Neuro-headache

Question 1

what are the 4 red flags suggesting secondary headache

Answer 1

SANO

Systemic symptoms= fever, neck stiffness, rash, weight loss

age=new in 50y.o+

neurological signs= confusion/swollen optic disc/impaired consciousness

onset= sudden severe headache

Question 2

migraine characteristics and how long it lasts

Answer 2

unilateral, pulsating
- worsened by Physical activity

4-72hrs

Question 3

phases of migraines

Answer 3

1.premonitory-yawning/light sensitive
2.aura
3.headache
4.resolution- rest and sleep
5.recovery -mood disturbance

Question 4

what are auras

Answer 4

complex array of symptoms reflecting brainstem dysfunction

Question 5

migraine management

Answer 5

lifestyle
-avoid triggers, diet, sleep

pharm
acute- paracetamol/NSAIDs/Prokinetics/triptans

LT preventative =[5ds+]/m= TCA/B-blockers etc

Question 6

what should be avoided in migraines

Answer 6

opiate-based and mixed analgesics

Question 7

tension type headache characteristics

Answer 7

bilateral
not worsened on movement
-not N+V/photophobia

episodic

approx 30mins - hours

Question 8

tension type headache treatment

Answer 8

1.reassurance
2.analgesic- like aspirin/paracetamol
3. preventative=rare

Question 9

cluster headache characteristics, how long it lasts

Answer 9

15-180 mins
-ipsilaterally//unilateral
-Conjunctival redness/ lacrimation
-Nasal congestion/ rhinorrhoea
-Eyelid oedema

-restlessness/ face sweating

Question 10

cluster headache treatment

Answer 10

acute-
triptan- nasal/ [S/C]
high flow O2–> inhibits neuronal activation of trigeminocervical complex

preventative -
verapamil (CCB)
-greater occipital nerve block