Headache Flashcards
what are red flags for headache?
new onset >55
known/previous malignancy
immune-suppressed
early mornign headache
exacerbation by valsalva
are migraines unilateral or bilateral?
unilateral
who is most commonly affected by migraines?
young women
what can trigger a migraine and what is a useful way to identify them?
triggers: sleep, diet, stress, hormones, exercise
headache diary
what is a migraine with aura?
sensory distrubance
lasts arounf 20-60mins
what are the three kinds of visual aura?
central scotomata
central fortification
hemianopic loss
describe central socotomata
area of depresed vision (blurring) on focus point of vision
describe central fortification
images floating (zig-zag pattern)
describe hemianopic loss
loss of vision on one side
what is an acephalgic migraine?
migraine aura without the headache
what is a basialr migraine?
vertigo, nausea
release of what substance is thought to cause migraines?
release of substance P, neurokinin A, CGRP → irritates blood vessels
how is migraine diagnosed?
at least 5 attacks
lasting 4-72 hours
mod/severe unilateral, throbbing pain
worse on movement
1 of photophobia/phonophobia
what are the non-pharmacological treatment options for migraine?
avoid triggers
headache diary
relaxtion
what are the pharmacoloigcal treatment options for migraine?
NSAID- take as early as possible to reduce headache
triptans- 5-HT agonist
what can be given as prophylaxis in migraines?
propanolol (avoif in asthma/HF)
topiramate carbonic anhydrase inhibitor
amitriptyline tricyclic antidepressant
how many migraine attacks warrant prophylactic treatment?
>3 attacks a month
(must trial each drug for minimum of 4 months)
describe tension headache
episodic
pressign tingling quality
mild-moderate
bilateral
no N&V
is photophobia/phonophobia present in tension headaches?
NO
what triggers tension headache?
usually environmental i.e. stress
what is autonomic cephalgia?
group of primary headahce disorders characterised by unilateral trigeminal ditribution pain
what investigation do people with suspected TCA require?
MRI of head and MR angiogram of the brain
what are the different types of trigeminal autonomic cephalgias (TAC)?
cluster headaches
paroxysmal hemicrania
SUNCT
idiopathic intracranial hypertension
trigeminal neuralgia
who is most commonyl affected by cluster headaches?
young males mostly 30/40s
are cluster headaches bliateral/unilateral?
unilateral
how often do cluster headaches occur and for how long do they last?
1-4 a day, for days to weeks
severe lasting 30mins -2 hrs
what pattern can be seen in cluster headaches?
circadian
seasonal (spring and autumn)
what is the treatment for cluster headaches?
sub cut triptan and oxygen in acute
steroids for 2 weeks
verapamil as prophylactic
who is affected by paroxysmal hemicrania?
elderly 50/60s
women > men
how would you describe a paroxysmal hemicrania?
severe unilateral headache
what is the frequency of paroxysmal hemicrania?
1-40 day
lasts 10-30mins
what is the treatment for paroxysmal hemicrania?
indomethacin
hwo do you differentiate between cluster headaches and paroxysmal hemicrania both of which are severe unilateral headaches?
paroxysmal hemicrania has shorter duration and much more frequent than cluster
how do you treat SUNCT?
lamotrigine
gabapentin
what is SUNCT?
Short lived Unilateral Neuralgiform headache with Conjuctival infection and Tearing
what is idiopathic intracranial hypertension?
increased intracranial pressure
what variation is seen in intracranial hypertension?
headaches w diurnal variation
how is intracranial hypertension investigated?
fundoscopy
visual field testing
LP
MRI head
who suffers trigeminal neuralgia?
tends to be older females
how would you describe the pain in trigeminal neuralgia?
severe stabbing pain
unilateral
what triggers trigeminal neuralgia?
triggered by touch
how long does trigeminal neuralgia last and how often does it occur?
lasts 1-90s occuring 10-100 times a day
what is the treatment for trigeminal neuralgia?
carbamazepine, gabapentin
can surgically intervene with ablation or decompression
