Headaches Flashcards by Thomas Eraifej

Causes of acute headaches

VICIOUS

Vascular
Infection
Compression
ICP
Ophthalmic
Unknown
Systemic

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Vascular causes of acute headaches

Intracranial haemorrhage

Infarction

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Infection causes of acute headache

Meningitis

Encephalitis

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Compression causes of acute headache

Hydrocephalus

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Ophthalmic causes of acute headache

Acute glaucoma

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Systemic causes of acute headaches

HTN: Phaeochromocytoma
Infection: sinusitis
Toxins: CO

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Causes of chronic headaches

MCT DINGS

Migraine
Cluster headaches
Tension headaches

Drugs
ICP
Neuralgia (trigeminal)
Giant cell arteritis
Systemic

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Drug causes of chronic headaches

Analgesics

Caffeine

Vasodilators

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Systemic causes of chronic headaches

HTN

Uraemia

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Subarachnoid haemorrhage features

Thunderclap headache
Sudden onset
Occipital

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Tension headache features

Bilateral
Band like
Non pulsatile

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Cluster headache features

Rapid onset
Unilateral
Severe pain around one eye

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Sx of cluster headache

Red, watery eye
Nasal congestion
Miosis +/- ptosis

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Length of cluster headache attacks

15 mins - 3 hrs

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Length of cluster headache clusters

4 - 12 wks

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Length of cluster headache remission

3 months - 3 yrs

Acute treatment of cluster headache attacks

100% O2
Triptans (Sumitriptan)

Prevention of cluster headache attacks

Verapamil
Topiramate
Lithium

Trigeminal neuralgia features

Male > 50 yrs

Unilateral stabbing pain

Trigeminal division distribution (usually V2/3)

Secondary causes of trigeminal neuralgia

Compression (aneurysm)
MS
Zoster

Triggers of trigeminal neuralgia

Washing area
Shaving
Eating
Talking

Medical mx of trigeminal neuralgia

Carbamazepine
Lamotrigine
Gabapentin

Surgical mx of trigeminal neuralgia

Microvascular decompression

Giant cell arteritis
Age
ESR
Treatment

Age > 60 yrs
ESR > 60
Prednisolone 60 mg

Giant cell arteritis presentation

Unilateral scalp tenderness Thickened pulseless temporal artery Jaw claudication Amaurosis fugax Sudden blindness

Association of giant cell arteritis

Polymyalgia rheumatica

Giant cell arteritis investigations

ESR \> 60 Raised PLT Raised ALP Decreased Hb Temporal artery biopsy

Treatment of giant cell arteritis

Prednisolone 60 mg PO OD 5-7d PPI Bisphosphonate

Migraine risk factors

F Obesity Patent foramen ovale

Types of migraine

Aura + Headache (classic) Isolated aura Headache w/o aura (common)

Migraine triggers

CHOCOLATE CHeese OCP Caffeine alcohOL Anxiety Travel Exercise

Migraine prodrome timing

Preceed migraine by hrs - days

Sx of migraine prodrome

Yawning Cravings Changes in sleep, appetite or mood

Migraine aura timing

Preceed migraine by mins

Sx of migraine aura

Visual - distortion, zig zags, hemianopia Paraesthesia Speech Motor Teicophosia Scintillating scotoma Fortification spectra

Migraine w/o aura diagnostic criteria

5+ headaches lasting 4-72 hrs + Nausea/vomiting or phono/photophobia + 2+ out of : - Unilateral - Pulsating - Interference with normal life - Worsened by routine activity

Treatment of an acute migraine episode

1) Paracetamol + metoclopramide 2) NSAID + metoclopramide 3) Rizatriptan (triptans) 4) Ergotamine

Prophylaxis of migraines

Avoid triggers 1) Propanolol, topiramate 2) Valproate, pizotifen, gabapentin

Mode of action of triptans

5-HT receptor agonist