAID, or an oral triptan and paracetamol
prophylaxis for migraine?
offer either topiramate or propranolol (TOTP)
what are triptans?
5HT agonist
example of triptan?
rizatriptan, eletriptan
which NSAID would you give?
aspirin
when would you consider prophylaxis?
more than 3 attacks per month or if very severe
Consider non-pharmacological methods such as?
accupuncture, relaxation exercises
which patients would you need to be careful giving propranolol to?
asthmatic
what kind of drug is topiramate?
carbonic anhydrase inhibitor
side effects of amytryptilline?
dry mouth, postural hypotension, sedation.
amytryptline is a TCA
common unilateral headache of the young?
migraine
when would you consider imaging ?
if late onset (>55)
known malignancy
Ipsilateral cranial autonomic features. what are they?
Ptosis
Miosis
Nasal Stuffiness Nausea/ vomiting Tearing
Eye lid oedema
Severe unilateral headache, Duration: 45- 90mins (20 mins-3 hours)?
cluster
frequency per day cluster headache?
1-8 per day
Treatment of a cluster headache?
high flow oxygen
Sub cut sumatriptan 6mg
Steroids- reducing course over 2 weeks
Verapamil for prophylaxis
prophylaxis of cluster headache?
verapamil
SUNCT treatment?
Tears LG
unilateral headache, unilateral autonomic features (dizziness/fainting/increased heart rate etc)
Paroxysmal hemicrania
Paroxysmal hemicrania treatment?
indomethicin
treatment of trigeminal neuralgia?
carbamazepine
what condition do you get trigeminal neuralgia in?
MS
trigger for cluster headache?
alcohol
cluster headache more common in males or females?
males
migraine prophylaxis for women associated with period?
frovatipran
