Headches Flashcards
1
Q
What are stages of Migraines?
A
- ‘Prodromal’ (pre-headache) stage: changes in mood, energy levels, behaviour and appetite that can occur several hours or days before an attack
- Aura: usually visual problems, such as flashes of light or blind spots, which can last for five minutes to an hour
- Headache stage: usually a pulsating or throbbing pain on one side of the head, often accompanied by nausea, vomiting, and/or extreme sensitivity
- Resolution stage: when the headache and other symptoms gradually fade away, although you may feel tired for a few days afterwards
2
Q
What are symptoms of Migraine?
A
- Severe, throbbing pain of one side of the head
- Nausea and Vomiting
- Sweating
- Poor concentration
- Feeling very hot or very cold
- Abdominal pain
- Diarrhoea
- Increased sensitivity to light or sound.
3
Q
What are some aura symptoms of migraines?
A
- Visual problems
- Numbness or a tingling sensation like pins and needles which usually starts in one hand and moves up your arm before affecting your face lips and tongue
- Feeling dizzy or off balance
- Difficulty speaking
- Loss of consciousness
4
Q
What are subtype of Migraines?
A
- Migraine with aura
- Migraine without aura
- Migraine aura without headache
5
Q
What are some associations with Migraines?
A
- Hormonal Changes (migraines appear around the time of their period. Menopause can improve or worsen migraines)
- Emotional Triggers
- Physical Triggers
- Dietary Triggers
- Environmental triggers
- Medications (Sleeping Tablets, COCP, Hormone Replacement Therapy)
6
Q
What are red flags of Migraines?
A
Call 999 if you have:
- Paralysis or weakness in one side
- Slurred or garbled speech, sudden agonising headache resulting in a blinding pain
- Headache along with a high temperature
- Stiff neck
- Mental confusion
- Seizure
- Double vision and a rash
7
Q
What is the treatment for migraines?
A
Treat acutely with combination therapy
- Oral sumatriptan (50mg or 100mg)
- Ibuprofen, Naproxen, Tolfenamic acid
Treat with monotherapy
- Oral Triptan or NSAID or Aspirin (900 mg every 4-6 hours when necessary up to 4g daily)
- Consider adding anti emetic even without vomiting – Metoclopramide
8
Q
What are side effects of Triptans?
A
- Warm Sensations
- Tightness
- Tingling
- Flushing
- Heaviness in the face, limbs, or chest
9
Q
What is a Cluster Headache?
A
- Cluster headaches are a rare type of headache that occur in clusters for a month or two at a time around the same time of year.
- Can last several days in bouts that extend weeks or months
10
Q
What are symptoms of a Cluster Headache?
A
- Extremely painful headache causing pain around one eye, temple or face. Pain is sharp, burning or piercing
- Watering or red eye and blocked or runny nose
- Drooping and swelling of one eyelid
- Smaller pupil in one eye
- Sweaty face
- Blocked or runny nostril
11
Q
What are triggers for Cluster Headaches?
A
- Smokers have a higher risk.
- Alcohol or strong smells such as perfume, pain or petrol can also trigger
12
Q
How are Cluster Headaches managed?
A
- Offer short burst oxygen therapy (12-15l)
- Acute
- Sumatriptan by subcutaneous injection (6mg for 1 dose. Mmax 12mg per day) or
- Sumatriptan by intranasally (10–20mg for 1 dose. Max 40mg per day) or
- Zolmitriptan – 5mg intranasal (10 mg max)
13
Q
What is further management of Cluster Headaches?
A
- Advise on avoidance of triggers and risk of medication overuse headache
- Identify and manage co-morbidities such as anxiety, depression and sleep apnoea
- Refer to secondary care for any secondary causes of headache.
- Refer to neurologist or GP with special interest in headache.
14
Q
What are preventative methods for Cluster Headaches?
A
Verapamil as preventative medication may be considered.
15
Q
What are some causes of headaches as a result of referred pain?
A
- Acute Sinusitis
- Chronic Sinusitis
- Acute Glaucoma
