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Flashcards in headache and migraine Deck (19):
1

History of presenting complaint?

Where is it?
Distribution
What is it?
Timing
Onset
Time course
Insidiously progressive
Intermittent
Vitamin D
So What?
Synthesis
Anatomical (1 or more)
Syndromal (IPD)
Aetiological

2

/Associated features of acute cephalgia

Associated features
Visual/Vestibular/Paraesthesiae/Autonomic
Meningism
Nausea/Vomiting
Neck stiffness
Photophobia
Seizure
Focal neurological features

3

Associated features of headaches?

Associated features (cont)
Aggravating factors
Light/Sound/Movement
Straining
Circumstances
Intercourse
Posture
Time of day
Syndromic presentations
Visual loss on stooping with pulsatile tinnitus
Jaw Claudication/Scalp tenderness
Abrupt onset with meningism
Postural headache
Coital

4

Screening examination?

Gait
Pupils
Fields
Fundoscopy
Eye movements
Facial sensation
Mouth
“AAH”/tongue bulk/cough
Neck flexion

Arms/Legs
Wasting
Tone
Outstretched hands
Pyramidal power testing
DTRs and plantars
Co-ordination
Finger nose/ Heel shin
Sensation
JPS/Vib/LT/PP distally

5

clinical characteristics of a migraine?

+/- Aura
Scintillations/fortification spectra/photopsia
Onset to peak
Seconds/minutes/hours
Duration
< 24 hrs
Frequency
Monthly (hormonal)
Character
Throbbing
Distribution
Unilateral

6

Associated features of migraines?

Associated features
Nausea
Photo-/phono- phobia
Aggravation with movement
P/N, clumsy, aphasic
Able to sleep?
Triggers
FHx

7

Migraine treatments?

Acute therapies
Analgesia
Anti-emetics
Triptans
Prophylaxis
Pizotifen
Tricyclic antidepressants
Beta blockers
Anticonvulsants

8

syndromes secondary to headaches?

Red Flag syndromes
Space occupation (SOL)
Sub arachnoid haemorrhage
Meningitis
Venous sinus thrombosis
Idiopathic intracranial hypertension
Giant cell/Temporal arteritis

9

space occupying lesion?

Subacute headache
Days/months
Morning headache
Aggravated by Valsalva manoeuvre
Coughing/sneezing
stooping/straining
Diplopia
VIth nerve
N/V
Focal +/- secondarily generalised seizure

 

Urgent
brain imaging
+/- Dexamethasone
+/- Mannitol
Referral to Neurosurgeon

10

Sub arachnoid haemorrhage symptoms?

Abrupt onset
Instantaneous
Thunderclap
Worst ever headache
Prostration
Meningism
Photophobia
Neck stiffness
N/V

 

Resuscitate
Airways
Breathing
Circulation
Urgent
Imaging
Lumbar puncture
Neurosurgical review
Nimodipine
Neurological obs/ICU

11

Meningitis?

Subacute onset
Minutes-hours
Meningism
Photophobia
Neck stiffness/rigidity
N/V
Febrile
+/- Rash-non-blanching
Shocked
Confused/Coma

12

Managemnet of meningitis?

Resuscitate
Airways
Breathing
Circulation
Blood Cultures
Throat swab
Urgent
Imaging
Lumbar puncture
Treatment with broad spectrum antibiotics
Close neurological observation/ICU

13

Venour Sinus Thrombosis?

Young fertile female
Pregnancy
Thrombophilia
Venous thrombo-embolism
Acute onset headache
Global
Associated features
N/V
Seizure/Coma
Papilloedema
Raised CSF opening pressure

14

Venous sinus thombosis management?

Thrombolysis
Iv unfractionated Heparin
+/- interventional thrombolysis
Control of raised intracranial pressure
Control of seizures
Close neurological observations/ICU

15

Idiopathis intracrainail hypertneion?

Young fertile female
Pregnancy
Subacute headache
Global
Associated features
N/V
Stooping blindness/blurring
Pulsatile tinnitus
Papilloedema
Impaired Visual fields
Enlarged blind spot
Peripheral constriction
Raised CSF opening pressure

16

Idiopathis intracrainal hypertension managemenr?

Acetazoleamide
Diuretics
Frusemide
Serial LP
Serial visual fields
Intraventricular shunting

17

Giant cell temporal arteritis?

Older patient
Subacute/onset
Hours/days/weeks
Constitutionally unwell
Low grade fever
Muscle aches/PMR
Scalp tenderness
Sudden onset blindness
Pathognomonic features
Tongue infarction
Jaw claudication
Pulseless temporal arteries
Raised inflammatory markers
ESR/CRP
TA Biopsy

18

giant cell arteritis?

Arrange temporal artery biopsy ASAP
Avoid blindness from
Anterior Ischaemic Optic neuropathy (Ophthalmic artery) or
Cortical infarction Vertebral arteries
High dose oral corticosteroids 60-80mg po/day

19