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After the MSA > Headache > Flashcards

Headache Flashcards

1
Q

What are the most common headaches?

A
  • Tension/muscular
  • Migraine
  • Analgesia overuse
  • Systemic illness
  • Cervicogenic - arising from the neck
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2
Q

What are the most serious headaches?

A
  • Subarachnoid haemorrhage
  • Meningitis
  • Tumours
  • Other space occupying lesion
  • Temporal arteritis
  • Strokes including CV sinus thrombosis
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3
Q

Describe a typical history of a patient with a tension headache

A
  • Weeks, months or years
  • Tightness or pressure, like an elastic band around the head
  • Constant, worse towards the evening
  • rarely with nausea
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4
Q

What are the treatments for tension headaches?

A
  • Reassurance, explain the muscles of the head
  • Reduce analgesia - won’t take away the tightness
  • Use relaxation exercise
  • Low dose amitriptyline (tricyclic antidepressant)
  • Wont go away overnight)
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5
Q

Describe common presenting complaint of patient with migraine

A
  • With or without aura, spreads over minutes
  • Unilateral or bilateral
  • Pulsating, sharp
  • Photophobia, phonophobia, gut symptoms e.g. diarrhoea
  • may be exacerbated by physical activity
  • Often a family history
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6
Q

Acute migraine treatment

A
  • Triptans
  • Aspirin, paracetamol
  • Anti-nausea
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7
Q

Prophylactic migraine treatment

A
  • Beta blockers
  • Low dose amitriptyline
  • Pizotifen
  • Topiramate
  • Sodium valproate
  • Candesartan
  • Flunarazine
  • Lisinopril
  • Methysergide
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8
Q

Other migraine treatments

A
  • Botulinum toxin injections
  • Anti CGRP monoclonal antibodies, erenumab
  • Acupuncture
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9
Q

why should women with migraine not use a combined oral contraceptive pill?

A

Increased risk of stroke

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10
Q

What is trigeminal neuralgia?

A
  • Shooting pain in one or more divisions of the trigeminal nerve
  • Extremely painful, may be triggered by cold or eating
  • In young people consider demyelination, in older people often abberant blood vessel touching CNV
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11
Q

What is the treatment of trigeminal neuralgia?

A
  • Carbamazepine
  • Gaba pentin
  • Injection
  • surgery
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12
Q

What is trigeminal autonomically cephalagia?

A
  • Recurrent pain in the trigeminal distribution with autonomic features (eye watering, nasal congestion, eye redness)
  • Cluster headaches
  • Paroxysmal hemicranias
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13
Q

what do paroxysmal hemicranias respond to?

A

Indomethacin

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14
Q

Describe medication overuse headache

A
  • Present for >15 days a month
  • Worsened while analgesia has been used
  • If using simple analgesia >15 days a month or >10 days for other acute
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15
Q

Describe thunderclap headahces

A

• Instant or rapidly appearing headache

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16
Q

What should be considered in a patient presenting with thunderclap headaches?

A

Sub arachnoid haemorrhage

17
Q

If a patient presents with thunderclap headaches, what investigations should be carried out?

A
  • CT head

* Lumbar puncture after 12 hours look for bilirubin and oxyhemoglobin

18
Q

What are the symptoms of raised intracranial pressure?

A
  • Headache (usually mild)
  • Diurnal variation (worse in the morning - red flag if waking from pain)
  • Maybe worse with coughing or straining
  • Often mild nausea
  • Neurological features
  • Look for papilloedema (swelling of optic disc)
19
Q

What could be causing raised intracranial pressure?

A
  • Tumour
  • Abscess
  • CSF blockage
20
Q

What are the symptoms of meningitis?

A
  • Fever
  • Photophobia
  • Neck stiffness
  • Altered consciousness
  • Petechial rash
21
Q

What should you treat meningitis with?

A
  • Ceftriaxone/cefotaxime

* Benzl penicillin

22
Q

What are the symptoms of temporal arteritis?

A
  • Features of polymyalgia - weak proximal muscles
  • Jaw claudication
  • Tender temporal arteries and may be thickened
  • Raised ESR (erythrocyte sedimentation rate)
23
Q

Investigations for temporal arteritis

A
  • Ultrasound

* Temporal artery biopsy

24
Q

What is the danger of temporal arteritis?

A

Blindness

25
Q

Features of cerebral venous sinus thrombosis

A
  • Headache, often severe
  • Often seizures
  • maybe bilateral
26
Q

What is transient global amnesia

A
  • thought to be a variant of migraine
  • Often during stress/exposure to the cold
  • Period of amnesia, unable to lay down any new memory
  • Lasts a few minutes to a few hours

After the MSA (22 decks)

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