headache and migraine Flashcards
(20 cards)
What are the 2 types of headaches?
Primary headache - not associated with underlying condition (most common) e.g migraine tension headache ..
Secondary headache - caused by underlying issue/condition e.g trauma, substance exposure , withdrawal, infection …
What are the red flags that suggest secondary cause?
- Pain: onset, duration,
frequancy, pattern - Associated symptoms: Aura, N&V, motion problems
- Autonomic symptoms: Lacrimation, conjunctival injection, rhinorrhoea
- Associated with a trigger?
- Comorbidity present?
- Medication taken or symptom release?
- Impact on daily activity?
- Examination: Vital signs, mental state, alertness …
What is a migraine?
Common primary heachache disorder
episodes of moderate/severe headache - unilateral mostly pulsating or throbbing
Assoxiated with photo/phonophobia, N&V
What is Aura?
Sensation experienced before or during a migraine attack
- visual aura: blind spot, blurred vision
- sensory aura: pins & needles
What are the types of migraines?
Episodic - attacks occur less then 15 days/month
Chronic - attacks on at least 15 days/month for more then 3 months
What are the triggers for a migraine?
Factors that can start an attack
Poor sleep
Irregular/missed meals
Excess caffeine
Menstruation
Stress
What factors increase the risk of chronic migraines?
- High frequency of episodic
migraine - Overuse of medication to treat
acute episodes - Excess caffeine
- Obesity
- Snoring/sleep disorders
- Co-morbidity – head injury,
pain disorder, anxiety,
depression - Life events – divorce,
marriage, job loss
How to diagnose migraine without aura?
At least 5 attacks of:
- heachache lasting 4-72hrs
- Heachache with at least 2 of:
unilateral location, pulsating,
moderate or severe pain,
affects daily tasks
- Headache with nausea &
vomiting
- headache not accounted by
another diagnosis
How to diagnose a migraine with aura?
At least 2 attacks of:
- 1+ fully reversible aura
symptom - visual, sensory or
speech
At least 3 of:
- 1+ aura symptom spreading
over 5 mins
- 2+ aura symptoms in
succession
- Each aura symptom lasts 5-60
mins
- At least one symptom is
unilateral
- At least one symptom is
positive
What are the Prodromal, Postdromal and Menstrual related symtpoms?
Prodromal - symtpoms occur from 2 days up to hours before other migraine symptoms e.g fatigue, poor conc, neck stiffness, yawning
Postdromal - occur after heachache and can last up to 48hrs e.g fatigue, elation, depressed mood
menstrual - women with migraine symptoms around the start of menstrual cycle (at leaxt 2/3 cycles)
Name 8 differencial diagnosis
Tension Headache
Cluster Headache
Paroxysmal Hemicrania
Cough/cold Headache
Trauma/injury to head/neck
Substance Withdrawal
Medication Overuse
CO Exposure
What is the self care management for migraines?
Migraine Diary
Avoid Triggers
Lifestyle changes – Stress, sleep hygiene, hydration, regular meals, exercise, weight
Treat co-morbidities – Sleep apnoea, insomnia, depression & anxiety
What to do if it is a Medication Overuse Heacdache?
Restrict acute meds use to max. 2 days a week
Inc. risk if using simple analgesics >15 days/month or Triptans/combination analgesics for >10 days/month
Whats the acute treatment for migraines?
Triptans:
- Zolmitriptan
- Rizatriptan
- Sumatriptan
- Naratriptan
Simple Analgesics
- NSAIDs
- Aspirin
- Paracetamol
Anti-Emetics
- Metoclopramide
- Prochlorperazine
Follow up on medication
2-8 weeks affter starting and earlier if headache changes or adverse effects
Assess frequancy of attacks, lifestyle improvements
When to consider phrophylactic treatments?
When to consider:
- attacks impact QoL
- acute Tx is Cl or ineffective
- Patient at risk of MOH
Treatment options:
- propanolol
- Topiramate
- Amitriptyline
- Pizotifen
- DO NOT offer Gabapentin
- Non Pharm – Behavioural
intervention, Acupuncture,
Riboflavin
What are triptans and how they work
5-HT1 receptor agonist - receptor activation causes cranial vessel constriction
e.g Sumatriptan, Almotriptan, Eletriptan, Frovatriptan, Naratriptan, Rizatriptan, Zolmitriptan
- sumatriptan - first line
if vomiting restricts oral intake: use nasal spray or subcut inj.
take one dose onset of symptoms, take another at leat 2 hours later if symptoms recur - max 2 doses/24 hrs
What are Anti-emetics and examples
Metoclopramide used in nausea treatment in acute migraine but NOT LICENSED
Metoclopramide not to be used regularly – risk of EPSE, short term use only
Prochlorperazine buccal tablet for nausea & vomiting
What are custer headaches?
Classed as a primary headache by ICHD
Part of a group of headaches called Trigeminal Autonomic Cephalalgias
Most common Trigeminal Autonomic Cephalalgia
Frequently recurring, localised, short lasting but severe
episodic - attacks in periods of 7 days to 1 year with at least 3 months pain free periods
chronic - attacks for 1 year or longer without pain free periods or less then 3 months
Symptoms of cluster headaches?
At least 1 of:
- Conjunctival injection and/or
lacrimation
- Nasal congestion and/or
rhinorrhoea
- Eyelid swelling
- Forehead and facial sweating
- Forehead and facial flushing
- Sensation of fullness in the ear
- Miosis and/or ptosis
