Headaches Flashcards
Causes of acute headaches
VICIOUS
Vascular - ICH, infarction Infection - Meningitis, Encephalitis Compression - hydrocephalus ICP Ophthalmic - acute glaucoma Unknown Systemic
Systemic causes of acute headaches
HTN: Phaeochromocytoma
Infection: sinusitis
Toxins: CO
Causes of chronic headaches
MCT DINGS
Migraine
Cluster headaches
Tension headaches
Drugs - analgesics, caffeine, vasodilators ICP Neuralgia (trigeminal) Giant cell arteritis Systemic - HTN, organ failure (uraemia)
Investigations for headaches
Bloods + Cultures
Urine
LP
Non contrast CT
Subarachnoid haemorrhage
Thunderclap headache
Sudden onset
Occipital
Tension headache
Bilateral
Band like
Non pulsatile
Cluster headache
Rapid onset Unilateral Severe pain around one eye Red, watery eye Nasal congestion Miosis +/- ptosis Attacks 15 mins - 3 hrs Clusters 4 - 12 wks Remission 3 months - 3 yrs
Acute treatment of cluster headache attacks
100% O2
Triptans (Sumitriptan)
Prevention of cluster headache attacks
Verapamil
Topiramate
Lithium
Trigeminal neuralgia
Unilateral stabbing pain
Trigeminal division distribution (usually V2/3)
Male > 50 yrs
Secondary causes of trigeminal neuralgia
Compression (aneurysm)
MS
Zoster
Triggers of trigeminal neuralgia
Washing area
Shaving
Eating
Talking
Management of trigeminal neuralgia
Med:
Carbamazepine
Lamotrigine
Gabapentin
Surg:
Microvascular decompression
Giant cell arteritis
Age
ESR
Treatment
Age > 60 yrs
ESR > 60
Prednisolone 60 mg
Giant cell arteritis presentation
Unilateral scalp pain / tenderness Thickened pulseless temporal artery Jaw claudication Amaurosis fugax Sudden blindness Associated with PMR
Giant cell arteritis investigations
ESR > 60 Raised PLT Raised ALP Decreased Hb Temporal artery biopsy
Treatment of giant cell arteritis
Prednisolone 60 mg PO OD 5-7d
PPI + Bisphosphonate
Migraine risk factors
F
Obesity
Patent foramen ovale
Types of migraine
Aura + Headache (classic)
Isolated aura
Headache w/o aura (common)
Migraine triggers
CHOCOLATE
CHeese OCP Caffeine alcohOL Anxiety Travel Exercise
Migraine symptoms
Aura 15-30 mins Then unilateral throbbing headache Phono/photophobia Nausea / vomiting Allodynia Often premenstrual
Migraine prodrome
Preceed migraine by hrs - days
Yawning
Cravings
Changes in sleep, appetite or mood
Migraine aura
Preceed migraine by mins Visual - distortion, zig zags, hemianopia Paraesthesia Speech Motor
Migraine w/o aura diagnostic criteria
5+ headaches lasting 4-72 hrs \+ Nausea/vomiting or phono/photophobia \+ 2+ out of : - Unilateral - Pulsating - Interference with normal life - Worsened by routine activity
