Headache and Migraine Flashcards
What investigation should you do if the headache is due to head trauma?
CT
What can be triggers in trigeminal neuralgia?
Washing affected area, shaving, eating, talking
What can cause trigeminal neuralgia?
Compression of trigeminal root
What does CHOCOLATE stand for? (Migraine partial triggers)
Chocolate, Hangover, Orgasm, Cheese/caffeine, Oral contraceptives, Lie-ins, Alcohol, Travel, Exercise
What presentations suggest sinusitis?
Dull, constant ache over frontal/maxillary sinuses, worse on bending over
What presentation suggests intracranial hypotension?
Worse on standing
Describe a tension headache
Bilateral, non-pulsatile +/- scalp muscle tenderness
What are some types of headache that tend to recur?
Migraine, cluster headache, trigeminal neuralgia
What features can suggest raised ICP?
Chronic, progressive headaches that are typically worse on waking, lying, bending forward, coughing
What features can suggest acute glaucoma?
Eye pain +/- reduced vision
What feature can suggest giant cell arteritis?
Jaw claudication, tender with thickened, pulseless temporal arteries
Describe a cluster headache
Rapid onset excruciating unilateral pain around one eye that may become watery and bloodshot
Describe the timing pattern of cluster headaches?
Pain lasts 15-180 mins once or twice a day for 4-12 weeks and then months-years pain free
Describe pain from trigeminal neuralgia
Intense unilateral stabbing pain lasting seconds in trigeminal nerve distribution
What other symptoms can accompany a migraine?
Nausea and vomiting, all stimuli can produce pain
What can type of auras are there?
Visual, somatosensory, motor, speech
What can cause an medication overuse headache?
Mixed analgesics
What should you ask about their life?
Stress and recent life events
What investigation should you do in trigeminal neuralgia?
MRI to exclude secondary causes
How can you help manage cluster headaches?
100% oxygen for 15 minutes, sumatriptan at onset
How can you manage trigeminal neuralgia?
Some AEDs
What migraine prophylaxis can you start?
Propranolol, amitryptyline
How can you help migraines during an attack?
Triptan, NSAIDs, anti-emetic
What non-pharmacological management can help migraines?
Acupunture
What contraception should people with migraines use?
Progesterone-only or non-hormonal contraception
What red flags can indicate SAH?
First and worst headache, thunderclap
What red flag can indicate acute glaucoma?
Unilateral eye pain
What red flag can indicate a tumour or vascular cause?
Unilateral pain and ipsilateral symptoms
What red flags can indicated increased ICP or venous thrombosis?
Cough-initiated headache, worse in the morning or bending forward
What red flag can indicate giant cell arteritis?
Persisting headache +/- scalp tenderness in over 50s
What red flag can indicate meningitis?
Headache with fever or stiff neck
What other red flags could be present?
Change in pattern of a usual headache, decreased level of consciousness
What’s are migraines?
Recurrent throbbing headache often preceded by an aura and associated with nausea, vomiting, visual changes
Describe a migraine
Unilateral pain, throbbing-type pain, moderate to severe intensity, motion sensitivity
Give an example of a triptan
Sumatriptan
Give an example of an anti-emetic
Prochlorperazine
What prevention for cluster headaches is there?
Verapamil is first line, then prednisolone, reduce alcohol and stop smoking
What is the first line prophylactic treatment of migraines?
Topiramate
What can cause tension headaches?
Depression, lack of sleep, missed meals, stress
