Headaches Flashcards
What are some red flags for headaches?
new onset >55 years old
New or previous history of malignancy
Immunosuppressed
Early morning headaches/waking up with headaches
Exacerbated by the valsalva manoeuvre
What are some of the features of a migraine?
At least 5 attacks with a duration of 4-72 hours
Unilateral
Worse on movement
Photo/phonophobia
Nausea and vomiting
20% occur with aura
What condition are migraines with auras associated with?
What medication, as a result, should not be given to people with migraine and aura?
Migraine with aura is associated with an increased risk of ischaemic stroke
As a result, the oral contraceptive pill is contraindicated
How are migraines treated?
- education and avoiding triggers
- oral triptan (Sumatriptan) and/or NSAID. Also consider adding an anti-emetic
(contraindications of triptans - coronary vasospasm, ischaemic heart disease, previous cerebrovascular incident)
- if >3 attacks a month, OR severe attacks, consider propranolol or topiramate as prophylaxis
What’s the headache type?
- band-like pressure around the head radiating to the neck
- tingling sensation occurring in the head
- absence of nausea and vomiting, or photophobia
- brought about by stress and strong association with depression/anxiety
Tension-type headache - managed with reassurance, rest and relaxation. If chronic, amitriptyline may be used
What types of headache are classed under the ‘Trigeminal Autonomic Cephalgias’ (TAC)?
Cluster headache
Paroxysmal hemicrania
SUNCT (short-lived unilateral neuralgiform headache with conjunctival injections and tearing)
What’s the headache type?
- headaches occur 1-8 times a day for a certain period of the year, then stop for ages
- severe unilateral pain described as stabbing in the retro-orbital, supra-orbital or temporal regions
- ipsilateral autonomic features - ptosis, miosis, lacrimation, nasal stuffiness
- circadian rhythm of onset (as people go to bed or in the early hours of the morning)
- headaches last for 10 minutes to 3 hours
Cluster headache
Typically seen in men between the ages of 20-55
How is Cluster headache treated both acutely and prophylactically?
Acute management - high flow O2 and sub cut Sumatriptan
Prophylaxis - Verapamil
What is the headache type?
- lots of headaches a day (1-40), lasting between 10-30 mins
- more common in females
- age of onset is typically 50-60
Paroxysmal hemicrania
How is paroxysmal hemicrania treated?
Indomethacin - complete response seen
What’s the headache type?
- 3-200 headaches a day, lasting 15-120 seconds each
- unilateral (temporal, retro-orbital or supra-orbital region)
- single stab or series of stabs in a saw-tooth pattern (neuralgiform headaches)
- conjunctival injections
- tearing
SUNCT (short lived unilateral neuralgiform headache with conjunctival injections and tearing)
How are SUNCT headaches treated?
Lamotrigine or Gabapentin
What is the pharmacological management for Trigeminal Neuralgia?
Carbamazepine - anticonvulsant, causes Na+ channel inactivation
