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Flashcards in FN: Headaches key features Deck (26):
1

SAH

1. Sudden onset, worse ever, occiptal headache
2. Meningism, focal signs, reduced conciousness

2

Venous sinus thrombosis

1. sagittal: headache, vomiting, seizures, reduced vision, papilloedema
2. Transverse: headache ± mastoid pain, focal CNS signs, seizures, papilloedema

3

Cortical Vein thrombosis

1. thunderclap headache
2. Stroke - like focal symptoms over days
3. focal seizures are common

4

Meningitis

Fever, photohobia, neck stiffness, kernigs +ve
Pupuric rash
Reduced consciousness

5

Encephalitis

fever, odd behaviour, fits, focal neuro, reduced consiouness

6

Acute glaucoma

1. Constant unilateral eye pain, radiating to forehead
2. reduced acuity, haloes, n/v
3. Red eye, cloudy cornea
4. dilated, non-responsive pupil

7

Tension headache

Bilateral/vertex-bitemporal, non-pulsatile, band-like

8

Migraine

Prodrome - aura - headache
Unilateral, throbbing
n/v, phono/photophobia

9

cluster headache

1. Rapid onset very severe pain around/behind one eye
2. Red, watery eye, nasal congestion
3. Miosis, ptosis
4. Attacks last 15min-3hrs, 1-2 x/day, mostly nocturnal
clsuters last 4-12 wks, remission lasts 3mo-3yrs. can be chronic vs. episodic

10

Cluster headache Rx

100% Oxygen via non-rebreathe mask, sumotriptan

11

Cluster headache prevention

Verapamil
Topiramate
Lithium

12

Hemicrania

1. Paroxysmal hemicranias: cluster-like headache lasting 5-45min, 5-30 x/day
2. SUNCT: short-lasting unilateral neuralgia with conjunctival injection and tearing, attack last 15-60s, recur 5-30x/hr
3. Hemicrania continua: continous cluster-like headache

13

Hemicrania Rx

All respond well to indomethacin

14

Trigeminal neuralgia

1. Paroxysmas of unilateral intense stabbing pain in trigeminal distribution (usually V2/3)
2. Male > 50yrs
3. Secondary in 14% compression of CNV, MS, Zoster, Chiari malformation

15

Trigeminal neuralgia Triggers

Washing area, shaving, eating, talking

16

Trigeminal neuralgia Ix

Exclude secondary cause by MRI

17

Trigeminal neuralgia Rx med

CBZ
Lamotrigine
Gabapentin

18

Trigeminal Rx surg

Microvascular decompression

19

Analgesia Overuse

1. episodic headache becomes daily chronic headache
2. Use OTC analgesia on 6 days/month max

20

ICP rise

Worse in AM, stooping, visual probs (papilloedema), obese women

21

ICP reduced

Worse sitting or standing

22

TMJ dysfunction

Periauricular pain on chewing
Asociated with crepitus
Earache, headache

23

Giant cell arteritis

>60 yrs, ESR>60, pred 60mg)
1. Unilateral temple/scalp pain and tenderness
2. Thickened, pulseless temporal artery
3. Jaw claudication, amaurosis fugax, sudden blindness
4. Assocation with PMR in 50%

24

GCA investigation

ESR very high
Platelets increased
ALP increased
HB low
Temporal artery biopsy

25

GCA Rx

High dose pred (60mg/d PO) for 5-7 d
guided by symptoms and ESR
Give PPI + bisphosphonates

26

GCA prognosis

2yr course then complete remission

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