Headache & Migraines

Question 1

migraine characteristics + treatment

Answer 1

all of the following:

• lasting 4-72hrs
• at least 2 of the following: unilateral/ pulsating/moderate-severe intensity/ aggravation by or causing avoidance of routine
• during headache at least nausea or vominting OR photophobia and phonophobia
• not attributed to another disorder

AURA

triggers

• cheese/chocolate
• OCP
• Caffeine
• anxiety
• periods
• alcohol

treatment:

• analgesia 1st line eg. NSAIDs
  (pregnancy. - paracetamol)
• 2nd line triptans

prophylactic for symptoms >3m = propranolol / amitryptalline

migraine + OCP = absolute contraindication

Question 2

cluster headache characteristics + treatment

Answer 2

• autonomic features: teary, red eye, ptosis/ miosis, nasal symptoms, facial flushing
• occurs in clusters
• unilateral
• orbital +/- supraorbital pain

common risk factors\

• CVS
• smoker
• male

treatment:
-100% o2 via non-rebreathe for 15mins
and triptans subcutaneous

prophylaxis = verapamil (CCB) or topiramate

Question 3

trigeminal neuralgia

Answer 3

male >50, asian

pain over the temporal area

• cold weather
• spicy food
• caffeine
• citrus fruits
• shaving/eating

mostly unilateral

treated with anti-epileptics: carbamezapine 1st line

Question 4

GCA

Answer 4

• Headache lasting a few weeks
• Tender, thickened, pulseless temporal arteries: tender on combing hair
• Jaw claudication: painful jaw especially on eating
• Sudden bilateral visual loss can occur
-Fever, weight loss or malaise

check ESR 1st

diagnostics = temporal artery biopsy

management = high dose of steroids, prednisolone

closely related to PMR (females, weakness or pain in shoulders, neck, pelvic)

Question 5

SAH

Answer 5

thunderclap headache

1stline = ct (asap , sensitivty decreases)
diagnostic = LP - xanthochromia (after 12 hrs)

emergency surgery

1. coiling endovascular, by neuroradiologists
2. surgery to clip by neurosurgeon

complications

• rebleed - common
• vasospasms - give nimodipine
• acute hydrocephalus (extra ventricular drain)
• hyponatraemia
• seizures

Question 6

IAH (intracranial hypertension)

Answer 6

obese young women

• papilloedema
• peripheral fields, loss in colour vision, increased blind spots
• severe: decreased visual acuity

diagnostic = measuring the pressure of CSF

management

• weight loss
• LP
• shunting

always consider cerebral venous sinus thombosis as a cause!!!!!!