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ENT, neuro, eyes > Headache/migraine > Flashcards

Headache/migraine Flashcards

1
Q

What is Lumbar puncture used ot investigate with headache?

A

Sus meningitis, SAH, intracranial HPTN

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2
Q

What headahces causes are sight threatening?

A

Intracranial HPTN
Giant cell arteritis
acute glaucoma

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3
Q

Red flags for headaches

A

Immunocompromised
Under 20 and hisotry of malignancy
History of malignancy known brain metastases
Vomit without other obvious cause
Recent head trauma
Worsening headache with fever
New onset neurological deficit, cognitive dysfunction
Change in personality
Impaired LOC
Exacerbated by cough, valsalva, sneeze or exercise
Orthostatic
Symptoms of GCA
Symptoms suggestive of acute angle glaucoma
Substantial change in characteristics of persons headache

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4
Q

How long is recent head trauma?

A

3 months

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5
Q

What is pruritis

A

Itchiness

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6
Q

Triggers for migraine

A

Tired, stress, alcoho, COCP, lack of food or dehydration, cheese, chocolate, red wines, citrus fruits, menstruation, bright lights

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7
Q

Clinical features of a migraine

A

Aura - 1/3
Severe, often unilateral throbbing headache
Nausea/vomitting Photophobia
Phonophobia
Attacks last up yo 72 hours

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8
Q

Primary vs secondary headahce

A

Seconadry = underlying condition

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9
Q

What is an aura?

A

Transient focal neurological symptoms eg scintillating scotoma, hemianopic disturbance, sensory symptoms that precede migraine

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10
Q

Headache in a migraine features to diagnose

A

Unilateral
Pulsating
Mod or severe intensity
Aggravated by ADLs
Ass symptoms

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11
Q

Postdromal and prodromal symptoms of migraine

A

Fatigue, poor concentration, neck stiffness before - hours to 2 days
Fatigue and elevated or depressed mood - 48 hours after

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12
Q

Differentials for migraine = secondary headaches

A

Trauma
Cranial vascular disorders - intracerebral bleed, CentralVT or GCA - ESPECIALLY TIA
Intracranial non vascular eg neoplasm
Esposure or withdrawal - CO, cocaine, alcohol incl medication overuse headache
Intracranial/systemic infection
Hypoxia, HPTN
Disorders of facial/cranial structure eg TMJ, Acute closure glaucoma, dental, otitis media, sinusitis
Psychiatric disorders

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13
Q

What conditions can cause facial pains

A

Trigneminal neuralgia
Post herpatic neuraligia
Optic neuritis

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14
Q

What analagesia offer in migraine

A

Triptain - sumatriptatn 50-100mg 1st line +/-
Simple - paracetemol, ibuprofen
Anti-emetic eg metoclopramide or prochlorperazine10mg

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15
Q

Why can metoclopramide not be used reguarly?

A

Extrapyramidal effects

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16
Q

When should acute medication be taken in migraine

A

Early when pain is mild

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17
Q

Why is prevention in migraine importnat

A

Affect on ADLs
Prevent medication voeruse headahce

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18
Q

Why discuss topirimate before prescribe

A

Teratogenic

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19
Q

Preventatitve meds for migraine

A

Propanolol 80-160mg daily
OR
topirimate 50-100mg
or
Amitryptilline 25-75mg at night

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20
Q

Non medical management chronic migraine

A

Acupuncture
Riboflavin

21
Q

Menstrual migraine what cna offer preventatitve

A

Frovatriptan or zolmitriptan

22
Q

How does tension type headache present?

A

Recurrent non disabling bilateral headahce - tight band ass w stress and no other symptoms, not aggravated by ADLs

23
Q

Tension headahce treat

A

Simple analgesia - paracetemol, NSAIDs
Acupuncture, low dose amitryptilline to prevent

24
Q

What is a medication overuse headache?

A

Developed or worsened while taking refualre meds specifically for headaches

25
Q

What durgs commonly cause medication Overuse headahce?

A

Opioids, triptans

26
Q

Treat MOU headache

A

Withdraw offending drugs - gradually with opioids

27
Q

What is raised ICP headahce ass with

A

Vomitting, papilloedema, fits, neurological signs

28
Q

Investgiation of choice for Raised ICP

A

CT or MRI scan

29
Q

Hwo does a cluster headahce present?

A

Intense pain around one eye - always same side
Restless due to pain severeity

30
Q

Frequency of cluster headahces

A

once or twice a day, 15 min to 2 hours each
Clusters last 4-12 weeks

31
Q

Ass eye symptoms in cluster headahces

A

redness, lacrimation, lid swelling

32
Q

Acute treatment for cluster headaches

A

100% oxygen, SC triptan

33
Q

Preventaative treatment cluster headahces

A

Verapamil
Tapering prednisolone considered

34
Q

How does trigeminal neuralgia present?

A

Unilateral - shock like transient electric pains, abrupt
One or two divisions of CNV
Triggered by light touch or spontaneous

35
Q

Treatment for trigeminal neuralgia

A

Carbamazepine

36
Q

Headahce in GCA

A

Rapid onset (<1 month) unilateral headache ass with jaw or tongue claudication and tender, palpable tmeporal artery (scalp)

37
Q

Features of SAH headahce

A

10/10 thunderclap back of head
N+V
meningism

38
Q

Sinusitis pain and ass symptoms

A

Frontal pressure - worse when bend forward
Nasal discharge, obstruction, postnasal drip -> chronic cough

39
Q

Acute sinusitis treat

A
40
Q

Acute glaucoma headahce presentation + ass symptoms and signs

A

Severe pain - ocular or headahce
Decreased visual acuity, red eye, haloes, semi dilated non reacting pupil, hazy cornea
N+V, abdo pain
Worse with mydriasis eg dark

41
Q

classic presentation meningitis

A

Fever, photophobia, neck stiffness, headache, purpuric rash

42
Q

Enephalitis classic presentation

A

Headache, fever, confusion/odd behaviour, seizures, LOC/reduced

43
Q

CENTRAL VENOUS THROMBOSIS HEADAHCE

A

sudden onset
Ass N+V, cranial nerve palsies, vision disturbance, seizures

44
Q

Treatment CENTRAL VENOUS THROMBOSIS

A

Anticoagulation or thrombolytics

45
Q

Acute single episode headaches

A

SAH
Head injury
sinusitis
acute glaucoma
meningitis/encephalitis
Central VST

46
Q

Chronic headaches

A

Tension
Mediation overuse
Raised ICP
Space occupying lesion

47
Q

Recurrent attack of headaches

A

Migraine
Cluster
Trigmeinal neuralgia

48
Q

GCA onset

A

subacute

ENT, neuro, eyes (34 decks)

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