Headaches and migraine Flashcards
Cluster headache, paroxysmal headache, SUNCT/SUNA and hemicranial continua are all what?
Trigeminal autonomic cephalagias
primary headaches
Duration of migraine vs cluster headache:
Migrane = 4-72 hours
Cluster headache = 15-180 minutes
What are trigeminal autonomic cephalagias?
Group of headaches characterised by ipsilateral cranial autonomic features such as lacrimation, ptosis, conjunctival infection, rhinorrhoea, nasal congestion and eyelid oedema
Criteria for cluster headache:
Unilateral supra/orbital/temporal severe pain for 15-180 minutes
Either or both of: one autonomic feature and a sense of restlessness/agitation
Criteria for migraine:
Duration of 4-72 hours with 2 of:
Unilateral, pulsating, moderate-severe pain, aggravated by exercise
1 of during headache:
N/V or photophobia and phonophobia
Headache worse when lying suggests what?
Due to CSF pressure
What does thunderclap headache ‘like a stone fell on my head’ suggest?
Subarachnoid haemorrhage
Do CT and lumbar puncture
What does thunderclap headache + behavioural change/confusion suggest?
Cerebral venous thrombosis
Do CT angiography/venography
What does thunderclap headache in occipital region suggest?
Vertebral artery dissection
What does thunderclap headache on side of head suggest?
Carotid dissection
stenosis or stroke
Sudden onset of symptoms suggests what kind of problem?
Vascular
Causes of thunderclap headaches:
Meningeal haemorrhages Intracerebral haemorrhages Cerebral venous thrombosis Arterial dissection Reversible cerebral vasoconstriction syndrome Pituitary apoplexy
Features of raised CSF pressure:
Worse in the morning
Better upright
Worse with valsalva
Features of low CSF pressure:
Worse as day goes on
Better lying down
Which condition commonly affects young very obese women?
Idiopathic intracranial hypertension
Features of IIH:
Bilateral, dull, pressing, frontal-retroorbital localisation
Lesions of optic nerve causing ongoing vision loss
Aggravated by coughing, pressing and physical activity
Nausea and photophobia
Papilloedema and diplopia
What is neuralgia?
Pain only for a second but 10/10 intensity
80 y/o patients
Differential for hemiparesis:
Migraine aura causing depolarisation in different brain areas past the gyrus
Moving character
What causes aura?
Occipital depolarisation of an area
Moving character, 20-30mins per symptom - normally stops at gyrus
Visual aura pattern:
Visual deficit will start in the centre of the vision then move outwards and disappear
Migraine treatment:
NSAIDs
Triptans
Anti-emetics (metoclopramide and domperidone)
Preventative migraine treatment if >10 days in a month:
Metoprolole Flunavizine Topiramate (anti-depressant) Valproate Anti-tryptyline Magnesium Candesartan Botox
Preventative biologic migraine treatment:
CGRP and CGRPR Abs
Fremanezumab
Galcanezumab
Eptinezumab
Ereumab
Definition of a medication overuse headache:
A. Headache on >14 days/month in a patient with pre-existing headache disorder
B. Regular overuse for >3 months of a symptomatic treatment for headache
C. No better diagnosis from ICHD-3
Which headache is the worst pain imaginable/smash head against wall bad?
Cluster headache
Treatment of cluster headache?
Only headache that responds to O2 - give 100% (12-15 L/min, re-breathe bag)
Triptans (subcutaneous/nasal)
Preventative treatment of cluster headache:
Verapamil
Topiramate
Lithium
