Headaches Flashcards
What is giant cell arteritis (GCA)
Inflammation of large and medium sized arteries
What artery is primarily affected in GCA
Branches of the external carotid artery
What patients are at a higher risk of GCA (3)
White female over 50
Give 5 common symptoms of GCA
- New headache
- Scalp pain or tenderness
- Aching and stiffness - neck, shoulders, hips
- Upper limb claudication
- Systemic: fever, weight loss, malaise, fatigue
What are 3 signs of GCA
- Abnormal fundoscopy - pallor of optic disc
- Absent temporal artery pulse
- Reduced visual acuity (+ diplopia/ change to colour vision)
What is the first line investigation for GCA
Vascular ultrasonography of temporal and axillary artery
What is the gold standard investigation for diagnosis of GCA
Temporal artery biopsy
Excluding first line and GS investigations of GCA, what other investigations should be ordered (3)
- ESR/CRP - high
- FBC - may have normocytic normochromic anaemia
- Fundoscopy - optic disc pallor/ oedema
When should a temporal artery biopsy be considered
When the patients pre-test probability is high ( I.e. typical features of GCA with raised ESR/ CRP) but ultrasound is normal
Give 3 positive finding of GCA on a temporal artery biopsy
- Multinucleated giant cells
- Granulomatous inflammation
- Intimal thickening and narrow lumen
Why are negative biopsies possible in patients with GCA (2)
Less helpful in extracranial GCA
* presence of skip lesions along the artery
* Involvement of arteries besides superficial temporal artery
What may a positive vascular ultrasonography for GCA show (2)
- Wall thickening (non-compressible halo sign)
- Stenosis or occlusion
What is the first line treatment for GCA with no visual Sx
40-60mg prednisolone orally OD in the morning after breakfast
What is the first line Tx for GCA with visual Sx
500-1000mg IV methylprednisolone once daily for 3 days then switch to oral prednisolone
What Tx can be considered in GCA if px don’t respond to first line
- Aspirin - 75mg once daily
- Specialist Tx - SC tocilizumab or Oral methotrexate once weekly
Give 3 complications of GCA
- Glucocorticoid toxicity - osteoporosis, diabetes, HTN
- Aortic aneurysm
- Vision loss
What is a migraine
Chronic, episodic, neurological disorder typically presenting in early-mid life (<40)
Give 4 RF of migraines
- Female
- Family Hx
- Obesity
- Sleeping disorders
Give 6 Triggers of a migraine
Chocolate
Oral contraception
Alcohol
Bright lights
Exercise
Menstruation
What is aura in relation to migraines
Unilateral fully reversible visual, sensory or other CNS Sx that develop gradually and are usually followed by a headache
Describe the 5 stages of a migraine
- Prodromal - 3 days before headache
- Aura - lasts up to 60mins
- Headache - lasts 4-72h
- Resolution - headache relieved
- Recovery
What is a hemiplegic migraine
Migraine with aura including motor weakness
Give 5 ways migraines present
- Severe, unilateral, throbbing headache lasting 4-72h
- Nausea
- Photophobia
- Worse with activity
- Aura: flashing lights, zigzag lines, Paraesthesia, blind spot
How is a migraine diagnosed
- Clinical diagnosis - Hx + physical exam
- ESR - normal. Exclude GCA
- CT/ MRI head - normal. exclude haemorrhage and secondary headaches