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Headache > Treatment > Flashcards

Treatment Flashcards

1
Q

What is the first-line treatment of migraine?

A

Can reduce or stop headache symptoms with early use of NSAIDs. Paracetamol can help some sufferers.

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2
Q

How does anti-emetics help with migraines?

A 
Gastric stasis (delayed emptying) often causes nausea and emesis during migraines. 
e.g. domeperidone, prochlorperazine, metoclopramide
Restore gut motility and enhance medication absorption.
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3
Q

What receptors are involved with nausea and vomiting?

A

Histamine, muscarinic, dopaminergic, sertongergic and opioid receptors. Anatagonising these will help with nausea and vomiting.

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4
Q

What are triptans?

A

e.g. sumatriptain, zolmitriptan
Strong antagonist at serotonin (5-HT) receptor. Triptans have been shown to induce vasoconstriction, mediated by action on 5-HT1B receptions in arterial smooth muscle.

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5
Q

What are contraindications of triptans?

A
  • History of TIA and CVA

- History of IHD, including MI. Also, in patients with severe or poorly controlled hypertension.

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6
Q

What is the second-line treatment for migraines?

A

NSAID + triptan (e.g. naproxen, sumatriptan) or repeat dose of a triptan following the first.
- Second dose of triptan only indicated for relapse after inital response and further doses should not be taken for at least 2 hours after 1st dose.

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7
Q

What is the criteria for consideration of prevention treatment of migraines?

A
  • Quality of life/business, school attendance is severely affected
  • 2 or more attacks per month
  • Migraine attacks do not respond to acute drug treatment
  • Frequent, very long or uncomfortable auras occur
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8
Q

What is used for the first-line prophylaxis of migraines?

A

Beta blockers, tricyclics or low dose amitriptyline are considered as first line choices.

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9
Q

What is used for prophylaxis of migraines caused by menstruation?

A

Transdermal oestrogen patches, starting 3 days before menstruation.

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10
Q

What is the second-line medication for the prophylaxis of migraines?

A
  • Several antiepileptic drugs e.g. sodium valproate or topirimate.
  • Antihypertensive agents - ACEi, ARBs, calcium channel blockers sometimes (verapamil and amlodipine)
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11
Q

What should be administered if there is a clinical suspicion of bacterial meningitis?

A

Empirical antibiotic therapy with an IV 3rd generation cephalosporin such as ceftriaxone.

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12
Q

What is the first-line treatment for meningitis in a GP setting?

A

IM benzylpenicillin

If listeria is suspected ampicillin should be added.

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13
Q

What should be administered if there is concern regarding encephalitis?

A

IV antivirals

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14
Q

What will be offered to household members as prophylaxis?

A

Antimicrobials (rifampicin)

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15
Q

What is the management of gliomas?

A
  • Surgery
  • Steroids
  • Radiotherapy
  • Chemotherapy
  • Treatment of any associated problems
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16
Q

What is the treatment for meningioma?

A

Surgical excision

  • Can recur when incompletely removed or is atypical/higher grade/malignant
  • Radiotherapy. stereo-radiotherapy and hormonal therapies are also used
17
Q

What are general routine measures to control ICP?

A
  • Head up tilt 30-45 degrees. Promotes venous outflow and CSF movement.
  • Keep neck straight and avoid tight ETT tapes: obstruction to jugular venous outflow
  • Avoid hypertension: to maintain cerebral blood flow (use vasopressors as required)
  • Maintain adequate sedation: reduces metabolic demands, ventilator asynchrony and sympathetic responses
  • Maintain euvolaemia and normo-hyper osmolar state: reduces cerebral oedema
  • Maintain normal pCO2: raised causes cerebral vasodilation and increases cerebral blood flow
18
Q

What is the management of sustained acute rise in ICP?

A
  • Heavy sedation +/- paralysis
  • CSF drainage
  • Osmotic therapy (mannitol)
  • Hyperventilation
  • Barbituate therapy e.g. phenobarbitone, thiopentane
  • Decompressive craniectomy
19
Q

What is the treatment for a cluster headache?

A
  • Sumatriptan injection - contraindicated for IHD and stroke
  • Hi-flow oxygen through a non-rebreathe bag and mask
  • Prednisolone for 1 week
20
Q

What is the treatment of giant cell arteritis?

A
  • Start prednisolone 60mg/day immediately

- IV methylprednisolone if evolving visual loss or history of amaurosis fugax

Headache (4 decks)

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