Headache (conditions on sofia) Flashcards
How will someone with migraines typically present?
Intermittent one sided headaches of moderate-severe intensity
Nausea
Aura
Photophobia
Phonophobia
Often something identifiable triggers the headache
What are some risk factors for migraine?
Women Obesity Sleep disorder Medication overuse Menstruation Stressful life events
How are migraines diagnosed?
Usually investigations aren’t needed- diagnosis is based on history and examination
What investigations are done for someone with migraines?
None usually but to rule out other conditions:
ESR= rule out temporal arteritis
CSF culture= rule out infection
CT head= acute headache to look for bleeds
MRI brain= if not acute and headaches are concerning
How are migraines managed?
For prohylaxis= propanolol or topiramate
For treatment= NSAIDs, anti emetics, oral triptan (nasal triptan if they are younger)
Tell patients to identify and avoid triggers
What medications are used for prophylaxis of migraines?
Propanolol or topiramate
How long do migraines usually last?
4-72 hours
What type of headache will point you towards a diagnosis of migraines?
Intermittent Lasts 4-72 hours Has triggers Unilateral Throbbing or pulsatile pain Associated with aura
What character is the pain from headaches in migraines?
Throbbing or pulsatile
How will someone with tension headaches usually present?
Intermittent not severe headaches, pain is bilateral, usually lasts 30 mins- few hours, often occipital or frontal pain, pain is dull and non pulsatile
Not associated with aura, nausea, photophobia etc
They may have pressure behind their eyes and stiffening of neck muscles
What are risk factors for tension headaches?
Mental tension
Stress
Missing meals
Fatigue
What investigations are done for tension headaches?
None, diagnosis is clinical
How long do tension headaches usually last?
30 mins-few hours but it can be longer eg days
What is the character of pain in tension headaches?
Dull
Non pulsatile
Bilateral
Maybe occipital or frontal
How are tension headaches treated?
NSAIDs, paracetamol, aspirin (no aspirin for under 16s)
If chronic then offer acupuncture for 5-8 weeks
How will someone with trigeminal neuralgia present?
Sharp, stabbing, intense facial pain that lasts few seconds- 2 minutes in the distribution of one or more branches of the trigeminal nerve
Pain is triggered by sensory stimuli like chewing, wind, shaving
Who is at risk of trigeminal neuralgia?
Those with MS
Women
Those of increased age
How is trigeminal neuralgia treated?
Anticonvulsant first line- usually carbamazepine
If severe and that doesn’t help then microvascular decompression or ablative surgery
What investigations are carried out for trigeminal neuralgia?
None, diagnosis is clinical
What are sinister causes of headache that need to be ruled out and how can you remember them?
VIVID:
Vascular- heamorrhage/ haematoma
Infection- meningitis/ encephalitis
Visual disturbance- temporal arteritis, acute glaucoma
Intercranial pressure (raised)- space occupying lesion like tumor, abcess, cyst
Dissection- carotid dissection
What is triad of symptoms alerts you to third nerve palsy?
Ptosis (drooping eyelid)
Mydriasis (dilated pupil)
Eye deviated down and out
What triad of symptoms points is indicative of Horner’s syndrome?
Ptosis- dropping eyelid
Miosis- constricited pupil
Anhydrosis- dry skin around the orbit
What are red flag symptoms when someone has a headache?
It follows trauma There are visual deficits There have been no previous episodes There are focal neurological signs/ deficits It is sudden onset It is intense If there are symptoms alerting you to malignancy eg weight loss/fever/night sweats Level of conciousness is decreased Seizures have occoured Headache is persistent and progressive Headache is worse lying down Past hx of malignancy/infection like HIV/ immunosupression
Describe the difference in symptoms between 3rd nerve, 6th nerve, 12th nerve palsy and horner’s syndrome
3rd nerve palsy= ptosis, mydriasis, eye down and out
6th nerve palsy= eye cannot abduct/ move laterally
12th nerve palsy= tongue deviates towards lesion
Horner’s syndrome= miosis, ptosis, anhydrosis
What is mydriasis?
Dilated pupil
Why is miosis?
Constricted pupil
What are the medical terms for dilated vs constricted pupils?
Dilated= mydriasis Constricted= miosis
