Management of HA's Flashcards
Prevalence of HA’s
Globally: 50% in the past year
Any HA = 79%
F> M
Types of primary HA?
- Migraines
- Tension type (TTH)
- Trigeminal autonomic cephalagia
- Other
5 phases of Migraine
1. Premonitory symptoms - affects 60% Aura - affects 20% Headache - affects 80% Termination – end of HA Postdrome – after effects
What are Premonitory symptoms?
Psychological symptoms:
depression, euphoria, mental slowness, hyperactivity
Neurologic: photophobia, phonophobia
nausea / vomiting
General:coldness, loss of appetite, food cravings
Features of Migraine Aura?
Develops over 5- 20 mins
lasts <60 mins, prolonged upto 1 week
Symptoms: visual/auditory numbness, tingling, ophthalmoplegia/hemiplegia
Migraine Visual Aura features?
Binocular confined to one hemifield Fortification spectra that starts centrally and expands out coloured fringes at edged scintillating scotoma Teichopsia Rarely total vision loss
Migraine HA features?
60 mins after aura finishes, lasts 4- 72 hrs
moderate to severe pulsating unilateral pain made worse by movement
assoc. with photo/phonophobia/poor conc. nausea & vomiting
Non - migraine HA aura features ?
no longer than 1 hr, completely reversible, absence of HA
visual/sensory/speech problems
In older px refer for TIA
Migraine pathophysiology?
Vasoconstriction corresponds with aura
vasodilation corresponds with HA - pain from intra - cranial and extra cerebral vessels
Genetics idiopathic External trigger: tiredness, foods, drink fatigue Glare, flicker - flashlights/tv Patterns - text
Migraine management
Refer to GP
reassurance - not life threatening, assoc. with serious illness, check hormones for women on the pill, write HA diary
Meds: Pain relief for acute attack, preventative if >5 per month
TTH features
Episodic/ chronic: 30 mins - 7 days Bilateral - extends from back of the neck occipital/parietal/posterior neck) tight pressing not pulsating pain mild to mod. (won't stop daily activities) assoc. with photo/phonophobia) NO NAUSEA/VOMITING assoc. with sleeplessness stress DD = MIGRAINE
Pathophysiology TTH
muscle contraction, psychological problems, stress
TTH referral
routine to GP
Trigeminal autonomic cephalgias features?
A.K.A Cluster HA
pain on one side of head in trigeminal nerve area
starts around one eye/cheek, spreads across head
Peaks in few mins, lasts 30 mins to few hrs
intense pain, may wake px
1- 8 attacks over days/weeks
Assoc. with facial flushing, conjunctival injection, lid oedema, rhinorrea, pupil constriction, partial ptosis
6 x more likely in M>F
Cluster HA pathophysiology ?
unknown cause, fMRI
Cluster HA management
routine referral to GP, prophylactic meds, analgesics
Temporal Arteritis features
Secondary HA A.K.A GCA normally over 60s F>M Constant HA with gradual onset which develops into severe aching Temporal scalp tenderness Jaw claudication Worse at night/cold Systemic assoc. fever/anemia, weight loss, polymalagia rheumatica
TA pathophysiology
arteritis affecting external carotid and ophthalmic arteries
elevated ESR
TA ocular signs
AION - partial/total infarction of ONH, occlusion of PCA
Arteritis - inferior altitudinal hemianopia
CRAO
Amaurosis Fugax
TA management
Emergency referral risk of sight loss in other eye (70% in 10 days) Risk of cerebral vascular accident Temporal artery biopsy MRI and Doppler study Erythrocyte sedimentation rate (ESR) C-reactive protein levels Treated with high doses of oral steroids Visual acuity does not recover
Aneurysm
Features?
Sudden, excruciating headache stiff neck vomiting focal lesions 3rd CNP if PCA affected hemiparesis if MCA affected
Aneurysm referral
emergency
Arteriovenous Malformation
Specific recurring headache Ruptured AVM or fistula sudden severe headache stiff neck Homonymous field defect typical of occipital AVM
AVM referral?
Emergency
Raised ICP HA features
intermittent, non - specific, dull pain
worse after exercise
transient HA on coughing
HA may be absent with ICP
Papilloedema features
Disc swelling and hyperaemia Nasal margins affected 1st Venous engorgement Blurring of disc margins and peripapillary RNFL Loss of spontaneous venous pulsation
Papilloedema management
emergency 24 hrs
HA assoc. with eye disorders
acute glaucoma refractive error heterophoria or heterotropia ocular motor nerve palsies ocular inflammatory disorder corneal lesions, anterior uveitis, optic neuritis
Trigeminal neuralgia features
Affects trigeminal nerve Over mandibular and maxillary region intense repetitive jabs of pain >50 YO routine referral
