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Neurology > Headache > Flashcards

Flashcards in Headache Deck (8)
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1
Q

differential dx of headache

A

Haemorrhage
Eclampsia (can occur post partum)
Arterial (dissections / temporal arteritis)
DVT of the brain = cavernous venous thrombosis
Tumour or trauma
Infection
Eye (glaucoma)

2
Q

MIGRAINES

Suspect Aura in those patients with or without headache who present with neurological symptoms that are;

A

Fully reversible
Occur gradually over at least 5 mins
Last for 5-60mins

3
Q

MIGRAINES
Diagnose migraine with aura with or without headache with one or more of the following typical aura sx (which meets when to sspect aura)

A

Visual sx
+ve = flickering lights
-ve = loss of vision partially

Sensory sx
+ve = pins and needs
-ve = numbness

speech disturbance

4
Q

What are the diagnostic features of a migraine?

A

Headache lasting 4–72 hours

At least two of:
			unilateral location
			pulsating quality
			moderate to severe pain intensity
			worsened by routine physical activity

At least one of:
nausea and/or vomiting
photophobia and phonophobia

5
Q

MIGRAINE:

  1. Acute Treatment
  2. Prophylactic Treatment
A
  1. Acute
    - NSAID + Triptan or Paracetamol + Triptan
    - Aspirin 900mg
    - Metoclopramide
    - Sumpatriptan
  2. Prophylactic (consider if migraines 2-4 per month)
    - Topiramate (risk of malformations and impair effect of OCP)
    - Propranolol
    - Amitryptalline
    - Pizofiten (Sandamigran)

Not for gabapentin

6
Q

When to refer to specialist ?

A

Refer patients with migraine to an expert when:
–> neurological symptoms are prolonged
–> the usual headache pattern deteriorates suddenly
–> they need acute treatment (analgesics or triptans) for more than 8 to 10 days per month and do not respond to prophylaxis in the usual dose range
–> they often need emergency department or hospital treatment or have to take days off work due to migraine
–> they have isolated aura without headache
the diagnosis is uncertain.
–> Send patients with thunderclap headache (even if they routinely have migraines) for urgent assessment in an emergency department.
(etg)

7
Q
  1. Dose of sumatriptan that can be given?

2. Can it be given on SSRI’s or SNRI’s?

A
  1. –> sumatriptan 20 mg intranasally. Wait at least 2 hours before repeating the dose if needed (maximum dose 40 mg in 24 hours)

OR

sumatriptan 50 to 100 mg orally. Wait at least 2 hours before repeating the dose if needed (maximum dose 300 mg in 24 hours)

  1. Yes but explain serotonin toxicity
    e. g. agitation, confusion, rapid heart rate, dilated pupils, muscle twitching or rigidity, sweating, diarrhoea, headache, shivering), despite its rarity.
8
Q

Cluster headaches
1/ acute treatment
2/prevention

A

1/ sumatriptan 20mg intranasally
2/ verapamil

(ref; etg)