Headaches and migraines Flashcards
First-line therapy for trigeminal neuralgia
Carbamazepine 100mg OD
- Max 1600mg
Red flags for trigeminal neuralgia presentation [6]
Ophthalmic/ bilateral pain
Sensory changes
Optic neuritis features
Deafness
Family Hx of MS
Age <40
Definition of medication overuse headache
Headache occuring at least 15 days/ month whilst taking analgesia
On background of existing headache
Analgesia overuse >3 days/ week for 3 months.
Headache red flags
Thunderclap character
Focal neurological signs (weakness, sensory losses, uncoordinated)
Visual disturbance
Hx of head trauma
Neck pain, meningitism
Worse when laying down/ standing
Personality/ cognitive changes
Weight loss, fever
Seizure
Worse on valsalva manoeuvre
Pregnancy
Contraindications of triptans
Uncontrolled hypertension
IHD
Stoke
Pregnancy
Prophylaxis for migraines
1st line = Propranolol 80-240mg divided
2nd line= Amitriptyline 50-75mg daily
Topiramate = 50-100mg daily, divided,
Adverse effects of topiramate
Paresthesia
Teratogenic
Episodic migraine is defined as…
Migraine <15 days a month
Chronic migraine is defined as…
Migraine >15 days/ month
Migraine triggers
Stress
Certain foods: i.e. chocolate, caffeine
Light
Dehydration
Menstruation
Abnormal sleep
Examples of aura that occurs in migraines
Lines/ sparkles in vision
Blurred vision
Loss of visual fields
Paraesthesia/ numbness
Risk factors for idiopathic intracranial hypertension
Obesity
Female
Pregnancy
Medications
- Steroids
- COCP
- Tetracycline
Presentation of idiopathic intracranial hypertension
Headache (postural)
Blurred vision
Pulsatile tinnitus
Papilloedema
CN6 palsy
Investigation findings for idiopathic intracranial hypertension
Lumbar puncture
- Raised open pressure (>20)
MRI venogram
- Transverse venous stenosis
Management options of IIH
Weight loss
Diuretics= Acetazolamide
Topiramate
Causes of non-communicating hydrocephalus
Obstructive structures
- Tumours
- Arachnoid cysts
Aqueductal stenosis
Arnold-Chiari malformation
Causes of communicating hydrocephalus
Subarachnoid haemorrhage
Infection: Meningitis
Head trauma
Choroid plexus tumour
Presentation of hydrocephalus
Babies
- Increased head circumference
- Bulging fontanelles
- “Sunsetting” eyes
- Drowsiness
Adults
- Headache: worse on laying/ valsalva/ in the morning
- Nausea/ vomiting
- Papilloedema
Triad of normal-pressure hydrocephalus
Urinary incontinence
Dementia
Gait disturbance
Hydrocephalus can be managed acutely with a…
External ventricular drain
Hydrocephalus can be managed long term with a…
Ventriculoperitoneal shunt
