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headache Flashcards

1
Q

what is the likely cause of a headache in a woman - onset typically puberty, menstruation, pregnancy, menopause

A

migraine

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2
Q

outline the Dx criteria for migraine (subdivide into with and without aura)

A

WITHOUT: at least five attacks of:
a. headache lasting 4-72hrs
b. N.O. at least 1 of N&V / photo/phonophobia
c. P.U.M.A. at least 2 of unilat / pulsatile pain / mod-sev intensity / worsened by normal activities
WITH: at least 2 attacks of
One or more typical aura symptoms (e.g. visual scotoma, zig zag lines, paresthesia, aphasia)
WITH
Each individual aura symptom lasting 5-60 minutes, with aura accompanied, or followed within 60 minutes, by headache.

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3
Q

what is the acute treatment of migraine?

A

1st line - Oral triptan (eg. sumatriptan) + NSAID / para
(nb - if vomiting - nasal spray / subcut)
Consider antiemetic - Prochlorperazine – if N&V (can give under buccal mucosa)
1st line if pregnant - PARACETAMOL
2nd line if pregnant - ibu / triptan

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4
Q

is it more common to have an aura with migraine or not..?

A

not

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5
Q 
outline the chronic tx (PREVENTION) of migraine
if:
1. young woman
2. asthmatic middle aged man
3. pre-menstrual
A

topiramate (CI teratogenic)
propranolol (CI asthma)
acupuncture / gabapentin 2nd line
zolmitriptan if pre-menstrual

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6
Q

outline your long-term management of GCA

A
  • Pred (stepping down dose whilst monitoring ESR)
  • Aspirin 75mg daily
  • PPI
  • Bisphosphonates
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7
Q

outline the typical presnetation of trigeminal neuralgia

A

brief unilat shock-like pains
severe
lasting seconds
triggered by light touch

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8
Q

give two key examinations to do in a GP setting when someone presents with a headache

A

BP (IIH/ SAH / risk of CVA)

papilloedema (IIH / raised ICP)

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9
Q

what is the underlying cause for trigeminal neuralgia?

A

The vast majority of cases are idiopathic but compression of the trigeminal roots by tumours or vascular problems may occur

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10
Q

what are the red flags in trigeminal neuralgia? (refer to neuro..)

A

Sensory changes.
Deafness or other ear problems.
History of skin or oral lesions that could spread perineurally.
Pain only in the ophthalmic division of the trigeminal nerve (eye socket, forehead, and nose), or bilaterally.
Optic neuritis.
Family history of multiple sclerosis.
Age of onset before 40 years.

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11
Q

what is the tx of trigeminal neuralgia?

A

Carbamazepine

if doesn’t respond - refer to neuro…

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12
Q

give some causes of a thunderclap headache

A

SAH

intracranial venous sinous thrombosis (Ix with CT/MR venogram, Tx with LMWH or streptokinase through a catheter

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13
Q

give some differentials for bilateral papillodema

A
  1. malignant htn
  2. BIH - young, overwight woman
  3. other causes of increased ICP
  4. cranial venous sinus thrombosis
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14
Q 
what might this be?:
headache occurs on wakening 
aggravated by bending / coughing
doesn't respond to analgesics
'bursting'
A

pressure headache - ?colloid cyst causing ball valve obstruction in the ventricles?

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15
Q

what is your first line Mx for a tension headache?

A

amitryptilline

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16
Q

what 3 treatments do you start in someone with GCA?

A
  1. high dose oral pred
  2. PPI
  3. bisphosphonates
17
Q

65 year old man with electric shock like pain from mouth to ear when he shaves

A

trigeminal neuralgia

18
Q

Trigeminal neuralgia:

  1. which two places? and direction
  2. describe the characteristics of trigeminal neuralgia pain
  3. list some triggers for trigeminal neuralgia
A
  1. mouth-ear (V2/V3) line in 2/3
    nose to orbit line in 1/3
    travels superior/posteriorly from mouth / nose
  2. electricity/ red hot needles
    builds to an excruciating pain felt deep in the face for a few seconds
    replaced by an unpleasant ache (red hot poker dragged across face….)
  3. chewing / cutaneous (shaving or brushiing teeth) or motor activity)
19
Q

how would you investigate trigeminal neuralgia?

A

MRI to exclude 2y causes - eg. tumour / MS

20
Q

describe some other features of trigeminal neuralgia (other than the character of the pain)

A

only during the day (diurnal variation
‘startle’ if attempt to touch the affected side
unkempt / haggard appearance
more than 50 years old usually

21
Q

how do you treat trigeminal neuralgia?

A

carbemazapine

2nd line specialist treatments:
lamotrigine
phenytoin
microvascular decompression (often caused by a vessel pressing on a nerve root…)

22
Q

post herpetic neuralgia:

  1. presentation?
  2. treatment?
A 
1. 3-5 days before eruption of vesicles
may have an elevated ESR
2.
treat the herpes zoster with aciclovir
treat the neuralgia with amitriptylline or gabapentin
capsaicin / TCNS

neuro (6 decks)

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