Headaches Flashcards
(34 cards)
What parts of the symptoms graph are important to include in the history?
- onset
- peak
- relieving factors
- exacerbating factors
- associated features
What are the headache red flags?
- new onset headache in >55 years old
- known/previous malignancy
- immunosuppressed
- early morning headache
- exacerbation by valsalva - coughing, sneezing
How often do migraines usually occur?
One attack a month
What is the criteria for headache diagnosis without an aura?
At least 5 attacks lasting 4-72 hours
2 of moderate severity, unilateral throbbing, worse on movement
1 with associated autonomic features - phonophobia/photophobia
Describe the pathophysiology of a migraine
Vascular and neural influences as a result of stress triggers leads to serotonin release - blood vessels constrict and dilate - chemicals including substance P irritate nerves and blood vessels causing pain
What is the migraine generating centre?
Dorsal raphe nucleus and locus coeruleus
What causes a migraine with an aura?
Triggers will cause activation of the trigeminal vascular system causing dilatation of cranial blood vessels, cortical spreading of depolarisation and ultimately release of substance P, neurokinin A and CGRP
How long do visual auras last?
20-60 minutes with a headache less than an hour after - can be simultaneous
What is the most common visual symptom?
Monochromatic
Name the triggers of migraines
- sleep deprivation
- dietary
- stress
- hormonal
- physical exertion
What is the acute treatment for a migraine?
Analgesia - aspirin, naproxen, ibuprofen
+/- antiemetic if gastroporesis
Triptans
What are triptans?
5HT agonists that should be taken at the start of a headache
Name two triptans used?
Rizatriptan
Frovatriptan - for sustained relief
When should prophylaxis be given in migraines?
More than 3 attacks a month or very severe attacks - trial for 10-12 weeks aim to titrate drug as tolerated to achieve efficacy at lower dose
Name three drugs that can be used as prophylaxis for migraines
- Amitriptyline
- Propranolol
- Topiramate
State the five types of ‘fancy’ migraine
Acephalgic - aura without a headache Basilar - vertigo Retinal/ophthalmic Hemiplegic - encephalopathic, weakness Abdominal - usually in kids +/- headache
Describe a tension type headache
Episodice, chronic pressing tingling, tends to be mild to moderate bilateral with no associated features
How is a tension headache treated?
Identify cause/triggers and relaxation physiotherapy
Amytriptyline/dothiepin can be used for three months
What is a trigeminal autonomic Cephalgia? Name the three types
Primary headache complexes affecting the trigeminal nerve
- cluster headache
- paroxysmal hemicrania/continua
- SUNCT
What are the signs of trigeminal autonomic cephalgia?
Ptosis, miosis, nasal stuffiness, nausea/vomiting, tearing, eye lid oedema
What is a cluster headache?
Often in young men, circadian rhythm with seasonal variation - severe unilateral headache lasting 20mins -3hours and 1-8 per day. Clusters can last weeks to months
How are cluster headaches treated?
High flow oxygen at home
Sub-cutaneous sumatriptan (reduces severity)
Steroids for 2 weeks
Verampamil prophylaxis
Describe paroxysmal hemicrania/continua
More common in elderly females - severe unilateral headache with unilateral autonomic features - lasts 2 mins to 45 hours and can have up to 40 attacks a day
What does paroxysmal hemicrania respond to?
Inclomethicin
