Headache Flashcards
Headache red flags
Worst headache ever/thunderclap
Unilateral with eye pain (cluster/acute glaucoma)
Unilateral + ipsilateral symptoms (migraine/ tumour/ vasc)
Cough-initiated/leaning forward/ worse in morning (ICP up/ venous thrombosis)
Persisting headache + scalp tenderness (GCA)
With fever/stiff neck - meningitis
Change in usual/ decreased consciousness
Cluster headache presentation
Rapid-onset around one eye with lacrimation, facial flushing, miosis, runny nose
Unilateral pain and almost always affects same side
15-180mins per episode, 1 or 2 per day, months between
Cluster headache treatment
100% O2 for 15 mins
+ Sumatriptan 6mg SC at onset or zolmititriptan 5mg nasal spray
Cluster headache prevention
Avoid triggers (alcohol) Corticosteroids short term Verapimil 360mg Lithium 900mg (must be monitored)
Trigeminal neuralgia presentation
Intense stabbing sharp pains lasting seconds in CNV distribution
Triggered by shaving/washing face/ eating/ talking
Trigeminal neuralgia treatment
Carbamazepine 100mg/12h PO, max 400mg/6h
Lamotrigine, phenytoin, gabapentin 2nd line
Surgery if drugs fail
Migraine presentation
Can be aura 15-30mins then unilateral throbbing headache
Photophobia/phonophobia
Nausea/vomiting
Migraine triggers
CHOCOLATE Chocolate Hangovers Orgasms Cheese/caffeine Oral contraceptives Lie-ins Alcohol Travel Exercise
Migraine treatment
Oral triptan (nasal if 12-17yrs) with NSAID/paracetamol
Aspirin 900mg can also be considered
Triptans CI if IHD, uncontrolled HT, SSRIs or lithium
Warm/cold packs or increased PaCO2 may help
Migraine prophylaxis
Propranolol 40-120mg/12h or Topiramate 25-50mg/12h
Amitriptyline 10-75mg off-license
12 weekly botox A is last resort in chronic migraine
Migraine considerations in females
Incidence of migraine + ischaemic stroke increased by combined OCP
Zolmitriptan 2.5mg BD when migraine expected for perimenstrual migraine
Worse headaches in pregnancy associated with pre-eclampsia + cardio complications so get help
