Headaches Flashcards
headache red flags
new onset >55 known/previuos malignancy immuno-suppressed early morning headache exacerbated by coughing/sneezing
migraine with/without aura is more common
without
IHS criteria for migraine without aura
at least 5 attacks lasting 4-72 hours
2 of: moderate/sever pain, unilateral, throbbing, worse on movement
1 of: autonomic features, photophobia/phonophobia
pathophysiology of migraines
stress triggers serotonin release in brain
blood vessels constrict and dilate
chemicals (eg substance P) irritate nerves and vessels causing pain
how long does aura last in migraine with aura
20-60 mins
most common aura in migraine
visual
triggers for migraine
sleep deprivation dietary - chocolate and cheese stress hormonal - menstrual cycle physical exertion
acute pharmacological treatment for migraine
1st line - NSAID (possibly anti-emetic if gastroparesis)
2nd line - triptans (5HT agonist) e.g. rizatriptan
when should prophylactic treatment of migraines be considered
> 3 attacks/month or very severe
prophylactic drugs used in migraines
propranolol
topriamate (carbonic-anhydrase inhibitor)
when should propranolol be avoided
asthma
PVD
heart failure
SE of topiramate
weight loss
paraesthesia
impaired concentration
enzyme inducer
lifestyle factors in migraine
avoid food triggers
2L water per day - decrease caffeine
decrease stress
regular exercise
30-40 year old man
severe unilateral headache lasting 20 mins-3 hours 1-8 times per day
cluster headache
how long does cluster bout last
weeks-months
when does cluster headache usually come on
striking circadian (sleep) and seasonal variation
acute treatment for cluster headaches
high flow O2
sub-cut sumatriptan
steroids
prophylaxis used in cluster headaches
verapamil
unilateral headache 10-30 mins 1-40 times per day
paroxysmal hemicrania
what non-headache feature is present in paroxysmal hemicranias
autonomic features
treatment for paroxysmal hemicrania
indomethacin
who requires MRI brain and MRI angiogram
new onset unilateral cranialautonomic features
elderly woman
stabbing unilateral pain lasting 1-90seconds 10-100 times/day
trigeminal neuralgia
trigger for trigeminal neuralgia
touch
