Headaches Flashcards
most important part of SOCRATES for headaches?
onset ie acute/subacute/chronic
exacerbating/relieving factors
associated symptoms
what can exacerbate a headache?
posture
sneezing
coughing
what symptoms can accompany a headache that you should ask about?
nausea and vomiting photophobia phonophobia visual disturbance nasal stuffiness
headache red flags?
>55 new onset known/previous malignancy immunosuppressed worse in early morning worse on coughing/sneezing
why should you ask if a cough/sneeze exacerbates a headache?
they raise intracranial pressure
PMH should look for…
previous cancer
are they thrombolytic?
FH should explore…
migraines
cancers
migraines are commoner in who?
young women
on average people have _ migraine attack(s) per month
1
migraine with aura is more common than without T or F
F, without aura is more common (80%_
timescale for migraine without aura?
4-72hrs
presentation of a migraine without aura
moderate-severe, throbbing
unilateral headache that is worse on movement WITH associated N&V or photo/phonophobia
pathophysiology of a migraine
stress triggers changes in the brain causing release of serotonin -> dilates BVs; substance P release causes pain
how long does an aura last?
20-60 mins
presentation of migraine with aura?
aura for up to an hour followed by a headache (can also happen at the same time)
name the different kinds of aura; what is the most common?
visual eg lights, odd smell, hallucinations
visual is most common
a central scotomata type of visual aura looks like…
a blurred dark circle in the middle of the visual field
a central fortification type of visual aura looks like…
a zigzagged circle in the middle of the visual field
hemianopic loss in a visual aura looks like…
half of the visual field is lost
migraine triggers
sleep diet stress hormones physical exertions
name a way of finding what triggers a patient’s migraines
getting them to fill out a headache diary
Tx of migraines
avoid triggers
headache diary
relaxation/stress management
NSAID +/- antiemetic ASAP
when would you consider prophylactic treatment for migraines?
if theyve had >3 attacks a month or are very severe
prophylactic drugs for migraines?
propranolol
topiramate (carbonic anhydrase inhibitor)
amitryptiline
side effects of topiramate
wight loss
paresthesia
impaired concentration
amitryptiline side effects?
dry mouth
postural ht
sedation
presentation of a tension headache?
mild-moderate pressing/tingling headache that is bilateral
associated symptoms are absent in tension headaches T or F
T
Tx of tension headache?
relaxation physio
reassure
antidepressant eg amitryptiline for 3 months
what are the trigeminal autonomic cephalgias?
group of primary headache disorders characterised by UNIlateral trigeminal distribution pain PLUS ipsilateral cranial autonomic features
name the ipsilateral cranial autonomic features that appear with TACs?
ptosis miosis nasal stuffiness N+V crying eyelid oedema
4 main types of TAC?
cluster
paroxsymal hemicrania
hemicrania continua
SUNCT
who gets cluster headaches?
young adult men (30s)
when do cluster headaches appear?
striking pain around sleep tme
presentation of cluster headache?
SEVERE unilateral headache lasting around an hour that appears up to 8 times a day
Tx of cluster headache
high flow O2 for 20 mins
sumatriptan SC
steroids (decrease over 2 weeks)
prophylactic treatment of cluster headaches?
verapamil
who gets paroxysmal hemicrania
elderly women (50-60s)
clinical presentation of paroxysmal hemicrania
severe unilateral headache with ipsilateral autonomic features lasting about 30 mins
how many can headaches can you get a day in paroxysmal hemicrania?
up to 40
Tx of paroxysmal hemicrania
indomethicin
what does SUNCT stand for?
short lived (up to 2 mins) unilateral neuralgiform headache conjunctival injections tearing (Crying)
Tx of SUNCT
lamotrigine
gabapentin
Ix of new onset unilateral cranial autonomic features
all need MRI brain and MR angiogram
what is the headache like in idiopathic intracranial hypertension
diurnal variation
morning N+V
MRI of IIH would show…
nothing
Tx of IIH
weight loss
acetazolamide
ventricular shunt
who gets trigeminal neuralgia?
elderly women
what triggers trigeminal neuralgia?
touch over CNV2 and 3
presentation of trigeminal neuralgia?
severe stabbing unilateral pain lasting around a minute multiple times throughout the day
Tx of trigeminal neuralgia
carbamazepine gabapentin phenytpim baclofen Sx = ablation/decompression
Ix of trigeminal neuralgia
MRI brain
