Neurology - Headaches Flashcards
Migraine causes
CHOCOLATE - M
Chocolate Hangovers OCP Cheese/caffeine Orgasm Lack of sleep Alcohol Travel Exercise
Menstruation
What is a migraine aura
Visual disturbance Nausea "Feeling in tummy" Dysarthria Sensory disturbance
Migraine presentation
Aura Acute onset Last up to 72 hours Unilateral Throbbing pain
Paraesthesia FND Photophobia Phonophobia N/V
Migraine investigations
Clinical diagnosis unless suspicious symptoms
Ophthalmoscopy
BP
Neuro assessment
Acute migraine management
Sumatriptan
NSAIDs
Ergotamine
Metoclopramide
Migraine prevention
Amitriptyline Propranolol Topiramate - Teratogenic Acupuncture Riboflavin
Tension headache causes
Stress
Lack of sleep
Dehydration
Anxiety
Tension headache presentation
Mild/moderate pain Bilateral Frontal and neck < 1 week Pressing nature
Tension headache investigations
Clinical diagnosis
Tension headache management
Avoid triggers
Aspirin
Sleep hygiene
Meditation
Chronic - TCA, acupuncture
Cluster headache causes
Alcohol Smoking Exercise Heat Histamine
Cluster headache presentation
Males Severe orbital pain "Worst pain ever" Unilateral Stabbing nature Relieved by movement 15-180 minutes Bouts lasting 6-12 weeks Worse at night
Cluster headache investigations
Optic assessment
Acute cluster headache management
Sumatriptan
O2
Cluster headache prevention
Verapamil
Topiramate
Prednisolone
Trigeminal neuralgia associations
Triggered by skin contact
Associated with MS
Trigeminal neuralgia presentation
Shock-like sensations in the trigeminal nerve - Maxillary branch Severe Unilateral Worse on touching face Up 10 100 attacks per day 1-180 seconds
Trigeminal neuralgia investigations
History
Neuro assessment
CT/MRI - Rule out MS
Rule out SOL
Trigeminal neuralgia red flags
Sensory changes Deafness Optic neuritis FHx - MS Onset < 40
Trigeminal neuralgia management
Carbamazepine
Lamotrigine Phenytoin Gabapentin Surgery - Microvascular decompression Radiotherapy
Giant cell arteritis causes
Vasculitis
Females
Associated with polymyalgia rheumatica
(Muscle and joint pain)
Giant cell arteritis presentation
Jaw claudication Severe Scalp pain Worse on chewing, talking, brushing hair Amaurosis fugax B symptoms
+ Proximal muscle and joint pain!
Giant cell arteritis investigations
Bloods
- ESR ^
- Platelets ^
- ALP ^
- Anaemia
Colour duplex USS + temporal artery biopsy
= Granulomatous inflammation
Giant cell arteritis management
Prednisolone + bisphosphonate
Low dose aspirin + PPI
Visual symptoms - Urgent ophthalmology review
