Headaches Flashcards
(25 cards)
Differentials of Headaches
+Migraine - photophobia, phonophobia, episodic, unilateral, throbbing. Females.
+Subarachnoid haemorrahge - THUNDERCLAP.
+Meningitis - pyrexia, vomiting, neck stiffness.
+Cluster headache - Unilateral pain around eye in clusters of a couple a day and then period of none. Male.
+Tension headache - band-like dull headache
+Giant cell arteritis - tenderness on scalp, jaw claudication. Elderly.
+Raised ICP/SOL - generalised, aggregated on bending, cough, in morning, progressive severity.
+Trigeminal neuralgia - paroxysms of intense stabbing pain, unilateral. Triggered on washing face, shaving, eating.
+Stroke
Migraine symptoms
Unilateral pulsatile or throbbing headache.
Nausea and vomiting.
Photophobia
Phonphobia
Impairs and is worsened by activities of daily living.
Aura before heachache with visual and sensory symptoms (flashing lights, blurred vision, parasethsia, numbness).
Triggers and risk factors of migraines
More common in females. More common in obesity. Risk also increased in COCP, smoking, hypertension, hyperlipidaemia.
Triggers = chocolate, oral contraceptive pill, hangover, alcohol, orgasm, exercise, menses.
Treatment of an acute migraine
Triptan e.g. sumatriptan +NSIAD/pcm. Triptans only licenced for over 18yrs. Do NOT use ergots or opioids. Consider anti-emetic treatment.
Preventative treatment of migraines
Consider if severe, frequent disabling migraines, making patients at risk of OD on analgesic and acute Rx meds (could lead to medication overuse headache).
1st line = Propranolol or topiramate.
2nd line = sodium valproate, gabapentin, pregabalin.
3rd line = Acupuncture.
Giant cell arteritis pathogenesis
Chronic granulomatous inflammation big arteries (vasculitis). Most commonly temporal and occipital.
Epidemiology of giant cell arteritis
More common in females than males. Most common in elderly (if <55yrs consider Takayasu’s arteritis). Commonly seen with polymyalgia rheumitica
Clinical features of giant cell arteritis
Unilateral scalp tenderness (on brushing hair)
Jaw claudication
Visual disturbance - amaurosis fugax, total sudden blindness.
Investigations + treatment for giant cell arteritis
Increases = ESR, CRP, LFT, platelets
Decrease= Hb
Biopsy of temporal artery but do not delay treatment of Prednisolone.
Tension headache info
Throbbing, unilateral, band-like headache. No nausea or neck-stiffness. Treatment with basic analgesia (paracetamol) and stress relief.
Cluster headache epidemiology
More common in males, more common in smokers.
Clinical features of a cluster headache
Unilateral, severe periorbital pain. Blood shot, watery eyes. lacrimation Rhinorrhea Miosis In clusters of multiple headaches over consecutive days then periods of no pain days.
Treatment of acute and preventative meds for cluster headache
Acute = 100% O2 via non-rebreathable mask + Subcut sumatriptan. Preventative = verapamil.
Trigeminal neuralgia causes
Vascular compression of nerve, AVM
Epidemiology of trigeminal neuralgia
more common in females. Mostly mandibular and maxillary branches
Symptoms of trigeminal neuralgia
Severe episodic pain in region of trigeminal branches.
Triggers fo trigeminal neuralgia
Washing area, cleaning teeth, shaving area, talking, cold wind, vibration.
Management of trigeminal neuralgia
Carbamazepine, keep pain diary and arrange follow-up.
Meningitis symptoms
Headache Neck stiffness Kernig's sign Photophobia Petechial, non blanching rash Seizures Decrease consciousness
Treatment for Meningitis
Dexamethasone + Cefotaxime.
Subarachnoid haemorrhage symptoms, investigations and management
Thunderclap headache. Kernig's sign Neck stiffness Star shaped haematoma on CT Nimodipine, surgical clipping.
Medicine over headaches:
- What medicines can cause them?
- Presentation
- Rx
- triptans opioids, NSAIDs, paracetamol.
- Headache for 15 or more days per month in a patient with a pre-existing headache + regular use of medicines for that headache. Headache may worsen on stopping medicine.
- Supported withdrawal of medication. Advise on withdrawal headaches. Arrange follow-up to monitor progress and support. Ensure co-morbidities are adequately controlled e.g. anxiety.
Red flag symptoms in headache 🚩🚩
Fever, photophobia, neck stiffness Dizziness Visual disturbance Sudden severe onset Worse on lying down, coughing, straining Severe enough to wake from sleep
Non-neuro causes of headache
Alcohol
Carbon monoxide poisoning
Drug side effect
