Neurology - Headache Flashcards
True or False
Cluster Headaches more commonly occur in women
Alcohol Can trigger Attacks
Those who suffer cluster headaches often have erratic sleep?
False
Cluster headaches are more common in men (3:1) and smokers
True
True
A 24 year old patient presents to the GP. He complains of a headache that he experiences yesterday, it lasted 2 hours and was sharp and stabbing on the left side of his head around his left eye.
During the headache he tried repeated positions to improve the headache but these didnt help. He was unable to work or study, lying down didnt help. He also experienced his eyes feeling watery and a stuffy nose.
He has never had this happen before and he is concerned that he might have a brain tumour.
What is the the most likely diagnosis and what is the recommended treatment for this conditions in the acute setting
Cluster headache
100% oxygen
Subcut triptan
What prophylaxis is given for cluster headaches?
Verapamil (sometime a tapering dose of prednisolone)
A 24 year old female patient presents with headaches. They occur around once a month. They tend to be on one side of the head and are throbbing in nature. She often feels sick and sometimes vomits. lying down in a dark room is helpful. They tend to last around 6 hours and are very debilitating.
The neurological examination is normal.
What is the most likely diagnosis, what would be the first line acute treatment for this condition?
Migraine without aura.
First line treatment: Offer combination therapy with oral triptan and an NSAID/paracetamol.
For younger people aged 12 - 17 offer a nasal triptan.
A 24 year old female patient presents with headaches. They occur around once a month. They tend to be on one side of the head and are throbbing in nature. She often feels sick and sometimes vomits. lying down in a dark room is helpful. They tend to last around 6 hours and are very debilitating.
The neurological examination is normal.
What is the most likely diagnosis, what would be the first line prophylactic treatment for this condition?
Prophylaxis against migraine = topiramate or propranolol
Propranolol is preferred in women of child bearing age.
A 24 year old female patient presents with headaches. They occur around once a month. They tend to be on one side of the head and are throbbing in nature. She often feels sick and sometimes vomits. lying down in a dark room is helpful. They tend to last around 6 hours and are very debilitating.
The neurological examination is normal.
Should this patient be offered prophylaxis against these headaches?
Not according to passmed which says that migraine prophylaxis should only be offer to those suffering 2 or more attacks per months. This woman is experiencing only 1 attack per month
Management for tension headache?
Aspirin, paracetamol or NSAID
A patient presents with a unilateral headache that came on over the course of a week. She feels that the side of her head is tender to touch. She also has began to find it painful when she is chewing on that side.
How would you like to investigate this patient?
- Check inflammatory markers
- ESR >50mm/hr (ESR can be <30 in 10% of patients)
- CRP may also be elevated
- Temporal artery biopsy
- skip lesions may be present
- Note CK and EMG are normal
A patient presents with a unilateral headache that came on over the course of a week. She feels that the side of her head is tender to touch. She also has began to find it painful when she is chewing on that side.
How would you manage the most likely diagnosis?
- urgent high dose glucocorticoids, before performing a temporal artery biospy
- If there is vision loss the IV met
