Stroke and headaches

Question 1

What is the management for an acute ischaemic stroke?

Answer 1

Aspirin as soon as haemorrhagic stroke excluded.
Thrombolysis (alteplase) within 4.5 hours and/or thrombectomy if evidence of salvageable brain tissue.

Long term:
Swap from aspirin to clopidogrel after 2 weeks.
If clopidogrel not tolerated, stay on aspirin.
Carotid endarterectomy if over 70% occlusion of the CA.

Question 2

What is the management for a haemorrhagic stroke?

Answer 2

Reverse warfarin with vitamin K
Consider surgical intervention.
Lower BP.

Long term look at improving BP control.

Question 3

What is the management for a TIA?

Answer 3

Start aspiring immediately

Refer within 24 hours to a neurology specialist
Refer within 7 days to neurology if there is more than 7 days since the episode.

Carotid doppler scan with carotid endarterectomy if over 70% stenosis.

Question 4

What is the acute and prophylactic treatment for migraine?

Answer 4

Acute - use NSAIDs and paracetamol.
Triptans - sumatriptan

Prophylactic:
propanolol (not in asthma)
Topiremate (not in women of childbearing age)
Amitrityline.

Question 5

What is the acute and prophylactic management for a tension headache?

Answer 5

NSAIDs and paracetamol

Can use amitriptyline for recurrent/frequent tension headaches.

Question 6

What is the management for a cluster headache (acute and chronic)?

Answer 6

Acute:
Oxygen and triptan

Chronic:
Verapamil