Head aches + Facial pain Flashcards
1
Q
Migraine
A
Divided into two main types
- aura (20% of patients)
- without aura (80% of patients)
- usually high impact and inability to function normally during episodes
2
Q
symptoms of migraines
A
- throbbing
- pulsatile
- unilateral (most of the time)
- photophobia
- Nausea + vomitting
- sensitivity to sound
3
Q
precipitating factors of migraines
A
- weekend migraine ( relax after stress )
- menstruation
- bright lights
- Dehydration
- Cheese + red wine
- Appear or worsen on contraceptive pill
4
Q
Migraines with Auras
A
- focal neurological symptoms develop 15-20 minutes prior to the headache
- Auras are most commonly visual
- flashing lights
- scomata : partial loss of vision in otherwise normal visual field
- blurred vision
- zig zag lines
5
Q
Treatment of acute migraines
A
- Simple analgesics - high dose asprin ( often in combination with an antiemetic )
- Triptan ( sumatriptan ) if not controlled with analgesia
- use of analgesia/triptans > 5 days per month
- Risk of developing medication-overuse headache
- this is a chronic headache largely resistant to analgesia and difficult to treat
6
Q
Migraine prophylaxis
prevention
A
- Avoid percipitating factors
- Prophylactic treatment should be considered in individuals with more than 3 episodes a month
- -> Beta blockers - Propanalol
- -> Amitripyline - (TCA)
- -> Pizotifen
- -> Sodium Valporate
7
Q
Tension type headaches
A
common and may exist in episodic form or chronic daily headache
- depression is a comorbid feature
8
Q
Tension type headache symptoms
A
- Bilateral
- Pain in ‘tight band around the head’
- pressure behind the eyes
- bursting sensation - Mild to moderate intensity ( patient can continue with day to day life)
- vomiting, nausea, photophobia not present
5, exacerbated by stress or anxiety - scalp and neck tender to touch
9
Q
Treatment of tension type headache
A
- avoidance of trigger factors
- relaxation techniques
- simple analgesia for headaches
10
Q
Causes of tension type headaches
A
- Cervical spondylosis ( cervical osteoarthritis)
- High blood pressure
( assoc with both but evidence is poor)
11
Q
Cluster headache
A
- uncommon condition
2. affects middle aged male smokers
12
Q
symptoms of cluster headache
A
- characterized by recurrent episodes of intense pain
- unilateral apain
- erythema around one eye
- ipsilateral congestion
- one watery eye - symptoms may occur on waking and last for an hour
- Horner’s syndrome occur during or between attacks
- Worst pain ever known to man + pushes towards suicide
13
Q
treatment for cluster headaches
A
- Analgesics do noting
- SC Sumatriptan is drug of choice for acute attacks
- high flow oxygen can help
- Prophylaxis :
- Veramapil
- Lithium
may be effective
14
Q
Trigeminal neuralgia
A
- syndrome of facial pain
- occurs predominantly in elderly
- hypertension is the major risk factor
15
Q
symptoms of trigeminal neuralgia
A
- recurrent episodes of sudden, severe, unilateral face pain that lsts from seconds to minutes
- pain at the distribution of trigeminal nerve
- sharp or stabbing pain
- originates in the mandibular division but often spreads
