Headache Flashcards
Tension type headache presentation
- BILATERAL PRESSING/TIGHTENING QUALITY
- NO SIG. ASS/ FEATURES
- NOT AGGRAVATED BY ROUTINE PHYSICAL ACTIVITY
NOT DISABLING
Tension type headache management
SIMPLE ANALGESIA
Abortive rx:
- ASPIRIN/PARACETAMOL
- NSAIDs
- TO AVOID MEDICATION OVERUSE HEADACHE = LIMIT TO 10 DAYS PER MONTH (~ 2 days per week)
Preventative rx:
- RARELY REQ.
- TRICYCLIC ANTIDEPRESSANTS
- AMITRIPYLINE, DOTHIEPIN, NORTRIPYLINE
- Limited to no more than ~ 2 days per week
Migraine presentation
Premonitory:
- WARNING SIGNS
- MOOD CHANGES
- FATIGUE
- COGNITIVE CHANGES
- MUSCLE PAIN
- FOOD CRAVINGS
Aura:
- FULLY REVERSIBLE
- NEUROLOGICAL CHANGES
- VISUAL SOMATOSENSORY
Early Headache:
- DULL HEADACHE
- NASAL CONGESTION
- MUSCLE PAIN
Advanced Headache:
- UNILATERAL, THROBBING, WORSENS IN SEVERITY
- NAUSEA, PHOTOPHOBIA, PHONOPHOBIA, OSMOPHOBIA
Postdrome:
- FATIGUE
- COGNITIVE CHANGES
- MUSCLE PAIN
What is aura + how is it different from TIA
TRANSIENT NEUROLOGICAL SYMPTOMS - resulting form cortical/brainstem dysfunction
can involve visual, sensory, motor, speech systems
slow evolution of symptoms + moves from 1 are to next
lasts 15 - 60 mins
TIA = loss of function, sudden onset, symptoms all start at same time + can be localised to specific vascular area
AURA = starts, spreads, worsens, more gradual
Migraine characteristics
- DISABLING PRIMARY HEADACHE
- CHRONIC DISORDER + EPISODIC ATTACKS + COMPLEX CHANGES IN BRAIN
- HAS TRIGGERS + SENSORY SENSITIVITY
triggers incl. = normal life events, sleep disturbance, hunger, stress, diet, dehydration, environmental stimuli e.g. light, sound, changes in oestrogen lvl
Migraine management
Abortive rx:
- ASPIRIN/NSAIDs
- TRIPTANS
- LIMIT TO ~ 10 DAYS/MONTH (to avoid medication overuse headache)
Prophylactic rx:
- PROPANOLOL, CANDESARTAN
- ANTI-EPILEPTICS
- TOPIRAMATE, VALPROATE, GABAPENTIN
- TRICYCLIC ANTIDEPRESSANTS
- AMITRIPTYLINE, DOTHIEPIN, NORTRIPTYLINE
- VENLAFLAXINE
Chronic Migraine
HEADACHE ≥ 15 DAYS/MONTH - of which ≥ 8 DAYS = MIGRAINE; ALL FOR > 3 MONTHS
transformed migraine: w/ or wo escalation in medication use
* Hx EPISODIC MIGRAINE * INCREASING FREQ. of HEADACHES: over weeks/months/years * MIGRAINOUS SYMPTOMS BECOME LESS FREQ. & LESS SEVERE * MANY PT. HAVE SEVERE MIGRAINE EPISODES + LESS SEVERE FEATURELESS FREQ./DAILY HEADACHE
Medication overuse
HEADACHE ≥ 15 DAYS/MONTH - DEVELOPED/WORSENED WHILE TAKING REGULAR SYMPTOMATIC MEDICATION
CAN OCCUR IN ANY PRIMARY HEADACHE
DISCONTINUING MEDICATION OVERUSE OFTEN (not always) DRAMATICALLY IMPROVES HEADACHE FREQ.
