headaches Flashcards
what is the onset time for a sub-acute headache
mins to hours
describe red flags fro headache
new onset headache if >55 known or prevent malignant history immunosuppressed early morning headache mode worse by valsalva
is a migraine unilateral or bilateral? describe migrain symtoms
unilateral
severe stabbing
photophobai/phonophobia , n and V
how many attacks must a person have had to class as migraines
5 minimum lasting 4-72 hours
what is feature criteria for migraine
2 of : mod/severe unilateral throb, worse on movement
1 of autonomic features: photophobia, photophobia, N&V
what are the migraine centres
dorsal raphe nuclei and locus corealus
what substances are released in migraine
substance P , neurokinin A and CGRP
what is the most common type of aura
visual eg central scotoma, central fortification or hemianopic loss
what is acute treatment of a migraine
NSAIDS- aspirin , naproxen, ibuprofen possibly an anti-emetic
triptan -rizatriptan
mechansim of action of triptans
5-HT agonist
prophylaxis of migrains . 1st 2nd and 3rd line
1st amitriptyline
2nd propanalol
3rd topiramate
mechanism of action for topiramate
carboni anhydrase inhibitor
lifestyles factors to reduce migraine
avoid trigger, drink 2L min, reduce caffeine , reuce stress, exercise
describe symptoms of tension headache
pressing band
bilateral
no autonimc featues
treatment of tension headache 1st line and prophlaxis
relaxation physio
prophylaxis is amitrityline or dothiepin for 3 months
name the 4 kinds of trigeminal autonomic cephalgia
cluster
paroxysmal hemicrania
SUNCT
hemicrania continua
who most comonly gets cluster heacahes ? age and gender
young men 30-40s
what is seen alongside trigeminal autonomic cepalgias
cranial autonomic features ptosis miosis nasal stuffiness n & taering eye lid oedema
where in the head do cluster heaches tend to occur
severe unilateral around eye that wake you from sleep
what time of day do cluster headahes commonly occur
around sleep - circadian
how many cluster headaches happen in a day and for how long
1-8 a day
around 45-90mins
treatment of cluster headache
high flow oxygen
sumatriptan sub cut
prophylaxis of cluster headaches
verapamil - ccb
describe continua /paroxysmal hemicrania and who gets
elderly females (50-60) most common
severe unilat headaceh
unilat autonomic features
10-30 mins 1-40 times a day
treatment of hemicrania
indomethicine
describe SUNCT
s-short 15-120 s u-unilat n- neuralgioform headache c- conjunctival injections t -tearing
treatment of a sunct headache
lamotrigene , gabapentin
describe isiopathic intercranial hypertensio
obese woman >men diurinal variation morning n&v vision loss- papillodema if vision loss on standing then emergency
what is the opening pressure like in idiopathic intercranial hyeprtension
increased opening pressure
treatment of intracranial hypertension
weight loss and acetozolamide
ventricular atrial/lumbar shunt
drug class of acetazolamide
carbonic anhydrase inhibitor
pathophysiology behind trigeminal neuralgia
blood vessels touching CN V and irritating
treatment of trigeminal neuralgia
carbamazapine
