Headaches: Flashcards
List the classification of headaches:
Primary:
- Migraine
- Cluster headache
- tension headache
Secondary:
- Meningitis
- SAH
- Giant cell arteritis
- Medication overuse headache
- Idiopathic intracranial hypertension
Other:
- Trigeminal neuralgia
What is migraine?
Recurrent headache associated with visual and GI disturbance (photophobia and nausea)
What is migraine with aura known as? And what is migraine without aura known as?
With - Classic migraine
Without - common migraine
Give some features of migraine:
- Reversible visual symptoms (unilateral blindness, flashes, fortification spectra)
- Reversible dysphagic speech
- tingling
What can trigger migraines?
Chocolate (oral contraceptives, caffeine, alcohol)
How long to migraine attacks last?
4-72 hours
What is the treatment for migraine?
Acute - NSAIDs +/- antiemetic (metoclopramide)
2nd line - triptans
What is used as prophylaxis in migraine?
Propanolol
What are cluster headaches?
Rapid onset, severe short lived headaches (15mins - 3hrs) - more common in men.
Unilateral orbital/supraorbital pain
What does the ‘cluster’ part of cluster headaches represent?
The variation in time. Headaches occur in clusters: frequency varies from once every other day to several a day for 1-3 months
What are some associated symptoms in Cluster headache?
Ipsilateral autonomic features:
- Lacrimation
- Eye redness
- Nasal blockage
- Flushing
Restlessness
What is the management for cluster headache?
Acute - triptans (sumatriptan)
What is given as prophylaxis in cluster headache?
Verapamil (CCB)
Give an example of a triptan?
Sumatriptan
What is the most common cause of headache?
Tension headache (lasting from 30mins to a week)
What are the features of tension headache?
- Bilateral, of a pressing/tightening quality (not pulsating)
- Less severe than migraines
- Stress is usually an etiological factor
What is the treatment of tension headache?
(largely self-limiting)
Acute:
- NSAIDs/paracetamol
Give 4 symptoms of giant cell arteritis (GCA):
- UNILATERAL VISUAL LOSS
- Scalp tenderness
- Jaw claudication
- Headaches
What is seen on investigation in GCA?
- ESR raised
- Temporal artery biopsy
What is the treatment of GCA?
Oral prednisolone
What are the features of headache due to raised intracranial pressure?
- Generalised ache
- Worsened by bending, coughing, straining (^ICP)
- Worse in morning
- Vomiting
- Visual changes
- Focal neuro signs
- Papilloedema (blind spot)
What can cause raised intracranial pressure?
- SOC
- Idiopathic intracranial hypertension
What localising sign can indicate raised ICP?
False localising sing such as III/VI CN palsy
Give three cardinal presenting symptoms of brain tumours:
- Symptoms of ^ ICP
- Focal or generalised epilepsy
- Progressive neurological deficit
What are the majority of primary brain tumour ?
1) Gliomas (e.g. astrocytoma) (85-90%)
2) Oligodendroblioma (5%)
What can be used to treat brain tumours?
- IV dexamethasone (decreases cerebral oedema)
- IV mannitol
- Seizures with anticonvulsant
- Surgical excision (+/- adjuvant chemo-radiotherapy)
What medication can be used in Glioblastoma multiforme?
Temozolamide
What are the features of trigeminal neuralgia?
- Knife-like stabbing pain in CN V distribution
- Unilateral
- Last fraction of a second to 2 mins long
What can be triggers of trigeminal neuralgia?
Washing face, shaving, eating, talking
What is the management of trigeminal neuralgia?
- Carbamazepine (anticonvulsant)
Give an example of an anti-convulsant:
Carbamazepine
