Headaches Flashcards
Causes of acute headaches
VICIOUS
Vascular
Infection
Compression
ICP
Ophthalmic
Unknown
Systemic
Vascular causes of acute headaches
Intracranial haemorrhage
Infarction
Infection causes of acute headache
Meningitis
Encephalitis
Compression causes of acute headache
Hydrocephalus
Ophthalmic causes of acute headache
Acute glaucoma
Systemic causes of acute headaches
HTN: Phaeochromocytoma
Infection: sinusitis
Toxins: CO
Causes of chronic headaches
MCT DINGS
Migraine
Cluster headaches
Tension headaches
Drugs
ICP
Neuralgia (trigeminal)
Giant cell arteritis
Systemic
Drug causes of chronic headaches
Analgesics
Caffeine
Vasodilators
Systemic causes of chronic headaches
HTN
Uraemia
Subarachnoid haemorrhage features
Thunderclap headache
Sudden onset
Occipital
Tension headache features
Bilateral
Band like
Non pulsatile
Cluster headache features
Rapid onset
Unilateral
Severe pain around one eye
Sx of cluster headache
Red, watery eye
Nasal congestion
Miosis +/- ptosis
Length of cluster headache attacks
15 mins - 3 hrs
Length of cluster headache clusters
4 - 12 wks
Length of cluster headache 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 features
Male > 50 yrs
Unilateral stabbing pain
Trigeminal division distribution (usually V2/3)
Secondary causes of trigeminal neuralgia
Compression (aneurysm)
MS
Zoster
Triggers of trigeminal neuralgia
Washing area
Shaving
Eating
Talking
Medical mx of trigeminal neuralgia
Carbamazepine
Lamotrigine
Gabapentin
Surgical mx of trigeminal neuralgia
Microvascular decompression
Giant cell arteritis
Age
ESR
Treatment
Age > 60 yrs
ESR > 60
Prednisolone 60 mg
Giant cell arteritis presentation
Unilateral scalp tenderness
Thickened pulseless temporal artery
Jaw claudication
Amaurosis fugax
Sudden blindness
Association of giant cell arteritis
Polymyalgia rheumatica
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 prodrome timing
Preceed migraine by hrs - days
Sx of migraine prodrome
Yawning
Cravings
Changes in sleep, appetite or mood
Migraine aura timing
Preceed migraine by mins
Sx of migraine aura
Visual - distortion, zig zags, hemianopia
Paraesthesia
Speech
Motor
Teicophosia
Scintillating scotoma
Fortification spectra
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
Treatment of an acute migraine episode
1) Paracetamol + metoclopramide
2) NSAID + metoclopramide
3) Rizatriptan (triptans)
4) Ergotamine
Prophylaxis of migraines
Avoid triggers
1) Propanolol, topiramate
2) Valproate, pizotifen, gabapentin
Mode of action of triptans
5-HT receptor agonist
