Headache & Migraine Flashcards
Outline the presentation of meningism
- Acute single episode, severe, all head
- Neck stiffness
Outline the presentation of SAH
- Sudden-onset WORST EVER
- Often occipital
- Meningism
- Focal onset
- Reduced consciousness
Outline the presentation of Head injury
- Site of trauma to generalised
- Resistant to analgesia
Outline the presentation of Venous Sinus Thrombosis
- Subacute/ sudden headache
Papilloedema
Outline the presentation of Sinusitis
- Dull, constant ache over frontal/ maxillary sinuses
- Tenderness +/- postnasal drip
- Pain worse bending over
Outline the presentation of Acute Glaucoma
- Elderly, longsighted ppl
- Constant, aching pain around 1 eye
- Radiating to forehead
- Reduced vision, visual haloes, n&v
- Red, congested eye
- Cloudy cornea
- Dilated, non-responsive pupil (/oval)
- Low acuity
Outline the presentation of Migraine
Typical: Prodrome - Aura - Headache
- (visual) Aura 15-30min and then 1hr unilateral throbbing headache
- isolated aura (no headache)
- Episodic severe headache without aura (+ n&V, photophobia)
- Allodynia (pain from stimulus)
Diagnosis: Typical Hx/ >5 headaches >4hr & n&v & photophia (& 2 of unilateral/ pulsating/ impairs
Outline potential triggers for Migraine
CHOCOLATE Chocolate Hangovers Orgasms Cheese Oral contraceptives Lie-ins Alcohol Tumult (loud confused noise) Exercise
Outline the treatment of (active) Migraine
NSAIDs
Triptans: Rizatriptan
Ergotamine
What is the class & mechanism of action of Rizatriptan
Triptan
Agonist to 5-HT receptors in cranial blood vessels causing constriction
How do you prevent a Migraine
Find & remove triggers
1st line: Propanolol, amitriptyline & topiramate
2nd line: Valproate, pizotifen, gabapentin, pregabalin
Outline the mechanism of action of Propanolol
What line is it in Migraine treatment
Block action of noradrenaline at B-adrenoceptors Located in; - Myocardium - Throughout circulatory system 1st line
Outline the mechanism of action of Amitriptyline
What line is it in Migraine treatment
Tricyclic Antidepressant
Serotonin-norepinephrine reuptake inhibitor
1st line
Outline the mechanism of action of Topiramate
What line is it in Migraine treatment
Anticonvulsant
1st line
What is the mechanism of action of Valproate
What line is it in Migraine treatment
Unknown. Na+ block & inc. GABA.
2nd line
What is the mech of action of Pizotifen
What line is it in Migraine treatment
Serotonin antagonist
2nd line
What is the mech of action of Gabapentin
What line is it in Migraine treatment
Anticonvulsant
2nd line
What is the mech of action of Pregabalin
What line is it in Migraine treatment
Anticonvulsant
2nd line
What is the pathophysiology of Migraine
Primary brain disorder resulting from altered modulation of normal sensory stimuli and trigeminal nerve dysfunction
Old: Constriction during aura, dilatation of intracerebral vessels, reduced water diffusion
Outline the presentation of Tension headaches
Outline treatment
Usual cause of - Bilateral, non-pulsatile heache - +/- scalp muscle tenderness - NO vomiting/ sensitivity to movement STRESS RELIEF
Outline the pathophysiology & presentation of Cluster Headaches
Unknown cause.
?-Superficial Temporal Artery smooth muscle hyper-reactivity to 5HT
?-Hypothalamic grey matter abnormalities also
?-Autosomal dominant gene
Presentation;
- Rapid unilateral (pain around 1 eye + eye symptoms)
- x2d/ nocturnal then long absent periods
Outline the management of Cluster Headaches
Acute attack: - 100 O2 for 15mins via non-rebreathable - Sumatriptan/ Zolmitriptan Preventatives: - God knows
Outline the mechanism of action of Sumatriptan/ Zolmitriptan
Triptan
Agonist to 5-HT receptors in cranial blood vessels causing constriction
