Headaches II Flashcards by Anouk Wijeratne

What are the features of migraines?

Tendency to repeated attacks
Triggers
easily hung-over 
visual vertigo 
motion sickness

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What are the three forms of migraine attacks?

Pain
Pain and focal symptoms
Focal symptoms

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What are the phases of migraines?

Prodrome
Aura
Headache
Resolution
Recovery

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What is prodrome?

Changes in mood, urination, fluid retention, food craving, yawning

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What is aura?

Visual, sensory (numbness/paraesthesia), weakness, speech arrest

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What is headache?

Head and body pain, nausea, photophobia

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What is resolution?

rest and sleep

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What is recovery?

mood disturbed, food intolerance, feeling hungover

48 hours or so

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What are negative aura symptoms?

Blackness

Loss of vision

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What are positive aura symptoms?

Flashes
Zigzags
Starburst
Expanding Cs

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What are treatments for an acute migraine attack?

Analgesia

Soluble preparations to aid absorption

Triptans-tablets (Sumitriptan), melts, nasal sprays, s/c injections (vasoconstrictors)

Synergise with NSAIDS
Hit the headache hard and fast

Opiates

A short nap

TMS

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How can TMS treat migraine?

interrupts complex networks that trigger and perpetuate migraine, which is caused by spreading electrical depression across the cerebral cortex.

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Why do have to be careful with opiates?

caution! Analgesic abuse potential.

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What are lifestyle issues that come with migraines?

Migraineurs have sensitive heads even in between attacks.

Over-react to any sort of stimulation.

Can’t ignore the world around them, it overstimulates their brains.

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What are potential migraine triggers?

dietary, environmental, hormonal, weather, dehydration, stress

Drink 2 litres water/day

Avoid caffeinated drinks

Don’t skip meals. Fresh food. Avoid ready meals & take-aways

Don’t oversleep or have late nights.

Electronics downstairs.

Analgesic abuse

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What prophylactic methods can prevent migraines?

Over-the-counter preparations

Tricyclic antidepressants (TCAs)

Beta-blockers

Serotonin antagonists

Calcium channel blockers

Anticonvulsants

Greater occipital nerve blocks

Botox: crown of thorns

Suppress ovulation

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What over the counter preparation can be used?

feverfew, coenzyme Q10, riboflavin, magnesium, EPO, nicotinamide

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What TCAs can be used?

amitriptyline 7pm

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What beta blockers can be used?

Propanlol

Atenolol

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What serotonin antagonists can be used?

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pizotifen, methysergide

What calcium channel blockers can be used?

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flunarazine, verapamil

What anticonvulsants can be used?

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: valproate, topiramate, gabapentin

What is erenumab?

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Injectable drug erenumab (Aimovig)

Monoclonal antibody
disables calcitonin gene-related peptide or its receptor (CGRP mAbs)

What does erenumab do?

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cut number of days people had migraines from an average of 8 a month to between 4 and 5 a month

What is a tension type headache?

Tight muscles around head and neck bilaterally, as though head is in a vice.

How do you treat tension type headache?

NSAID’s preferred: Ibuprofen Naproxen, Diclofenac Paracetamol Tricyclic antidepressants:- Amitriptyline 50-75mg daily 30-60% derive some symptomatic relief SSRI’s probably less effective

What is a cluster headache?

Severe unilateral pain lasting 15-180 minutes untreated. Classified as a trigeminal autonomic cephalgia. (phantom of the opera distribution) At least one of the following, ipsilaterally: Conjunctival redness and/or lacrimation Nasal congestion and/or rhinorrhoea Eyelid oedema

What are other symptoms of cluster headaches?

Forehead and facial sweating Miosis and/or ptosis A sense of restlessness or agitation Frequency between one on alternate days to 8 per day. Not associated with a brain lesion on MRI

How do treat cluster headaches?

Inhaled oxygen. Oxygen inhibits neuronal activation in the trigeminocervical complex S/C or Nasal Sumatriptan so it acts faster

What drug can you give to prevent prophylactically cluster headaches?

Verapamil (CCB)

What is the difference in distribution between migraines and cluster headaches?

M: 33% men, 67% women CH:90% men, 10% women

What is the difference in duration between migraines and cluster headaches?

M: 3-12 hours CH: 45min – 3 hours

What is the difference in frequency between migraines and cluster headaches?

M: 1-8 attacks monthly CH: 1-3 attacks daily (often at night)

What is the difference in remission between migraines and cluster headaches?

M: Long remissions unusual CH: Long remissions common

What is the difference in nausea between migraines and cluster headaches?

M: Nausea & vomiting frequent CH: Nausea rare

What is the difference in pain between migraines and cluster headaches?

M: Pulsating hemicranial pain CH: Steady, exceptionally severe, well localised pain, unilateral in each cluster

What is the difference in symptoms between migraines and cluster headaches?

M: Visual or sensory auras seen CH: Eye waters, nose blocked, ptosis etc

What would SOCRATES be for a tension headache?

``` Generalised site Dull, band around head pain Radiates to neck/shoulder Lasts 3-4 hours Exacerbating factors - stress, no sleep, anaglesia helps ```

What are the investigations for a tension headache?

Clinical diagnosis

What would SOCRATES be for a migraine?

``` S: Unilateral O: Paroxysmal (episodic) C: Pulsating/Throbbing A: N&V, Photophopbia, Aura T: 4-72 hours E: Activity, stress, hormone, menstruation, OCP, foods e.g. tyramine in cheese/wine S: Moderate to Severe ```

What are the causes of migraines?

``` CHees OCP Caffeiene alcohOL Travel Exercise CHOCOLATE ```

What are the features of Migraines?

``` POUND Pulsatile One day diraation Unilateral Nausea Disabling intensity ```

What would SOCRATES be for a cluster headache?

S: Unilateral, behind the eye O: Acute onset, same time each day C: often burning/piercing pain A: swollen eyelid, forehead swelling, nasal congestion, partial horner's syndrome

What are some features of cluster headaches?

Males primarily | Associated with

What conditions cause facial pain?

Sinusitis Trigeminal neuralgia Cluster headache Temporal arteritis

What are the features of sinusitis facial pain?

Facial 'fullness' and tenderness | Nasal discharge, pyrexia or post-nasal drip leading to cough

What are the features of trigeminal neuralgia facial pain?

Unilateral facial pain characterised by brief electric shock-like pains, abrupt in onset and termination May be triggered by light touch, emotion

What are the features of cluster headache facial pain?

Pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours Clusters typically last 4-12 weeks Intense pain around one eye Accompanied by redness, lacrimation, lid swelling, nasal stuffiness

What are the features of temporal arteritis facial pain?

Tender around temples | Raised ESR

Headaches II Flashcards

(49 cards)