Headaches Flashcards
Diagnostic criteria for migraine without aura
5 or more attacks lasting 4-72 hours
1 of: autonomic features, photo/phonophobia
2 of: moderate/severe, unilateral, throbbing pain, worse on movement
Nature of migraine aura
Fully reversible
VISUAL, sensory or motor
Lasts 20-60 mins
Headaches usually follows but can occur simultaneously
What is the medical treatment for a migraine?
NSAIDs +/- anti-emetic
Triptans (taken at start of headache)
What are the prophylactic treatments for migraine?
Propranolol, topiramate or amitriptyline
When should migraine prophylaxis be considered?
> 3 attacks per month, or if very severe
For how long should each migraine prophylactic medication be trialled?
4 months
What are the features of tension type headache?
Mild/moderate
Pressing tingling quality - non pulsatile
Bilateral
? scalp muscle tenderness
What are the subtypes of trigeminal autonomic cephalgia?
Cluster headache
Paroxysmal hemicrania
Hemicrania continua
SUNCT
What are the features of cluster headache?
Severe unilateral headache
Ipsilateral cranial autonomic features (ptosis, nasal stuffiness, N+V, miosis, eye lid oedema, tearing)
What is the treatment for cluster headache?
High flow O2
s/c sumatriptan
Verapamil prophylaxis
What are the features of paroxysmal hemicrania?
Similar to cluster headache, but shorter more frequent headaches
What are the features of SUNCT?
Short lived Unilateral Neuralgiaform headache Conjunctival injections Tearing
What are the features of trigeminal neuralgia?
Triggered by touch to v2/3
Severe stabbing unilateral pain
Very short duration
What is the treatment for trigeminal neuralgia?
MRI brain to exclude secondary causes
Carbamazepine, gabapentin, phenytoin, baclofen
May consider surgery
What are the features of idiopathic intracranial hypertension?
More common in females, obesity
Pulsatile tinnitus
Exacerbated on valsalva