Headache syndromes Flashcards
(23 cards)
Red flags for headache
New onset >55 Known/previous malignancy Immunosuppressed (intra-cranial infection) Early morning headache Exacerbated by valsalva
Migraine without aura criteria
At least 5 attacks with duration 4-72 hours.
Includes 2 of: moderate/severe, unilateral, throbbing, worse on movement
Includes 1 of: autonomic features, photophobia/phonophobia
Where is the migraine center in the brain?
Dorsal raphe nucleus
Locus coeruleus
Abortive management of migraine
NSAID
If gastroparesis then anti-emetic
Maybe triptan
When would you consider migraine prophylaxis?
More than 3 attacks per month or very severe attacks
First, second and third line migraine prophylaxis.
1st - low dose amitriptyline
2nd - propanolol
3rd - topiramate (CA inhibitor)
4th line migraine prophylaxis (lots of options)
Gabapentin Pizotifen Sodium valproate Botulinum toxin injection Anti-calcitonin gene related peptide Ab
What is the minimum trial required for pharmacological migraine prophylaxis?
Minimum of 3 months
Tension headache management
Relaxation physiotherapy
Antidepressant (dothiepin or amitriptyline for 3 months)
Reassure
When do cluster headaches most often occur?
Around sleep
Seasonal variation
Duration, frequency and how long the cluster bout lasts of cluster headache
Duration - 45-90 minutes
Frequency - 1 to 8 a day
How long it lasts - a few weeks to months
Cluster headache management
High flow oxygen for 20 mins
Sub cut sumatriptan
Steroids - reducing course over 2 weeks
Verapamil for prophylaxis
Investigation of all trigeminal autonomic cephalgias
MRI brain and MR angiogram to check there is nothing there
Paroxysmal hemicrania duration and frequency
Duration - 10-30 minutes
Frequency - 1-40 a day
Management of paroxysmal hemicrania
Absolute response to indomethacin
What does SUNCT stand for?
S - short lived (15-120 seconds) U - unilateral N - neuralgiform headache C - conjunctival injections T - tearing
Management of SUNCT
Lamotrigine
Gabapentin (2nd line)
Trigeminal neuralgia symptoms
Severe stabbing unilateral pain
Triggered by tough usually over V2/3
Duration, frequency and length of bouts of trigeminal neuralgia
Duration - 1-90 seconds
Frequency - 10 to 100 a day
Bouts may last from a few weeks to months
Trigeminal neuralgia medical treatment
Carbamazepine
Gabapentin
Phenytoin
Baclofen
Trigeminal neuralgia surgical management
Ablation
Decompression
Trigeminal neuraglia investigations
MRI brain
Acronym for migraine triggers (CHOCOLATE)
C - chocolate H - hangovers O - orgasms C - cheese/caffeine O - oral contraceptives L - lie-ins A - alcohol T - travel E - exercise