HEADACHE AND FACIAL PAIN Flashcards
What 2 categories of drugs should be used in the first instance when treating acute migraine?
- simple NSAID
- Prokinetic antiemetic (metoclopramide
What migraine specific medications can be trialled if simple analgesia and antiemetics are not successful?
Triptans
In what instances may migraine prophylaxis be used?
- When there are 2 migraines per month that produce disability lasting >72 hours
Name 2 options that may be trialled in prophyalxis against migraine?
- Propranolol
- TCAs
- SSRIs
- Anti-epileptic drugs such as topiramate
- Accupuncture and botox
What investigation should be ordered in all patients suffering from cluster headache? What is the indication?
- MRI head
- Skull base or meningeal pathology
What is the management in an acute attack of cluster headache?
- High flow oxygen
- 6mg nasal or subcut sumatriptan
What prophylaxis can be prescribed against cluster headaches?
- Verapamil 40mg BD
- Prednisolone at 60mg gradually titrated down over 2-3 weeks
What is Cushing’s triad of raised ICP?
Cushing’s triad consists of bradycardia (also known as a low heart rate), irregular respirations, and a widened pulse pressure (increased SBP)
What are the two medical therapies which may be recommended in cases of idiopathic intracranial hypertension?
- acetazolamide
- steroids
What scale can be used grade severity at initial presentation in SAH?
Hunt and Hess scale
How long must pass before an LP is done to diagnose SAH?
12 hours
This risk of cerebral vasospasm and subsequent cerebral ischaemia can be reduced by prescribing what medication in SAH?
Nimodipine 60mg every 4 hours
What is the management of cerebral venous sinus thrombosis?
Laoding dose of LMWH and subsequent warfarin titrated to keep INR 2-3
What is the management of temporal arteritis?
High dose IV steroids titrated over a long period of time (2-3 years)
What is the only medication shown to be effective in trigemianl neuralgia?
carbamazepine
What are the 2 most common causes of bacterial meningitis?
- Streptococcus pneumniae
- Neisseria meningitides
What are Kernig’s and Brudzinski’s sign?
Kernig’s: pain and resistance on passive knee extension with hips fully flexed
Brudzinski’s: forced flexion of the enck causes hip flexion
What should be prescribed prior to admission in patients with query meningococcal disease?
- IM benzylpenicillin 1.2g
What is the treatment regimen for TB?
- rifampicin, isoniazid, pyrazinamide ethambutol + steroids for two months
- continue rifampicin and isoniazid for a further 10 months
What is the mangement of viral meningitis?
Which viral meningitides require antiviral therapy?
Which antiviral therapy is used?
- supportive care, antipyretics
- HSV, CMV, varicella
- acyclovir
Each causative agent of bacterial meningitis requires its own tailored medical therapy. Which abx should be prescribed as broad cover in bacterial meningitis prior to culture?
IV ceftriaxone
What si the classicial triad of encephalitis?
Fever, headache, altered mental state
What is the most common management of encephalitis?
- IV antivirals
Which type of encephalitis can often lead to psychiatric type symptoms?
How is it managed?
What else is concerning about this condition? (think cause)
- NMDA encephalitis
- IV steroids and IV Ig +/- plasma exchange
- This can be a paraneoplastic condition
What is the management of GCA?
- If no visual involvement: 40-60mg prednisolone OD
- Symptoms should improve in 7-14 days
- Taper dose after 1-2 months gradually
- By 10mg every 2/52 to 20mg, then by 2.5mg every 2-4/52 to 10mg, then by 1mg every 1-2 months
- Vision loss/amaurosis fugax
- IV methylprednisolone 500mg-1g od for 3 days
- Consider 60mg prednisolone PO if established visual loss
What is the management of acute angle closure glaucoma?
- Supine positioning
- Timolol
- Acetazolamide
- Mannitol
- Pilocarpine
