headaches Flashcards

1
Q

headache red flags

A

new onset headache >55
known/previous malignancy
immunosupressed
early morning headache
exacerbation by valsava - coughing, sneezing -> raised ICP

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2
Q

first investigation for headache

A

fundoscopy - pailloedema -> raised ICP

(headache diary)

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3
Q

migraine with aura (20%) criteria

A

aura fully reversible
aura duration 20-60mins
headache follows <1hr later but aura can occur simultaneously

(trigeminal vascular problem with vasoddilation of crainial blood vessels)

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4
Q

migraine without aura criteria

A

at least 5 attacks
duration 4-72hrs
2of: moderate/severe, unilateral, throbbing pain, worse movement

1of: autonomic features, photphobia

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5
Q

migraine triggers

A

sleep
dietary
stress
hormonal
physical exertion

(keep headache diary to identify)

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6
Q

migraine

A

recurrent, severe headahce which is usually unillateral + throbbing in nature
- assoc aura, nausea + photosensitivity, menstruation

usual trigger

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7
Q

tension headache

A

recurrent, bilaterl headache, often described as “tight band”

not aggravated by routine activities

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8
Q

temporal arteritis

A

> 60yrs old
usually rapid onset (<1month) unilateral headache
jaw claudication
tender, palpable temporal artery
raised ESR
sudden vision loss

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9
Q

cluster headache

A

episodes over weeks - 2 a day, lasting 15-120mins
intense pain around eye - always same side
assoc redness, lacrimation + lid swelling

more common in men + smokers

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10
Q

migraine pathophysio

A

vascular + neural influence cause migraines in susceptible individuals
increased sensitivity, in both cases, the chemicals result in the sensitization of trigeminal neurons + brainstem pain pathways
o this makes otherwise innocuous sensory stimuli (such as CSF pulsation + head movement) painful, and light and sound are perceived as uncomfortable

  • Stress triggers changes in brain, these changes cause serotonin to be release
  • Blood vessels constrict + dilate
  • Chemical including substance P irritate nerves + blood vessels causing pain
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11
Q

acute management of migraines

A

NSAIDs - take as early as poss, 60% reduction in headache at 2hrs

Triptans - treat at strt of headache, too many can induce headache
-> rizatriptan, eletriptan, frovatriptan

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12
Q

criteria + management for migraine prophylaxis

A

> 3 attacks a month or very severe
must trial for min of 3months

  • amitriptiline - SE: dry mouth, postural hypotension, sedation
  • propranolol - avoid in asthma, PVD, heart failure
  • topiramate - not 1st, lots of SE start slow (weight loss, paraesthesia, impaired concentration)

acupuncture if fails

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13
Q

autonomic cephalgia

A

group of headache disorders characterised by unilateral trigeminal distribution pain that occurs in assoc with prominent ipsilateral autonomic features

cluster headaches - males
hemicrania - females

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14
Q

autonomic features that can occur in autonomic cephalgia

A

ptosis
miosis
nasal stuffiness
N+V
tearing
eye lid oedema

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15
Q

autonomic cephalgia investigations

A

MRI brain
MR angiogram

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16
Q

trend in cluster headache episodes

A

striking circadian (around sleeo) + seasonal variation - more common in spring

17
Q

triggers of cluster headaches

A

alcohol
strong smells
exercise

18
Q

treatment of cluster headaches

A

high flow oxygen 100% for 20mins
subcutaneous sumatriptan 6mg

prophylaxis
- verapamil
- steroid - reducing course over 2 wks

19
Q

hemicrania

A

elderly (50s-60s)
women

paroxysmal unilateral autonomic features
duration - 10-30mins
frequency - 1-40 a day
usually in orbital, supraorbital or temporal region

20
Q

hemicrania treatment

A

indomethacin
–> ABSOLUTE response, if no response probs something else

21
Q

tension headache treatment

A

reassurance, basic analgesia, relaxation techniques, hot towel

pharmological = antidepressants
- dothiepin or amitriptyline
- give for 3months

22
Q

idiopathic intracranial hypertension features

A

F>M
obese, young

worse in morning, N+V
worse lying down
vision loss
papilloedema, blurred vision
enlarged blind spot

23
Q

idiopathic intracranial hypertension risk factors

A

obesity, female
pregnancy
combined oral contraceptive pill
tetracyclines

24
Q

idiopathic intracranial hypertension investigations

A

MRI brain with MRV sequence - normal, empty sella
cerebrospinal fluid - elevated pressure, normal constituents
visual fields

Fx = empty sella, flattened optic disc

25
Q

idiopathic intracranial hypertension management

A

weight loss
acetazolamide (diuretic)

ventricular atrial/lumbar shunt
monitor visual fields + CSF pressure

26
Q

trigeminal neuralgia

A

pain syndrome characterised by severe unilateral pain
-> brief elctric shock like pain, abrupt in oset + terminations

(triggered by touch)
most idiopathic, compression of trigeminal roots by tumours/vascular problems may occur

27
Q

trigeminal neuralgia features

A

elderly >60
W>M
severe stabbing unilateral pain
duration = 1sec-90sec
frequency = 10-100 aday

bouts of pain may last from a few weeks to months before remission

28
Q

trigeminal neuralgia investigations

A

MRI
- FLAIR sequence
- Ciss sequence

29
Q

trigeminal neuralgia management

A

pharmacological
- carbamazepine = 1st line
- gabapentin
- phenytoin

surgical
- ablation
- decompression

30
Q

giant cell arteritis investigation + management

A

elevation CRP + plasma viscosity
US temporal artery biopsy

steriods