headaches in pregnancy Flashcards
what should be your first step in management for a pregnant patient complaining of headaches ?
rule out pre-eclampsia
what are the red flags associated with headaches ?
thunderclap headaches focal neurological symptoms changes with posture neck stiffness fever valsalva
what is the classical presentation of migranes ?
pulsating/throbbing one day long unilateral associated with nausea and vomiting disabling
what is the treatment of migranes ?
avoid the precipitates , rest and hydrate acupuncture, Magnesium sumatriptan steroids amitriptyline prophylactic: aspirin, propanolol
what is the classic presentation of idiopathic intracranial hypertension ?
obese young woman
on coughing and straining
diplopia, visual loss
what is the treatment of idiopathic intracranial hypertension ?
decrease inn weight
acetazolamide
what are the features of pre-eclampsia ?
BP> 140/90
proteinuria
affection of other organ systems
hyperreflexia, clonus
what feature of headaches may raise our suspicion for pre-eclampsia in a pregnant woman ?
a headache that doesn’t go away with analgesia
what is a post-dural Tap ?
a form of severe headache that occurs after a spinal injection or epidural
what is the classic presentation of a post dural tap ?
is fronto-occipital
radiates to the neck
lasts a maximum of 6 weeks
what is posterior reversible encephalopathy syndrome ?
clinico-radiological syndrome that is characterized by visual loss , seizures, headache and vomiting
what is significant in imaging of posterior reversible encephalopathy syndrome ?
posterior circulation oedema
what is the pathophysiology behind PRES ?
auto regulation of brain blood flow
what is cerebral vein thrombosis commonly mistakenly diagnosed for ?
pre-eclampsia
what is the treatment for cerebral vein thrombosis ?
heparin for 6 months
then screen for hemophilia
what is reversible cerebral vasoconstriction syndrome ?
multifocal arterial constriction and dilatation
what is the classical presentation of RCVS ?
thunderclap headache
nausea and vomiting
diplopia
what can be done to differentiate between RCVS and SAH ?
CVS will show diffuse arterial beading
what is the treatment for RCVS ?
calcium channel blockers
corticosteroids
magnesium sulphate
if a patient comes complaining of a thunderclap headache, what are the differential diagnosis ?
subarachnoid haemorrhage
reversible cerebral vasoconstriction syndrome
what are the differential diagnosis of papilloedema in the scope of headaches ?
cerebral vein thrombosis
idiopathic intracranial HTN
what is status migrainosus ?
an ongoing headache that lasts more than 72 hours
