Primary Headaches (IHH, Migraine, Medication overuse, Cluster)☺️ Flashcards
IHH Presentation
Persistant frontal, retroorbital
Bilateral, dull
Worsened by coughing, physical activity, pressing
Papilloedema => Ongoing progressive visual loss - different to migraine
Enlarged blind spot
If CNVI involved => diplopia
N+photophobia
IHH Pathophysiology
Risk factors
High ICP
Most common - obese females in 20-30s
Pregnancy
Drugs
-COCP, CS, tetracycline, VitA, Li
IHH Investigations
Diagnosis
Find any underlying causes
CT, MRI
ICP monitoring
IIH diagnosis of exclusion
IHH Management
Lifestyle - weight loss
Medication - diuretics, antiepileptic (topiramate)
Surgical -
- repeated lumbar puncture
- optic nerve sheath decompression and fenestration
Migraine prevalence
Pathophysiology
Young females
Result of abnormal brain activity affecting nerve signals, chemicals, blood vessels => pain
Migraine diagnosis
Min 5 attacks lasting 4-72hrs
Min 2 of
- unilateral
- pulsation
- moderate/severe
- worse with activity
Min 1 of
- N+V
- photophobia/phonophobia
Clinical course of migraine
Prodrome - 48hrs due to hypothalamic involvement
- fatigue
- cravings
Aura - 20min per symptom, last for 1hr - hypothalamic activity spreads to other brain areas
- marching progression through visual => sensory => motor, aphasia
- LOSS OF FUNCTION
Headache - 72hrs
- photophobia, phonophobia
- N+V
Resolution
-fatigue
Migraine management
- acute
- preventative
Acute treatment
1st line - paracetamol, ibuprofen at first signs of headache
2nd line - triptan (before its at its worse+ antiemetics (metoclopramide or domperidone)
Preventative
- topiramate OD (antiepileptic)
- others - propanolol/amitriptyline
Identify and avoid triggers - migraine diary
- date, time, duration
- warning signs
- symptoms
- medication
Common migraine triggers
Tired, stress Alcohol COCP, periods Lack of food, fluids Bright light
Cheese, chocolate, red wine, citrus
Medication overuse headache prevalence
Pathophysiology
More common in women
Pathophysiology unclear
Medication overuse diagnostic criteria
Have preexisting headache disorder
15 days+/month with headache
Regular overuse for 3months+ of acute/symptomatic headache treatment
Medication overuse management
Definitive - withdrawal of overused drug
- simple analgesis, triptans can be stopped abruptly
- warn that symptoms may initially worsen but should improve over weeks
Keep headache diary
Reassess underlying cause
Cluster headache presentation
Diagnostic criteria
Min 5 attacks with the same presentation
15mins-3hrs
Severe unilateral eye pain, same side everytime
Restlessness/agitation Ipsilateral to pain -Tears, runny nose. sweating -Eyelid edema -miosis, ptosis
Frequency ranging from 1 every other day - 8 a day
-attacks will cluster
Management of cluster headache
- acute
- preventative
Acute - high flow O2
-2nd line - triptan (SC, IN) - can only use it 2x a day due to increased risk of side effects with prolonged use
Confirmation needed with neuroimaging
Preventative - verapamil whilst they have episodic clusters
- taper off when clusters end
- alts - topiramate, lithium
Primary vs secondary headache
Primary more likely if
- headache type known for years
- gradual onset
- no neuro deficit
Secondary more likely if
- new unknown headache
- sudden onset (as if something fell on your head = ASSUME VASCULAR UNLESS PROVEN OTHERWISE WITH CT, LP
- electric shock-like - trigeminal?
- neuro deficit, altered consciousness
- 50+
- positional changes, precipitated by something
- systemically unwell
