Headache Flashcards
headache red flags
new onset >55 early morning/wakes you up exacerbated by sneezing/coughing neck stiffness seizures change in vision, photophobia
classic type of person with migraine (gender, age)
female
teenager-40yo
migraine triggers (4)
stress
hormonal (periods)
sleep
diet - cheese, red wine, caffeine
what chemical does triggers (eg stress) release
what does this do to blood vessels (in brain)
what does this result in
serotonin
vasodilation of cranial blood vessels
pain = migraine
how long can migraines last for (each time)
how often do people get migraines
4-72 hours
once per month (avg)
what GI symptoms may migraine present with
nausea and vomiting
what ophtho symptoms may migraine present with
photophobia
aura
how does the headache feel in a migraine
unilateral throbbing headache
acute management for migraine (2)
NSAIDs
triptans - costly
prophylaxis for migraines
lifestyle modification - avoid triggers (use diary)
first line - propanolol (not asthmatics), topiramate (carbonic anhydrase inhibitor)
second line - gabapentin, sodium valproate
what is contraindicated in people with migraines with aura
oral contraceptives
presentation of tension headache
no nausea/vomiting no photphobia/aura bilateral mild/moderate 'monday morning'
management of tension headache (3)
relaxation
beta blockers
antidepressants
pathophysiology of tension headache
nothing, theyre fine
what are the 3 types of trigmeninal autonomic cephalgias
cluster headache
paroxysal hemicrania
SUNCT
how do trigeminal autonomic cephalgias present (2 categories of symptoms)
unilateral trigeminal distribution (headache)
ipsilateral cranial autonomic features - eg ptosis, miosis, nasal stuffiness, tearing, eye lid oedema
who get cluster headache s(gender and age)
young men
who get paroxysmal hemicrania (gender and age)
50-60yo women
what are the autonomic features in trigeminal cranial cephlagia (5)
ptosis miosis nasal stuffiness tearing eye lid oedema
how often do men get ‘clusters’ of cluster headaches
every couple months
how long do the headaches last in cluster headaches
ow many do you get in a day
45-90mins
1-8 in a day
how long to paroxysmal hemicrania headaches last
how many do you get in a day
10-30 mins
1-40 in a day
acute treatment of cluster headaches
oxygen and sumatriptan SC
prophylactic treatment of cluster headaches
verapamil
treatment of paroxysmal headaches (in older women)
indomethicin (diagnostic if it works)
what is SUNCT
how does it differ from other types of trigeminal autonomic cephalgia
stands for;
short lived
unilateral headache
neuralgia headache
conjunctival injections tearing
it lasts longer than other trigeminal autonomic cephalgia
investigations for trigeminal autonomic cephalgia
MRI/CT
who get idiopathic intracranial hypertension
obese females
when is headache worse in idiopathic intracranial hypertension
morning
idiopathic intracranial hypertension causes increased … and hence … (eye symptom)
increased ICP = papilloedema = vision loss
investigations for idiopathic intracranial hypertension
fundoscopy - for papilloedema
brain MRI - for other causes of papilloedema
management of idiopathic intracranial hypertension
LOSE WEIGHT! though no one does lol
acetazolamide
how does acetazolamide work in relieve idiopathic intrancranial hypertension
what is another common drug that would do this same job
decreases ICP
diuretics
who gets trigeminal neuralgia
elderly women
what is the pathophysiology of tirgeminal neuralgia
blood vessel touches trigeminal nerve = extreme pain when nerve is triggered (eg by touch to face, chewing etc)
presentation of pain in trigeminal neuralgia
how long does pain last for
how many times per day do they get pain
sharp stabbing unilateral pain
lasts <90 seconds
happens 1-100 times per day
investigations for trigeminal neuralgia
MRI
treatment for trigeminal neuralgia
carbamazepine
gabapentin
phenytoin
ablation decompression (big surgery)
20yo female
headache with nausea, aura and photophobia
once per month
lasts 4-72 hours
migraine
feels like a band squeezing round head
tension headache
bilateral headache
no nausea/vomiting/visual loss/photophobia
mild/moderate
feels like a band squeezing round head
tension headache
young male unilateral headache eye lid oedema ptosis lasts 45-90mins, 1-8 times per day
cluster headache
general headache treatment (a good guess in exam)
triptan
60yo women unilateral headache miosis tearing nasal stuffiness lasts 10-30mins, 1-40 times per day
paroxysmal hemicrania
obese female
vision loss
headache worse in morning
nausea and vomiting
idiopathic intracranial hypertension
elderly women
severe unilateral stabbing pain in face
<90secs, 1-100 times per day
triggers - chewing, touch face
trigeminal neuralgia
