Headaches Flashcards

1
Q

headache red flags

A
new onset >55
known/previuos malignancy
immuno-suppressed
early morning headache 
exacerbated by coughing/sneezing
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2
Q

migraine with/without aura is more common

A

without

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3
Q

IHS criteria for migraine without aura

A

at least 5 attacks lasting 4-72 hours
2 of: moderate/sever pain, unilateral, throbbing, worse on movement
1 of: autonomic features, photophobia/phonophobia

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4
Q

pathophysiology of migraines

A

stress triggers serotonin release in brain
blood vessels constrict and dilate
chemicals (eg substance P) irritate nerves and vessels causing pain

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5
Q

how long does aura last in migraine with aura

A

20-60 mins

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6
Q

most common aura in migraine

A

visual

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7
Q

triggers for migraine

A
sleep deprivation
dietary - chocolate and cheese
stress
hormonal - menstrual cycle 
physical exertion
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8
Q

acute pharmacological treatment for migraine

A

1st line - NSAID (possibly anti-emetic if gastroparesis)

2nd line - triptans (5HT agonist) e.g. rizatriptan

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9
Q

when should prophylactic treatment of migraines be considered

A

> 3 attacks/month or very severe

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10
Q

prophylactic drugs used in migraines

A

propranolol

topriamate (carbonic-anhydrase inhibitor)

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11
Q

when should propranolol be avoided

A

asthma
PVD
heart failure

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12
Q

SE of topiramate

A

weight loss
paraesthesia
impaired concentration
enzyme inducer

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13
Q

lifestyle factors in migraine

A

avoid food triggers
2L water per day - decrease caffeine
decrease stress
regular exercise

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14
Q

30-40 year old man

severe unilateral headache lasting 20 mins-3 hours 1-8 times per day

A

cluster headache

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15
Q

how long does cluster bout last

A

weeks-months

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16
Q

when does cluster headache usually come on

A

striking circadian (sleep) and seasonal variation

17
Q

acute treatment for cluster headaches

A

high flow O2
sub-cut sumatriptan
steroids

18
Q

prophylaxis used in cluster headaches

A

verapamil

19
Q

unilateral headache 10-30 mins 1-40 times per day

A

paroxysmal hemicrania

20
Q

what non-headache feature is present in paroxysmal hemicranias

A

autonomic features

21
Q

treatment for paroxysmal hemicrania

A

indomethacin

22
Q

who requires MRI brain and MRI angiogram

A

new onset unilateral cranialautonomic features

23
Q

elderly woman

stabbing unilateral pain lasting 1-90seconds 10-100 times/day

A

trigeminal neuralgia

24
Q

trigger for trigeminal neuralgia

A

touch

25
Q

medical treatment for trigeminal neuralgia

A

carbamazepine
gabapentin
phenytoin
baclofen

26
Q

surgical treatment for trigeminal neuralgia

A

abalation

decompression

27
Q

when should an MRI be performed in trigeminal neuralgia

A

any signs on examination
atypical features
poor response to treatment