Headache Syndromes Flashcards
what are the red flag symptoms when a patient presents with headache (5)?
new onset headache >55 known/previous malignancy immunosuppression early morning headache exacerbated by valsalva
who is migraine more common in - males or females?
females
what is the average number of attacks in a month for patients with migraine?
one a month usually
what is the criteria for diagnosing migraine without aura?
> 5 attacks lasting 4-72 hours
two of = moderate/severe, unilateral, throbbing pain, worse on movement
one of = autonomic features, photophobia, nausea etc.
what is aura?
fully reversible visual, sensory, motor or language symptoms
how does migraine with aura present?
aura lasting 20-60 minutes, followed by migraine <1 hour later
state some examples of things that could trigger migraine
sleep diet stress hormones physical exertion
what drugs can be used as acute abortive agents in migraine?
NSAIDs
triptans
name some NSAIDs that can abort a migraine and the dose that should be given
aspirin 900mg
naproxen 250mg
ibuprofen 400mg
what are triptans?
5-HT agonists
what routes can triptans be administered by?
oral
sublingual
subcutaneous
name three triptans that can be used to abort a migraine
razatriptan
eletriptan
frovatriptan - for sustained relief
when should migraine prophylaxis be considered?
more than three attacks per month OR very severe attacks
what are the three options for migraine prophylaxis?
amitriptyline
propranolol
topiramate
what dose of amitriptyline should be given for migraine prophylaxis?
10-25mg
what are some possible adverse effects of amitriptyline?
dry mouth
postural hypotension
sedation
what dose of propranolol should be given for migraine prophylaxis?
80-240mg daily
what conditions are contraindications to propranolol?
asthma
PVD
what type of drug is topiramate?
carbonic anhydrase inhibitor
what dose of topiramate should be given as migraine prophylaxis?
25-100mg daily
what are possible side effects of topiramate?
weight loss
paraesthesia
impaired concentration
enzyme inducer
how do tension type headaches present?
pressing, tingling pain
bilateral
no N+V
what medication can be prescribed if needed for tension type headaches and for how long?
antidepressants - dothiepin or amitryptiline
for three months
what characterises the trigeminal autonomic cephalalgias (TACs)?
unilateral trigeminal distribution pain
occurs in association with prominent ipsilateral cranial autonomic features
name some examples of ipsilateral cranial autonomic features
ptosis miosis nasal stuffiness N+V tearing eye lid oedema
what are the four types of trigeminal autonomic cephalalgias?
cluster headaches
paroxysmal hemicrania
hemicrania continua
SUNCT
what investigations are done for suspected trigeminal autonomic cephalalgias?
MRI brain
MR angiogram
who gets cluster headaches?
young people
more common in males
how do cluster headaches present?
severe unilateral headache, lasting 45-90 minutes
how many headaches a day does someone with cluster headaches usually get?
1-8
how are cluster headaches managed?
high flow oxygen 20 mins
SCUT sumitriptan 6mg
steroids
what can be given for prophylaxis for cluster headaches?
verapamil
who most commonly gets paroxysmal hemicrania?
elderly patients
more common in females
how does paroxysmal hemicrania present?
severe unilateral headache lasting 10-30 mins
how many headaches do patients with paroxysmal hemicrania get each day?
1-40
how is paroxysmal hemicrania managed?
absolute response to indomethacin
who most commonly gets hemicrania continua?
50-60s
more common in females
how does hemicrania continua present?
constant severe unilateral headaches with unilateral autonomic features
how is hemicrania continua managed?
absolute response to indomethacin
what does SUNCT stand for?
short lived unilateral neuralgiform headache conjunctival injections tearing
how is SUNCT managed?
lamotrigine
gabapentin
what is a key risk factor for idiopathic intracranial hypertension?
obesity
how does idiopathic intracranial hypertension present?
diurnal variation
morning N+V
visual loss
what does CSF show in idiopathic intracranial hypertension?
elevated pressure
normal constituents
what assessments should be done in idiopathic intracranial hypertension?
visual fields
CSF pressure
what are the management options for idiopathic intracranial hypertension?
weight loss
acetazolamide
ventricular atrial/lumbar peritoneal shunt
what triggers trigeminal neuralgia?
touch
usually in the area supplied by V2 + V3
how does trigeminal neuralgia present?
severe stabbing unilateral pain, lasting 1-90 seconds
what medications can be used to manage trigeminal neuralgia?
carbamazepine
gabapentin
phenytoin
baclofen
what are the surgical management options for trigeminal neuralgia?
ablation
decompression
what investigation is done for trigeminal neuralgia?
MRI brain
