Headache Flashcards
What are the red flags for headache?
new onset of headache in someone >55 known/previous malignancy immunosuppression early morning headache exacerbation by valsavla
What is the aeitology of migraines?
women>men - is hormonal led so often happens ages 16-20 then again 40-50
20% have migraine with aura
typically have 1 attack per month
What is the IHS criteria for migraine without aura?
at least 5 attacks
duration of 4-73 hours
2 of: moderate/severe, unilateral pain and throbbing - worse on movement
1 of: autonomic features, photophobia/phonophobia
What is the pathophysiology behind migraines?
both a vascular and neural problm
stress triggers changes in the brain causing SEROTONIN to be released causing blood vessels to constrict and dilate
SUBSTANCE P is released which irritates nerves and blood vessels causing pain.
What are the characteristics of migraine with aura?
the aura is fully reversible and occurs as a visual, sensort, motor or language disturbance
lasts for 20-60 minutes and headache occurs <1hour after or can occur simultaneously
What triggers migraines?
stress alcohol caffeine hormonal sleep physical exertion
What is the first step of treatment for migraines?
lifestyle - eliminate triggers, stress management, exercise
What is the second step of treatment for migraines?
NSAIDs - aspirin, ibuprofen, naproxen
When would you consider prophylaxis treatment of migraines?
if >3 attacks a month or very severe
What medications can be used for prophylaxis of migraines?
Amytriptyline
Propanolol
Topiramide
What can you try if prohylaxis treatment doesnt work?
gabapentin
botulium toxin
peptide A
How do basilar migraines present?
get vertigo
How do acephalgic migraines present?
experience the aura but not the headache
How do hemiplegic migraines present?
stroke like migraine - lasts for days/weeks
What are the characteristics of tension type headaches?
bilateral pressing/tingling quality
mild - moderate pain
How are tension headaches treated?
relaxation therapy
antidepressants - dothiepin or amytriptyline
What are trigeminal autonomic cephalgias?
group of primary headache disorders characterised by unilateral trigeminal division pain that occurs in associaion with prominent ipsilateral cranial features: ptosis, miosis, tearing, nausea, vomiting, nasal stuffiness, eye lid oedema
What are the 4 main types of trigeminal autonomic cephalgias?
Cluster headaches
Paroxysmal hemicrania
SUNCT
Trigeminal neuralgia
What are the characteristics of cluster headaches?
men>women
30-40years
How do cluster headaches present?
happen around sleep and seasonal variation
severe unilateral headache - 45-90mins duration
10/10 pain
1-8 a day
cluster bouts last from a few weeks to a month
What is the treatment for cluster headaches?
high flow oxygen
sumatriptan
steroids - 2 weeks
verapamil for prophylaxis
What are the charactersitics of paroxysmal hemicrania?
women>men
50-60years
How does paroxysmal hemicrania present?
severe, unilateral headache and autonomic features
lasts 10-30 minutes
can have 1-40 a day
What is the treatment for paroxysmal hemicranias?
WILL RESPOND TO INDOMETHICIN
