Headaches Flashcards
What is the etiology of migraines?
- irritations of CNS structures
- Activation of Trigeminal n. (release of neuropeptides)
- sensitization (neurones get increasingly responsive to stimuli)
Drugs used to abort migraine
NSAID (aspirin, NAPROXEN, Ibuprofen) (reduction by 60% in 2hrs)
-TRIPTANS (5ht agonist) —RIZATRIPTAN and ELEtriptan
When is prophylactic rx given for migraine?
- if you have more than 3 ATTACKS in a month
- or very debilitating
S.E of sumatriptan?
- raises BP
- C.I in CAD and Prinzmetal’s Angina
Which drug can be given as a migraine prophylaxis and is a tricyclic antidepressant?
AMITRIPTYLINE
- s.e: dry mouth, postural hypotension, sedation
Name other prophylactic drugs for migraines.
- Propanolol (reduces freq. of migraines in 60-80% of pts)
- TOPIRAMATE (^ GABA)
- Valproate
What is the AIM of prophylaxis?
- titrate drug as tolerated to achieve efficacy at the LOWEST dose
(start low and keep on)
Which drug used for prophylaxis in migrain has a POOR s.e profile?
- TOPIRAMATE
weight LOSS, paraesthesia, impaired conc, enzyme inducer,
Which prophylactic drug causes stones in the kidney?
- TOPIRAMATE
- because it a carbonic anhydrase inhibitor (MORE Calcium in the urine)
Valproate is ALSO used as a prophylaxis for Migraine. What are its S.E?
- tremor
- hepatootoxicity
- NTD
- wgt gain
- GI distress
What is SEEN in migraines and is NOT seen in tension headaches?
- those with migraines may experience N & V
- photo-/phonophobia
How to manage Tension headache?
- relaxation physiotherapy
- antidepressant ( Amitriptyline) for 3 MONTHS
- reassure
Cluster headaches are often in _____
men and SMOKERS
What is key about cluster headache?
- ipsilateral cranial AUTONOMIC fts are seen
What are the 4 types of trigeminal autonomic cephalgias?
- cluster
- paroxysmal hemicrania
- hemicrania continua
- SUNCT
When does a cluster headache strike?
- around sleep
- seasonal variation
- same time EVERY day
What are the distinct fts of a cluster headache?
- EXCRUTIATING unilateral headache
- last 15mins to several hrs
- as freq. as one EVERY other day to 8 per day
How to treat cluster headache?
- HIGH flow oxygen (100% for 20 mins)
- sub. cutaneous sumatriptan 6mg
-PROPHYLAXIS verapamil & prednisolone (reduce over 2 weeks)
What is SUNCT?
- Short-lived (12-120s)
- Unilateral
- Neuralgiaforme headache
- Conjunctival injections
- Tearing
What is the diff. between SUNCT and the others?
SHORT-LIVED
—the pain can occur 3-200 times a DAY !
How to treat SUNCT?
D.t to activation of autonomic nervous system in the Trigeminal nerve—-so …
Gabapentin
Lamotigrine
Who is prone to paroxsymal hemicrania?
- women in their 50s-60s
How long does paroxysmal hemicrania last?
2-45mins
freq: 1-40 a day
How to treat paroxysmal hemicrania?
- Indomethicin
shorter and more frequent than cluster
Those with NEW onset unilateral cranial fts require what?
Imaging of the brain
MRI or MR angiogram
Idiopathic intracranial hypertension is commonly seen in which demographic gr.?
- Females
- OBESE
How does IIH present as?
- Throbbing headache; WORSE in the MORNING, coughing or STRAINING
- morning N and V
- day time
- feeling sick, sleepy, irrtable
- –vision maybe DARK or GREYED out for a few seconds
What are the findings for IIH in MRI and CSF ?
MRI = normal
CSF: elevated pressure and NORMAL constituents
How to manage IIH?
- weight loss
- ACETAZOLAMIDE
- diuretics
- Ventricular-atrial SHUNT
- lumbar peritoneal shunt
- monitor visual fields and CSF pressure
Who gets trigeminal neuralgia?
- > 60y.o WOMEN
How does Trigeminal neuralgia present as?
- severe STABBING unilateral pain— made worse by CHEWING and SPEAKING
- lasts 1s-90s
- freq. of 10-100/day
How to treat trigeminal neuralgia ?
- PHENYTOIN/ GABAPENTIN/ CARBAMAZEPINE/ BACLOFEN
How to manage trigeminal neuralgia?
by decompression or ablation
Why is Ergotamine no longer given as rx?
- causes gangrene and overuse headache
Management of migraines?
offer simple analgesia
- offer triptans ALONE or with PCM (or another NSAID)
- —sumatriptan is FIRST line - offer anti-emetic even in the absence of N &V
What are said to be triggers for migraines?
CHeese OCP Caffeine AlcohOL Anxiety Travel Exercise
chocolate—atonym
Causes of IIH?
- subdural hematoma
- brain tumor
- iron def. anemia
- OBESE or overweight
- LUPUS
- CKD
- hormone problems: CUSHING’S, hypoparathyroidism. hyper-/ hypo- thyroid
- meds: some antibiotic, COCP, steroids
How to go about investigating IIH?
- neurological examinations (muscle strength/ balance/ reflexes)
- assessment of eyes and vision
- CT
- MRI
- LP
