Neurology 3 Flashcards
How do you investigate a migraine?
Mainly clinical
Exclude differentials - bloods, consider for CT/MRI
If you take the OCP and have a migraine with aura, what are you at risk of?
Ischaemic stroke
What triggers a migraine?
CHOCOLATE
CHeese
OCP
Caffeine
AlcohOL
Anxiety/stress
Travel
Exercise
Also too much/little sleep, sensory stimuli, dehydration
What are migraines?
Recurrent acute attacks of unilateral frontal pulsating headache
What worsens migraines?
Head movement or physical activity
What are migraines associated with?
N+V + photo/phonophobia
What are the features of migraines?
POUND
Pulsating
Onset 4-72hrs
Unilateral
Nausea
Disabling
How do migraines start?
25% with an aura
What is an aura of a migraine like?
Usually visual - flashes/lines/zigzags = fortification spectra, scotoma (black hole in visual field)
What are the less common features of migraines?
Paraesthesia, dysphasia etc
What is the acute management of a migraine?
Triptans (sumatriptan) + NSAIDs +/- anti-emetic if nauseous
What is the non-medicated prophylaxis for migraines?
Reduce triggers
Stop OCP
What is the 1st line medicated prophylaxis for migraines?
Beta blocker (propranolol)
What are the other options for medicated prophylaxis of migraines?
Anticonvulsant (topiramate), amitriptyline, botulinum toxin type A
What is there a risk of when treating a migraine?
Medication overuse headache - avoid offering opioids or ergots
What is the most common headache?
Tension headache
What triggers a tension headache?
Stress/anxiety, sleep deprivation, eye strain, noise etc.
How does a tension headache present?
Bilateral tight pressing band-like sensation +/- scalp tenderness
How long do tension headaches last?
30 mins to 7 days, can be chronic or episodic
What are the key differentials of a tension headache from a migraine?
Non-pulsatile
Not worsened on head movement/physical activity
No N+V
How do you diagnose a tension headache?
Clinical diagnosis from history
How do you manage a tension headache?
Lifestyle advice e.g. regular exercise, avoid triggers
Stress relief
NSAIDs for symptoms
How do you reduce the risk of a medication overuse headache?
Limit use of analgesia to no more than 6 days/month
Avoid opioids
Where is a tension headache felt?

