Headache Flashcards
What causes Aura in migraine?
Cortical depression in the occipital lobe.
What constitutes chronic migraine?
More than 15 days a month of headache and more than 8 days a month of migraine.
Name prophylactic medications for migraine.
Bisoprolol or candesartan
Anti epileptic drugs (gabapentin,topiramate, valproate etc)
Tricyclic antidepressants (amitriptylline)
Propanalol
Define cluster headaches
Strictly unilateral pain in head that lasts for 15 minutes to 3 hours and occurs on 1 or 2 for a day for a while then goes away (hence cluster)
Can also get Prominent ipsilateral autonomic symptoms.
What is the definition of chronic cluster headache?
Remissions lasting less than a month.
Define SUNCT
Unilateral stabbing or pulsating pain. Triggered by cold, touch and chewing. Get 3-200 a day.
Tablets don‘t work so Need subcutaneous or nasal triptans. Verapimil used for prophylaxis.
What are signs of raised ICP?
Progressive headache
Headache worse in morning or wakes patient up
Valsalva manoeuvres make it worse
Focal or non focal signs
Seizures
Visual disturbances and pulsatile tinnitus are signs of CSF causing raised ICP
What causes intracranial hypotension, what’s a sign for it and how is it investigated and treated?
Leaking CSF from either a spontaneous causes or iatrogenic cause (lumbar puncture)
Worse headache when standing up and better when lying down
Do MRI brain and spine
Treat with bed rest, analgesia, caffeine (IV and oral) and epidural blood patch.
What is a contraindication for triptan use for migraine?
Vascular problems
Name a CGRP antagonist
Telcagepant
What migraine suppressive treatment is first line for tension type headaches?
Tricyclic antidepressants
What is seen on functional imaging studies during a cluster headache attack?
Hypothalamic activation
What drugs can be used to acutely treat cluster headaches?
Subcutaneous sumatriptan for acute
Lithium, verapamil or a short course of steroids to get rid of a cluster of headaches
Define paroxysmal hemicrania
Similar to cluster headaches but last less time and more frequently and not in clusters.
Responds to indometacin
What other headache condition can accompany migraine?
Primary stabbing headache
What investigations need to be done after experiencing a primary sex headache?
Need to rule out a SAH with CT etc
What causes idiopathic intracranial hypertension and in what kind of patients does it usually occur in?
Reduced resorption of CSF
Young and overweight females usually with polycystic ovaries
What are the presenting features of IIH?
Headache
Transient visual obscurations due to papilloedema
Optic nerve damage from papilloedema
Sixth CN nerve palsy which is a false localising sign
Name a risk factor for trigeminal neuralgia
Hypertension which leads to a vascular loop compressing the nerve from the pons area
How does Giant cell arteritis present?
Headache Tenderness of the scalp Non pulsatile arteries Jaw claudication Tenderness/swelling of temporal and occipital arteries Tiredness Malaise Fever Sudden painless loss of vision in one eye due to ophthalmic artery involvement
What are the investigational findings in GCA?
Raised ESR (50-120mm/h)
Raised CRP
Can get abnormal LFTs and low albumin
A temporal artery biopsy is patchy and abnormal and is the main diagnostic test
What condition is GCA associated with?
Polymyalgia rheumatica
What is the main treatment for GCA?
60-100mg prednisolone
Treatment should not be delayed for tests especially if vision has been affected or a stroke has happened
