Headache DDx Flashcards
What are considered ‘red flags’ when a patient presents with a headache?
Headache waking them from sleep
Known/previous malignancy
Immunosuppressed
Exacerbated by Valsalva (coughing/sneezing)
Define a tension headache:
Bilateral non-pulsatile headache potentially with scalp tenderness.
Not associated N&V, photophobia or phonophobia
What medication has be shown to have a positive effect on tension headaches?
Anti-depressants
What is the management for tension headache?
Physiotherapy
Massage
Define a cluster headache:
Severe unilateral headache lasting 15mins - 3 hours with pain often around the eye
Can have up to 1 or 2 a day
Chronic or episodic
What are some symptoms of a cluster headache
Watery bloodshot eye Lid swelling Lacrimation Flushing rhinorrhoea Miosis
What group tend to suffer from cluster headaches?
30-40y/o
M>F
What is the treatment options for an acute episode cluster headache?
Acutely:
High flow oxygen
Steroids
Sumatriptan sub cut 6mg
What prophylactic treatment can be given for a cluster headache?
Verapamil
What is SUNCT syndrome:
Rare headache belonging to a group pf headaches known as trigeminal autonomic cephalagias (TAC) Short lived Unilateral Neuralgic headache Conjuctival injections Tearing
What treatment can be given for SUNCT?
Lamotrigine
Gabapentin
What type of headache presents with severe unilateral pain lasting only seconds but occuring between 10-100 times a day?
Trigeminal Neuralgia
What can trigger trigeminal neuralgia?
Touch
What branches of CNV are involved in trigeminal neuralgia?
CNV 2 & 3
Males are more affected by trigeminal neuralgia. True or false
False.
F>M
What ethnicity is trigeminal neuralgia more common in?
Asians
What age group is trigeminal neuralgia more common in
> 60y/o
List some medications which can be used to treat trigeminal neuralgia:
Carmbamazipine Lamotrigine Phenytoin Baclofen Gabapentin
Other than medication what else can be done to treat trigeminal neuralgia?
Surgical ablation or decompression
What type of headache, affecting mainly 50s-60s, presents with severe unilateral pain lasting 10-30mins between 1 and 40 times a day?
Paroxysmal Hemicrania
What other type of headache is paroxysmal similar to and how might they differ?
Cluster
A paroxysmal headache is shorter in duration but more frequent
What drug has an absolute response in paroxysmal hemicrania?
Indomethicin
What are the features of a headache associated with idiopathic intercranial hypertension?
Worse on waking Nausea and vomiting Seizures and odd behaviors May have vision loss Worsened by lying flat, bending forward and coughing
What must you exclude in idiopathic intercranial hypertension?
Space occupying lesion
What investigation should you do for a headache assoc with idiopathic intercranial hypertension?
What should you avoid?
CT imaging
DO NOT lumbar puncture until after imaging - patient is at risk of coning
What examinations should be done for idiopathic intercranial hypertension?
Fundoscopy
Visual field exam
Are females or males more likely to suffer from headache of idiopathic intercranial hypertension?
Females
What is another risk factor for idiopathic intercranial hypertension?
Obesity
What is the management for headache associated with idiopathic intercranial hypertension?
WEight loss
Monitoring visual fields and CSF
Acetazolomide
Shunt if necessary
List some differential diagnosis of headache?
Space occupying lesion Infection Stroke GCA Acute glaucoma Sinusitis Medication overuse
How many patients with migraine suffer from aura?
20%
What is the criteria for a migraine IF no aura.
5 attacks of severe unilateral throbbing headache
Lasting 4-72 hours
N & V
May have photo or phono phobia
What can trigger migraine?
Diet Stress Sleep Hormones (menstruation) Exercise
How does stress increase the risk of a migraine?
Stress leads to increased levels of serotonin, which causes blood vessels to constrict and dilate
Substance P is then released, stimulating pain receptors
What risk factors are there for a migraine?
Use the anagram CHOCOLATE
Chocolate Hangovers Orgasms Cheese OCP Lie - ins Tumult Exercise Other risks include female, obesity and smoking
What medication is used for prophylaxis of migraine?
1st line: Propranolol Amitriptyline and Topimirate
2nd Line: Valproate, Gabapentin, pregabalin
What medications can be used to treat an acute migraine?
NSAIDS e.g. aspirin
oral 5-HT antagonists e.g. triptans and ergots
When are triptans contraindicated?
In ischaemic heart disease, coronary spasm and uncontrolled hypertension
What is a serious side effect of ergotamine that must be mentioned to the patient before it is prescribed for migraine?
Gangrene
Vascular damage
How often do patients tend to suffer from migraines?
1 attack a month
