Headache Flashcards
What are the elements of the SNOOP4 mnemonic for headache red flags?
S - systemic symptoms/signs, systemic disease
N - neurological symptoms or signs
O - onset sudden/first/worst
O - older
P - pattern change, progressive headache, precipitated by valsalva, postural aggravation
papilloedema
pulsatile tinnitus
What are the different types of primary headache?
tension type headache
migraine
trigeminal autonomic cephalalgias
new daily persistent headache
What differentiates SUNCT from paroxysmal hemicrania from cluster headache?
duration
SUNCT - seconds to minutes
paroxysmal hemicrania - 2-30 minutes
cluster headache - 15-180 minutes
What features are required for a diagnosis of trigeminal autonomic cephalalgia?
unilateral autonomic symptoms/signs during the attack: red eye, tearing, miosis, ptosis, rhinorrhoea, nasal stuffiness, fullness/tinnitus
Which demographic typically gets cluster headache?
males age 20-40
Do patients with cluster headaches get photophobia/phonophobia?
yes - but it is unilateral
What are treatment options for cluster headache?
triptans GON block oral corticosteroids verapamil lithium melatonin topiramate gabapentin
What treatment should be trialled first for paroxysmal hemicrania?
50mg indomethacin TDS
What is used for acute treatment of migraine?
antiemetic
NSAID
triptan
Which patients require prophylactic treatment for migraines?
> 3 significant migraines per month
What are the different classes of medication that can be used for migraine prophylaxis?
beta blockers anti serotonin anticonvulsants calcium channel blocker other anti hypertensives TCAs
What is the mechanism of action of botox in migraine?
modulates neurotransmitters
Which patients qualify for botox for migraine in Australia?
> 15 days of headache a month, failed 3 preventers
What are erenumab, galcanezumab and fremazenumab?
CGRP monoclonal antibodies
