Headaches Flashcards
What are the features of a migraine?
Moderate to severe intensity Pounding or throbbing pain Usually unilateral Photophobia and photophonia Aura may be present Nausea and vomiting
What are the features of a hemiplegic migraine?
What condition can it mimic?
Typical migraine symptoms Sudden or gradual onset Hemiplegia Ataxia Change in consiousness
Can mimic a stroke
What is the acute and prophylactic management for migraines?
Acute: Paracetamol Triptans (50mg sumatriptan) NSAIDs Antiemetics if vomiting
Prophylaxis:
Propranolol
Topiramate - a teratogenic that can cause clef lip
Amitriptyline
What are the features of tension headaches?
Tight-band headache
Bilateral
Associated with stress
What can trigger a migraine?
Stress Change in diet Oral contraceptive pill Exercise Caffeine Alcohol
What are the features of a cluster headache?
Excruciating headaches behind eye lasting a few hours, often twice a day at night
Occur in clusters for weeks then headache-free for months
Red, swollen and watering eye
Miosis
Ptosis
Nasal discharge
Facial sweating
What group of patients are cluster headaches more common in?
Male
Smokers
What is the management for cluster headaches?
Acute:
100% high flow oxygen
Triptan
Prophylaxis:
Verapamil
What is the management for tension headaches?
Acute:
Aspirin, paracetamol or NSAIDs
Prophylaxis:
Acupuncture
Low-dose amitriptyline
What are the features of temporal arteritis?
>50s Rapid onset unilateral headache Jaw claudication Scalp tenderness Visual disturbances Tender, palpable temporal artery
What are the features of a subarachnoid haemorrhage?
Sudden onset severe headache that feels like being hit by baseball bat Meningism - photophobia, neck stiffness Nausea and vomiting Coma Seizures Sudden death ECG changes including ST elevation
What can cause spontaneous SAH?
Diseases associated with intracranial aneurysm:
Adult polycystic kidney disease
Ehlers-Danlos syndrome
Coarctation of aorta
AV malformation
What investigations is carried out in SAH?
CT head
Lumbar puncture:
Used if unable to confirm SAH on CT
Perform it 12 hours after onset of symptoms
Presence of xanthochromia and normal or raised opening pressure = SAH
What can cause raised ICP?
Idiopathic intracranial hypertension Trauma Meningitis Tumours Hydrocephalus
What are the features of raised ICP?
Severe headache that is worse in morning, when coughing, lying down, bending over or during valsalva manoeuvre Vomiting Visual disturbances Seizures Neurological symptoms Reduced levels of consciousness Papilloedema
What are the features of trigeminal neuralgia?
Intense facial pain lasting for seconds - hours
Electric shock pain
What is the management for trigeminal neuralgia?
Carbamazepine
What are the red flag symptoms for serious conditions causing headaches?
Fever, photophobia or neck stiffness (meningitis or encephalitis)
New neurological symptoms (haemorrhage, malignancy or stroke)
Dizziness (stroke)
Visual disturbance (temporal arteritis or glaucoma)
Sudden onset occipital headache (subarachnoid haemorrhage)
Worse on coughing or straining (raised intracranial pressure)
Postural, worse on standing, lying or bending over (raised intracranial pressure)
Severe enough to wake the patient from sleep
Vomiting (raised intracranial pressure or carbon monoxide poisoning)
History of trauma (intracranial haemorrhage)
Pregnancy (pre-eclampsia)
What medication can be used to lower raised ICP?
Mannitol
If raised ICP is due to tumour, use dexamethasone