* TRIPTANS, ERGOTS, OPIODS + COMBINATION ANALGESICS > 10 DAYS PER MONTH (~ > 2 days/week) * SIMPLE ANALGESICS > 15 DAYS/MONTH * CAFFEINE OVERUSE ○ LIMIT DRUG USE TO ~ ≤ 2 DAYS PER WEEK
Trigeminal autonomic cephalgia general presentation
- UNILATERAL HEAD PAIN = predominantly V1
- V.SEVERE/EXCRUCIATING
- CRANIAL AUTONOMIC SYMPTOMS
○ CONJUNCTIVAL INJECTION/LACRIMATION ○ NASAL CONGESTION/RHINORRHOEA ○ EYELID OEDEMA ○ FOREHEAD & FACIAL SWEATING ○ MIOSIS/PTOSIS (HORNER'S SYNDROME)
* ATTACK FREQ. & DURATION DIFFERS * TREATMENT RESPONSES DIFFER
Cluster headache presentation
Attack:
- UNILATERAL PAIN = ORBITAL & TEMPORAL mainly
- EXCRUCIATINGLY SEVERE (suicide headache)
- RESTLESS & AGITATED DURING ATTACK
- PROMINENT IPSILATERAL AUTONOMIC SYMPTOMS
- MIGRANE SYMPTOMS OFTEN PRESENT
- PREMONITORY SYMPTOMS = TIREDNESS, YAWNING
- ASS. SYMPTOMS = NAUSEA, VOMITING, PHOTOPHOBIA, PHONOPHOBIA
- TYPICAL AURA
- RAPID ONSET = comes on w/i minutes
- DURATION = 15 mins - 3 hrs, majority are 45 - 90 mins
- RAPID CESSATION of PAIN
- SEVERAL ATTACKS PER DAY
Bout:
- EPISODIC IN 80 - 90%
- ATTACKS CLUSTER INTO BOUTS = typically lasting 1 - 3 MONTHS w/ PERIODS of REMISSION ≥ 1 MONTHS
- ATTACK FREQ. = 1 EVERY OTHER DAY - 8/DAY (increases as bout progresses)
- May be CONTINUOUS BACKGROUND bwtn ATTACKS
- ALCOHOL = TRIGGERS ATTACKS DURING BOUT, but NOT IN REMISSION
- STRIKING CIRCADIAN RHYTHMICITY
- ATTACKS OCCUR AT SAME TIME EVERY DAY + BOUTS OCCUR AT SAME TIME EACH YEAR
- CHRONIC CLUSTER IN 10 - 20%
- BOUTS LAST > 1 YEAR w/o REMISSION
- Or REMISSION < 1 MONTH
Cluster headache management
Abortive (headache)
- S/C SUMATRIPTAN 6mg/NASAL ZOLMATRIPTAN 5mg
- 100% O2 7 - 12 L/min via TIGHT FITTING NON-REBREATHING MASK
Abortive (headache bout)
- OCCIPITAL DEPOMEDRONE INJECTIONS = SAME SIDES as HEADACHE
- TAPERING COURSE of ORAL PREDNISOLONE
Preventative
- VERAPAMIL (high doses may be req.)
- LITHIUM
- METHYLSERGIDE (risk of retroperitoneal fibrosis)
- TOPIRAMATE
Paroxsysmal hemicrania presentation
• UNILATERAL PAIN = ORBITAL & TEMPORAL mainly
○ EXCRUCIATINGLY SEVERE ○ BACKGROUND CONTINUOUS PAIN can be PRESENT * 50% RESTLESS & AGITATED DURING ATTACK * PROMINENT IPSILATERAL AUTONOMIC SYMPTOMS * MIGRANOUS SYMPTOMS poss. PRESENT * RAPID ONSET * DURATION = 2 - 30 mins * RAPID CESSATION of PAIN * FREQ. = 2 - 40 ATTACKS/DAY + NO CIRCADIAN RHYTHM
TRIGGER = BENDING/ROTATING HEAD ~ 10%
80% CHRONIC : 20% EPISODIC
Paroxsysmal hemicrania management
- NO ABORTIVE TREATMENT
- PROPHYLAXIS = INDOMETACIN
- ALTERNATIVES = COX-II INHIBITORS, TOPIRAMATE
SUNCT/SUNA presentation
- UNILATERAL ORBITAL/SUPRAORBITAL/TEMPORAL PAIN
- STABBING/PULSATING PAIN
- SOME AUTONOMIC SYMPTOMS = CONJUNCTIVAL INJECTION & LACRIMATION
- DURATION = 10 - 240 s
- ATTACK FREQ. = 3 - 200/DAY + NO REFRACTORY PERIOD
CUTANEOUS TRIGGERS = WIND, COLD, TOUCH, CHEWING
SUNCT/SUNA management
NO ABORTIVE TREATMENT
PROPHYLAXIS:
* LAMOTRIGNINE * TOPIRAMATE * GABAPENTIN * CARBAMAZEPINE/OXYCARBAZEPINE
