Headache Flashcards
Are migraines more common in men or women?
Women
Are migraines more often uni or bilateral?
Unilateral
Decribe the pain in migraine
Dull & throbbing
How do you treat migraine?
Analgesia: NSAIDs & paracetamol/aspirin & metoclopramide/ Naproxen/Diclofenac *beware analgesic headache
Antiemetics
Triptans: s/c sumatriptan
Final stage: Botox injections for chronic migraine.
What prophylaxis is used for migraine?
Beta blockers (propanolol), or topirimate, amytriptyline or 2md line sodium valproate
How many attacks needed for diagnosis of migraine?
5 lasting 4-72 hours
When are triptans contraindicated?
Hypertension, coronary artery disease, CV disease and pregnancy
What are the differentials for single episode headache?
Head Injury Sinusitis Tropical Disease Acute Glaucoma Low Pressure Headache (CSF leak) Meningitis Encephalitis SAH Venous Sinus Thrombosis
What are signs of sinusitis?
Dull, constant, tender over sinuses, worsened by leaning forward
What are signs of tension headache?
Tight band across forehead, bilateral pain, non pulsatile +/- scalp tenderness
“head in a vice”
7 days long
No vomiting or sensitivity to head movement.
What are signs of cluster headache?
Rapid onset & cessation, severe, unilateral eye pain (bloodshot and swollen & flushed face)
Occurs 1-2 daily for 1-3 months with month symptom-free between.
How do you treat tension headache?
Stress relief and NSAIDs
How do you treat cluster headache?
S/c sumatriptan and high flow O2. Prednisolone 5 days for short term prophylaxis or Verapimil used for long term (CHECK ECG) or lithium (CHECK LFTs) or melatonin injections
What are signs of Giant Cell Arteritis (GCA)?
Temporal headache with scalp tenderness, jaw claudication and a non pulsatile temporal artery
What is the risk of GCA?
Irreversible bilateral vision loss
What is treatment of GCA?
Prednisolone
Signs of Trigeminal Neuralgia?
Unilateral stabbing pain in V3 region severe and breif, face screws up- triggered by shaving or washing face. Normal neuro exam
Treatment of trigeminal neuralgia?
Carbamazepine & surgical decompression
Raised ICP signs
Worse on coughing, leaning forwards, and in the morning. Papilloedema and vomit & seizures & odd behaviour.
What pain relief most cause analgesic headaches?
Tricyclics
Signs of Idiopathic Intercranial Hypertension (IIH)?
Constant throbbing, worse in the morning, blurred/double vision.
IIH is usually found in who?
Overweight women
What is the sign on CT of Venous Sinus Thromboembolism?
Empty Delta sign
Venous Sinus Thromboembolism treatment
Anticoagulate: LMW Heparin then Warfarin
Which gender get cluster headache more?
Male
Trigger for cluster headache?
Alcohol, Exercise & GTN
Where in head is SAH pain?
Occipital
Which nerve palsy seen in SAH?
IIIrd
ECG changes on SAH?
Deep T wave inversion
Management of SAH
CT (less sensitive with more time)- CT angiography to find aneurysms.
LP (delay for 12 hours for xanthochromia)
NIMODIPINE for vasospasm
Saline hydration
Endovascular clipping or coil.
DEXAMETHASONE for cerebral oedema.
SAH prognosis
30% full recovery
30% die
30% disability
What is a berry aneurysm?
defect in media and elastica of cerebral arteries such that the media bulges out
What diseases are SAH associated with?
PCK & coarctation of aorta
What are signs of extradural haemorrhage?
Occur due to skull fracture affecting MIDDLE MENINGEAL ARTERY. LUCID PERIOD then blown pupil, limb weakness, and neuro signs. Lens shape. Coning risk and slow increase in ICP.
Extradural haemorrhage treatment?
Mannitol for ICP
Decompression surgically
Subdural haemorrhages are caused by?
Trauma - Bleeding from bridging veins between cortex and venous sinuses leading to haematoma between dura and arachnoid.
Subdural haemorrhages more common in?
AGE, ALCOHOL & ANTICOAGS (& low ICP & brain metastases)
What to subdural haemorrhages cause?
MIDLINE SHIFT & hemiparesis
fluctuating consciousness, slowing physically and intellectually,
How long do subdural haemorrhages take to develop
Can be over months
CT Subdural Haemorrhage?
Crescent shaped
Subdural Haemorrhage treatment
Burr Hole Craniotomy
How do you manage trigeminal neuralgia?
Carbamazepine
What causes trigeminal neuralgia pain?
Compression of trigeminal nerva
What often occurs alongside trigeminal neuralgia?
MS
What are complications of trigeminal neuralgia?
Poor dentition as cant brush teeth
What are common symptoms of trigeminal neuralgia?
Pain on wind on face
Pain in teeth
Cant brush hair
When do you refer trigeminal neuralgia?
When meds dont work
When eyes involved
Medication overuse headache Disorder
15+ days per month with pre existing headache disorder
Use for over 3 months of drugs used for headaches
10+ days of opioids or ergotamine OR 15+ days of ibuprofen etc
How is MOH treated?
Stop medications causing
Advise it takes 2 months to improve and might get worse first- keep headache diary
Review and assess underlying headache disorder
Prevent relapse- awareness and management
When cant you take COCP?
Migraine with aura
What drugs are worst for MOH?
Triptans
