Headaches in pregnancy Flashcards
Headache red flags
Thunderclap - rapid time to peak headache intensity e.g. SAH
Focal neurological symptoms like limb weakness
Cognitive disturbance e.g. in CVT
Headache that changes with posture
Headached worsened by exertion - e.g. SAH, raised ICP
Fever - meningitis
Neck stiffness -
Features of migraine
Unilateral
Pulsating
Builds up
Nausea/comiting/sensitivity to light or sound
Examples of migraine aura?
Flickering lights, tingling
Resolve within 60 mins
Can triptans and NSAIDs be used in migraines?
NSAIDS in 1st and 2nd T
Consider sumatriptans if refractory to other treatments
Additional risks in pregnant women with migraines?
2x risk of PET
Increased risk of stroke and MI
Generalised, non-throbbing, aggravated by coughing, with diplopia is suggestive of…
Idiopathic intracranial hypertension
(aka benign intracranial hypertension)
How to diagnose idiopathic intracranial hypertension?
Abnormally elevated CSF pressure (>20) on lumbar puncture
Treatment for idiopathic intracranial hypertension?
Therapeutic lumbar puncture or acetazolamide (500mg BD)
What is PRES?
Posterior reversible encephalopathy syndrome
associated with pre-eclampsia!
Symptoms of PRES?
headache, vomiting, visual disturbances, seizures, altered mental state
Findings on MRI in PRES?
Oedema in the posterior circulation
When is the risk greatest for cerebral venous thrombosis?
3rd trimester and 4 weeks post-partum
Sx of CVT
Headache, focal deficits, seizures, cranial nerve signs, papilloedema
Best ix for CVT?
T2 weighted MRV
Rx for CVT
6 months LMWH
