Headache Flashcards
What are the headache red flags?
New onset headache > 55 Known/previous malignancy Immunosuppression Early morning headache Exacerbated by valsalva (coughing, sneezing, straining)
What are the criteria for diagnosis of migraine without aura?
- at least 5 attacks
- duration 4-72 hours
2 of: - moderate/severe
- unilateral
- throbbing
- worse on movement
1 of: - autonomic features (nausea and vomiting)
- photophobia/phonophobia
Name some common migraine triggers
Sleep Dietary: chocolate, cheese Stress Hormones (natural or oral contraceptives) Exercise Alcohol
Which two classes of drug are used in the acute treatment of migraines?
NSAIDS
Triptans (5HT agonists)
Give some examples of NSAIDs which can be used to treat an acute migraine?
Aspirin
Naproxen
Ibuprofen
What are the contraindications for use of triptans?
IHD Coronary spasm Uncontrolled hypertension Recent lithium SSRIs
What lifestyle advice should be given to patients diagnosed with migraines?
Healthy diet, avoid triggers Keep hydrated Avoid caffeine Reduce stress Regular exercise
When should prophylactic migraine drugs be considered?
If > 3 attacks per month or very severe
How long should one prophylactic drug be tried for before switching to another?
3 months
Give some examples of drugs used for prophylaxis of migraines
Amitriptyline
Propranolol
Topiramate
What are the side effects of amitriptyline?
Dry mouth
Postural hypotension
Sedation
When should propranolol be avoided?
Asthma
Peripheral vascular disease
Heart failure
What are the side effects of topiramate?
Weight loss
Paraesthesia
Impaired concentration
Enzyme inducer
Describe the features of a tension headache?
Bilateral
Non-pulsating
Mild/moderate
Absence of N&V, photophobia or phonophobia
How is a tension headache managed?
Relaxation physiotherapy
Stress relief
Antidepressants e.g. dothiepin, amitriptyline
What are the trigeminal autonomic cephalgias?
Primary headache disorders characterised by
- unilateral trigeminal distribution pain
- in association with ipsilateral cranial autonomic features
What are the cranial autonomic features?
Ptosis Miosis Nasal stuffiness Nausea and vomiting Tearing Eyelid oedema
What are the 4 main types of trigeminal autonomic cephalgias?
Cluster
Paroxysmal hemicrania
Hemicrania continua
SUNCT
Describe the features of a cluster headache
Rapid onset, unilateral pain around one eye
Eye may become watery, blood shot, with lid swelling, lacrimation, facial flushing, rhinorrhoea, miosis +/- ptosis
How long do cluster headaches usually last?
45-90 minutes
1-8 attacks per day
clusters last 4-12 weeks
What is the acute treatment for a cluster headache?
High flow oxygen 100% for 20 mins
SC sumatriptan
Steroids
Which drug can be used for prophylaxis of cluster headaches?
Verapamil
What is the difference between cluster headaches and paroxysmal hemicrania?
Paroxysmal hemicrania more common in older people (50-60) and women
Attacks shorter duration (10-30 mins) but more frequent (1-40 per day)
What is the treatment for paroxysmal hemicrania?
Absolute response to Indomethicin
