Headache assessment 2 Flashcards
What is meningism?
lie patient flat then lift patients head up to test for any resistance
What would you examine for with a patient with a thunderclap?
meningism
Horner’s syndrome
What is Horner’s syndrome?
sympathetic nerve stimulation to the eyes is removed causing eye drooping
What are some differential diagnosis of thunderclap headache?
- subarachnoid haemorrhage
- meningitis
- CVST (cerebral venous sinus thrombosis)
- pituitary apoplexy
- spontaneous intracranial hypotension
What investigations should be done for a thunderclap headache?
- CT
- Lumbar puncture (for gram stain, culture, check for glucose and protein and bilirubin)
- angiogram if no diagnosis after other tests
- MRI if signs of intracranial hypotension
What are the three categories of headache?
- new onset
- recurrent
- constant
What examination should you do for a migraine?
- neuro exam to ensure its normal
- cardio exam as can be marker for CV disease
- check for neck or TMJ dysfunction or short sighted
What lifestyle changes can improve migraines?
- Keep hydrated
- sleep
- avoid hunger
- exercise
What are the modifiable risk factors?
- medication overuse
- neck/posture improvement
- BMI
- Eye (check eyes)
- Jaw
What are the acute treatments of migraines?
- Triptans
- often paired with NSAIDs
- Anti-emetics can also be used
- often taken in combination
What preventative medications can be used for migraines?
- beta blockers
- anti-convulsants
- anti-depressants
- monoclonal antibody v CGRP
What examinations are important for constant headaches?
- cervical spine tenderness
- TMJ tenderness
- papillodema
- evidence of systemic illness
What investigations should be done for chronic migraines?
- sleep apnoea
- scans can offer reassurance
- check FBP, TSH, cortisol and LFT
What psychology treatments are important for migraines?
- ensuring patient this pain is a false alarm and doesn’t signify further problems
What medications are given for chronic migraine?
- Topiramate
- anti-CGRP
- Botulinum toxin can be given if chronic and unresponsive to at least three other drugs
