Headache - vertigo Flashcards
headache - definition / MC in (sex)
- pain due to irritation of of structure such as dura, cranial nerves or extracranial structures
- MC in women, except clusters
main types of headache
- cluster
- tension
- migraine
other causes of headache (10)
- subarachnoid hemorrhage
- meningitis/encephalitis
- hydrocephalus
- neoplasia
- arteritis
- trigeminal neuralgia
- head injury
- acute glaucoma
- sinusitis
- venous sinus thrombosis
main types of headache - localization
- cluster –> unilateral
- tension –> bilateral
- migraine –> unilateral
main types of headache - duration
- cluster –> 15min-3h repetitive
- tension –> more than 30 min (typically 4-6h)
constant - migraine –> 4-72h
tension headache - characteristic of pain and other symptoms
- steady pain
- No photophobia
- No phonophobia
- No aura
cluster headache - characteristic of pain and other symptoms
- Repetitive brief headaches
- Excruciating periorbital pain with lacrimation
- Rhinorrhea
- may present with HORNER syndrome
cluster headache may induce …
HORNER syndrome
cluster headache is more common in
males
Migraine - characteristic of pain and other symptoms
- pulsating pain
- nausea
- photophobia or phonophobia
- may have aura
Migraine mnemonic
POUND
Pulsatile, One-day duration, Unilateral, Nausea, Disabling
migraine is due to
irritation of: 1. CN V 2. Meninges 3. Blood vessels
migraine due to blood vessel irritation - mechanism
release of substance P, calcitonin gene-related peptide, vasoactive peptide
cluster headache - treatment
acute: 1. 100% 02 2. sumatriptan
prophylaxis: verapamil
tension headache - treatment
- Analgesics
- NSAID
- acetaminophen
- Amitryptyline for chronic pain
Migraine - treatment
Acute: triptans, NSAIN, dihydroergotamine
ProphylaxiS: lifestyle changes (sleep, exercisem diet eg,) propranolol, topiramate, Ca2+ channel blockers, amitriptyline, valproate
trigeminal neuralgia headache - duration / type of pain
typically less than 1 minute
repetitive shooting pain in distribution of CN V
Vertigo - definition
sensation of spinning while actually stationary. (subtype of dizziness but distinct from lightheadedness
types of vertigo (MC?)
- peripheral vertigo (MC)
2. central vertigo
peripheral vertigo - etiology
inner ear etiology
- semicircular canal debris (benign position vertigo)
- vestibular nerve infection
- Meniere disease
- ototoxic drugs
- Ramsay Hunt syndrome
peripheral vertigo - diagnosis
positional testing –> delayed horizontal nystagmus
causes of central vertigo
Brain stem or cerebellar lesion
eg. stroke affecting vestibular nuclei or posterior fossa tumor
central vertigo findings
- directional change of nistagmus
- skew deviation
- diplopia (eyes)
- dysmetria
- focal neurological findings
dysmetria
lack of coordination of movement typified by the undershoot or overshoot of intended position with the hand, arm, leg, or eye. It is a type of ataxia.
central vertigo diagnosis
- positional testing –> immediate nystagmus in andy direction, may change direction
- Focal neurologic findings
prophylaxis of migraine
- propranolol
- topiramate
- Ca2+ channel blockers
- amitriptyline
- life style modifications
- valproate
triptans - clinical use
- acute migraine
2. cluster headache attacks
triptans - mechanism of action
5-HT (1B/1D) agonists (seretonin) –>
a. inhibit trigeminal nerve activtion
b. prevent vasoactive peptide release
c. induce vasoconstriction
triptans - toxicity
- coronary vasospasm
2. mild paresthesia
triptans are contraindicated in
patients with CAD or Prinzmetal angina
headache - pain due to irritation of structures such as
- dura
- cranial nerves
- extracranial nerves
meningism signs
- acute severe headache, felt over most of the head
- nech stiffness
- photophobia
causes of headache with meningism
meningitis
encephalitis
subarachnoid hemorrhage
encephalitis vs meningitis according ONE clinical sign
encephalitis –> strange behaviour
sinusitis - pain worse when
bending over
Horner syndrome - headache
- cluster
2. venous sinus thrombosis
migraine due to blood vessel irritation - mechanism - release of
- substance P
- calcitonin gene-related peptide
- vasoactive peptides
tension headache - treatment for chronic pain
amitriptyline
vertigo is always worsened by
movement
semicircular canal debris –>
benign position vertigo
1st line for trigeminal neuralgia
Carbamazepine
positional testing for nystagmus is also called
Hallpike manoeuvre
Epley manoeuvre –>
clear the debris from the semicircular canalas (benign positional vertigo)
Menierre disease - symptoms
- recurrent attacks of vertgio (>20 mins)
- tinnitus
- hearing loss
- fullness sensation
