Headache Flashcards
What are the red flags of a headache?
New onset age >55 Malignancy Immunosuppression Early morning Exacerbation by valsalva
Migraines are commoner in men/women
Women
Most migraines occur without an aura. True/false?
True
Stress causes what substance to be released in the brain?
Serotonin
What is the effect of serotonin release?
Vasoconstriction/dilation
Substance P release
What effect does substance P have?
Nerve and blood vessel irritation
What is an aura?
A fully reversible visual/sensory/motor/language symptom
How long does an aura last?
20-60 minutes
What is the most common type of aura?
Visual
Give some triggers of a migraine
Sleep Dietary Stress Hormones Physical exertion
What is the main acute treatment for a migraine?
NSAIDs (aspirin, naproxen or ibuprofen)
What 5-HTP agonist drugs can be used to treat migraine acutely?
Triptans (rizatriptan/eletriptan/frovatriptan)
What is the main benefit of NSAIDs over triptans?
Cost - NSAIDs are much cheaper
When is migraine prophylaxis considered?
When a patient has >3 attacks per month
What is the main prophylactic drug used in migraines?
Propranolol
What other drugs are used in migraine prophylaxis?
Topiramate Amitriptyline Gabapentin Botulinum Monoclonal antibody
What is the main downside of topiramate?
Poor side effect profile (weight loss/impaired concentration)
How long should a patient be on a prophylactic drug before stopping?
4 months
What lifestyle changes can be made in patients with migraines?
Healthy diet
Reduced caffeine
Reduced stress
Exercise
Give some examples of ‘fancy’ migraines
Acephalgic Basilar Retinal Ophthalmic Hemiplegic Abdominal
Tension type headaches tend to be worse than migraines. True/false?
False - less severe with less adverse effects
What drugs can be used to treat a tension type headache?
Antidepressants (dothiepin/amitriptyline)
What are trigeminal autonomic cephalgias?
A group of primary headache disorders characterised by unilateral trigeminal pain with cranial autonomic features
Give some cranial autonomic features seen in TACs
Ptosis Miosis Nasal stuffiness N+V Tearing Eye lid oedema
What are the four main types of TACs?
Cluster
Paroxysmal hemicrania
Hemicrania continua
SUNCT
Cluster headache tends to affect younger men. True/false?
True
How long do cluster headaches tend to last?
45-90 mins
What is the treatment for cluster headaches?
High flow O2
Subcutaneous sumatriptan
Steroids
Paroxysmal hemicrania tends to affects younger men. True/false?
False - elderly women
Paroxysmal hemicrania lasts longer/shorter than cluster headache and is more/less frequent
Shorter duration and more frequent
What is the absolute treatment for paroxysmal hemicrania?
Indomethicin
What does SUNCT stand for?
Short-lived Unilateral Neuralgiaform headache Conjunctival injections Tearing
What is the treatment for SUNCT?
Lamotrigine/gabapentin
What imaging is used for new onset unilateral cranial features?
MRI brain
MR angiogram
Who tends to get idiopathic intracranial hypertension?
Obese women
What does idiopathic intracranial hypertension present with?
Headache
Nausea and vomiting
Visual loss
What investigation is done in idiopathic intracranial hypertension?
Spinal tap (only ever done in IIH)
How is idiopathic intracranial hypertension treated?
Weight loss
Acetazolamide
Ventricular atrial shunt
Who tends to get trigeminal neuralgia?
Elderly women
What are the features of trigeminal neuralgia?
Severe stabbing unilateral pain
Triggered by touch
How is trigeminal neuralgia treated medically?
Anticonvulsants (carbamazepine/gabapentin)
How is trigeminal neuralgia treated surgically?
Ablation
Decompression
