Headache Flashcards
What are the triggers for a migraine?
CHOCOLATE C: Chocolate H: Hangovers O: Orgasm C: Cheese O: OCP L: Lie ins A: OH- T: Tumult (loud noises) E: Exercise
What is the criteria for migraine without aura?
A) >5 attacks fulfilling B-D criteria
B) 1-48hours
C) >2: B/L or U/L, pulsating, mod-severe intensity, aggravation/avoiding normal routine
D) During headache: N&V or photo/phonophobia
What is the criteria for migraine with aura?
A) Recurring headache lasting 1-48hours
B) >2 attacks fulfilling C
C) >3: Reversible aura, aura developing gradually over >4mins, no longer than 60mins, headache following aura in <60mins
What are the prodromal Sx of a migraine?
Yawning
Cravings
Mood & Sleep disturbance
How are migraines managed?
Weight loss (linked to oestrogen)
ACUTE: NSAID + PO Triptan + Paracetamol
CHRONIC if >2/month: BB (Propranolol) or Amitriptyline/Topiramate/ Valproate
How are migraines treated prophylactically?
Topiramate or Propranolol if severe and >2/month
What are the red flags of a headache?
Worsening with fever Sudden onset reaching max intensity at 5mins ↓conciousness ↓vision Jaw claudication Vomiting ↓GCS
What are the +ve & -ve phenomena that can be associated with migraine?
\+ve = addition of neuro Sx (tremor) -ve = loss of normal neuro function (sensation)
What are the types of tension headache?
Episodic: <15days/month
Chronic: >15days/month likely due to meds
How does a tension headache present?
Tight band/ pressure sensation around head Symmetrical (B/L) Gradual onset Regular + mild intensity Exacerbated by STRESS No aura or N&V
How is a tension headache managed?
Reassurance
ACUTE: Aspirin, Paracetamol/NSAID
Consider TCA
What are the triggers of cluster headache?
Male smoker
Alcohol
Sleep (lack of)
How does a cluster headache present?
15mins-2hour duration Often NOCTURNAL Intense sharp stabbing pain around EYE Red, watery eye Lid swelling U/L rhinorrhoea (on side of headache) Restless patient
How is a cluster headache managed?
100% O2 15L/min + IV/SC Triptan
How is a cluster headache treated prophylactically?
Verapamil
What are the causes of sinusitis?
Anatomical: Septal deviation, polyps
Mucosal: Viruses (Rhinovirus), bacterial (Strep Pneumoniae, Haemophilus)
Smoking
What are the Sx of sinusitis?
Facial pain + tenderness Frontal pressure worse bending forward Rhinorrhoea: Thick & purulent Mouth breathing (nasal obstruction) Fever Post nasal drip= chronic cough
How is acute bacterial sinusitis diagnosed?
> 3 Sx:
- Discolouration & purulent discharge w/ U/L predominance
- Fever >38
- Severe local pain w/ U/L predominance
- ↑ESR/CRP
- Double sickening: Deterioration in health after initial mild illness
How is sinusitis investigated?
Bloods: ↑ESR/CRP
CT paranasal sinus/ nasal endoscopy: Recurrent sinusitis
How is acute sinusitis treated?
Analgesia + nasal saline irrigation
Ephedrine 0.5%
PO Abx: Amoxicillin
How is chronic sinusitis treated?
Intranasal corticosteroids
Refer to ENT for functional endoscopic sinus surgery
What is hydrocephalus?
↑ in vol of CSF occupying the cerebral ventricles
How is hydrocephalus classified?
Non-communicating/obstructing: CSF obstructed in ventricles or between ventricles & SA space
Communicating: Communication between ventricles & SA space, problem outside of ventricular system
Normal pressure
Hydrocephalus ex vacuo: Ventricular expansion secondary to brain atrophy (Alzheimer’s, Pick’s disease) CSF normal
What are the causes of hydrocephalus?
Idiopathic: 1/3 adults
Obstructive Congenital: Arnold-Chiari, toxoplasmosis,
Obstructive acquired: Intraventricular haematoma, tumours, aqueduct stenosis
Communicating: SAH, infection
Meningitis
Prematurity
What are the Sx of hydrocephalus?
KIDS: Vomiting, irritable, rapid ↑ in head circumference, setting sun sign, ↑limb tone
ADULTS: Headache, vomiting, papilloedema, impaired upwards gaze, unsteady gait (leg spasticity), CN6 palsy, blurred vision
How is hydrocephalus investigated?
-CT +/- contrast:
Dilated Lateral + 3rd V w/NORMAL 4th V = Aqueduct stenosis
Dilated Lateral + 3rd V w/ABNORMAL 4th V = Posterior fossa mass
Generalised dilatation = communicating hydrocephalus
-USS IN BABIES: Anterior fontanelle
How is hydrocephalus managed?
Depends on severity
Serial LP in acute deterioration
Meds: Furosemide + Acetazolamide
Surgery: External ventricular drain/shunt
What are the complications of hydrocephalus?
Fatal in first 4yrs of life if untreated
Epilepsy
Learning & developmental difficulties
Surgery: Infection, shunt obstruction, subdural haematoma
What is fibromyalgia?
Syndrome characterised by widespread pain throughout body w/tenderness at specific anatomical sites
What are the RFs of fibromyalgia?
Women 30-50yo Low income Divorced Poor education
What conditions are associated w/fibromyalgia?
IBS
RA
AS
SLE
How does fibromyalgia present?
Chronic, widespread pain >3m Multiple sites Absence of inflammation Multiple tender sites Lethargy Sleep disturbance Headaches
How is fibromyalgia diagnosed?
Widespread pain involving BOTH sides of body + ABOVE & BELOW waist + including axial skeleton
Smythe 11/18 tender points
How is fibromyalgia managed?
Explain diagnosis
Aerobic exercises
CBT
Low dose: Pregabaline, Amitriptyline, Duloxetine
