Headache 0.0 / 5 ? MedicineNeurologyUniversityAll boards Created by: zCreated on: 15-03-16 19:19 Migraine aura phase (evolves over 30-60mins so can diff w/ TIA) visual- flahing lights, zigzag lines, fortification spectra, paracentral scotoma hemianopia sensory- paraesthesiae, numbness hemiparesis ophthmaloparesis headache phase severe, throbbing, unilateral, photo/phonophobia, N&V, worse w/ activity NB common to have no aura, can be bilateral, can last 2-5 days Mx avoid trigger factors dietary: cheese, chocolate, alcohol, coffee, dieting, dehydration non-dietary: stress, menstruation, OCP, exercise, relaxation, travelling, altered sleep acute Tx: analgesic (not codeine), anti-emetic, triptan if severe prophylaxis: B antagonist (propanolol) or AED (topiramate) or amytriptyline or acupuncture, botox for chronic migraine 1 of 6 Tension type headache band around head "pressure", "going to explode" may have other features of anxiety acute hyperventilation (panic attacks) chronic hyperventilation distal and perioral paresthesiae, dizzy spells, palipitations Mx reassurance lifestyle changes analgesics (aspirin, paracetamol, ibuprofen, never codeine) prophylaxis (amitryptaline, ?SSRIs) possible psych referral NB medication overuse headache any analgesic, esp codeine, also ergotamine, triptans no set dose triggers it Dx confirmed 3 months post-w/drawal 2 of 6 Cluster headache one of the trigeminal autonomic cephalgias (TACs) clinical features: unilateral several occular/frontal pain eye injected/watering unilateral nasal discharge agitation often at night 30-60 mins, may have multiple attacks occur in clusters Ix MRI- can be due to pituitary lesions (e.g. pituitary adenoma) Mx acute: sumatriptan, oxygen prophylaxis: verapamil, methysergide, lithium, prednisolone 3 of 6 Temporal arteritis clinicla features headache scalp tenderness jaw claudication (rare) fever, weight loss, anaemia raised ALP polymyalgia rheumatica Ix ESR temporal artery biopsy Cx TIA, stroke, blindness Tx prednisolone 60mg daily for 1 month then reduce (by 5mg every 2 weeks until 10mg then by 1mg per month to 5mg then by 1mg every 2 months) continues for 2-3 years (even though sympt pos only for days) 4 of 6 Benign/idiopathic intracranial hypertension clinical features headache visual disturbances tinnitus blindness papilloedema CNVI palsies precipitants: obesity, OCP, pregnancy, steroid therapy, tetracyclines, nitrofuraantoin Ix CT/MRI - cerebral venous sinus thrombosis LP Mx monitor visual fields remover precipitant- weight loss acetazolamide or other diuretic lumpo-peritoneal shunt optic nerve sheath fenestration 5 of 6 When GPs should refer ?tumour focal symptoms, headache wakes pt, epilepsy physical signs e.g. hemiparesis ?SAH ?temporal arteritis ?cluster headache or other TAC 6 of 6
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