Headache Flashcards
Red flags
new onset headache >55yrs known/ previous malignancy immunosuppressed early morning headache exacerbated by valsalva (exhalation against closed airway)
Migraine demographics
More common in women
on av- people have 1 attack a month
With aura- 20%
IH5 criteria for migraine without aura
At least 5 attacks
Duration 4-72hrs
2 of- mod/ severe unilateral pain, worse on movement,
1 of autonomic features, photophobia, photophobia
Pathophysiology of migraine
Stress triggers changes in the brain, these cause serotonin to be released, blood vessels constrict and dilate. Chemicals including substance P irritate nerves and blood vessels causing pain
Migraine with aura
Aura- fully reversible, visual, sensory, motor or lang symptom. Duration- 20-60mins
Treatment of migraine
non pharmacological- avoid triggers, headache diary, relaxation/stress management
pharmacological- NSAID- aspirin, naproxen, ibuprofen
Triptans- 5HT agonist- treat at start of headache
rizatriptan,
prophylaxis of migraine
If > 3 attacks per month or very severe
Topiramate or propranolol
Propanolol for prophylaxis dose
80-240mg/ day
avoid in asthma, pvd
Topiramate for prophylaxis dose
25-100mg
poor side effect profile, start slowly
side effects of topiramate
weight loss, paraesthesia, impaired concentration
Lifestyle prophylaxis for migraine
balanced diet, hydration, reduce stress, exercise
Cluster headache- age, duration and freq
30/40yrs, M>W
45-90 mins
1-8/day- bout may last weeks- months
cluster headache symptoms
striking around sleep, seasonal variation, severe unilateral headache
cluster headache treatment
high flow oxygen 20mins, SC sumatriptan, steroids
prophylaxis of cluster headache
verapamil
Paroxysmal hemicrania- age, duration, freq
50-60s, w>m
10-30mins
1-40/ day
paroxysmal hemicrania symptoms
severe unilateral headache, unilateral autonomic features
paroxysmal hemicrania treatment
idomethican
SUNCT
Short lived Unilateral Neuralgiaform headache Conjunctival injections Tearing
SUNCT duratiion
15-120secs
SUNCT treatment
Lamotrigine, gabapentin,
Trigeminal neuralgia- age, duration, freq
> 60yrs W>M
1-90secs
1-100/day bouts may last weeks to months
trigeminal neuralgia symptoms
triggered by touch- usually v2, v3
severe stabbing unilateral pain
Treatment of trigeminal neuralgia
medical- carbamazepine, gabapentin, phenytoin, baclofen
surgical- ablations, decompression
