Headache
Red flags
Fever from any infection > vasodilation
Meningism
> viral meningitis
> Pharyngitis
> OM
> sinusitis
> dental
Trauma > bleed
Chronic progressive > Tumour
Occipital > ?tumour
> CO poisoning
> HTN
Chronic and remitting
- Aura > migraine
Severe, unilateral frontal/orbital <3h: ? Cluster headache
Worse with eating, mandibular condyle pain > TMJ disfunction
Papilloedema (w N Scan + raised opening pressure)
(good article in uptodate to finish reading)
Migraine
Alice in wonderland syndrome:
.....Complications
Chronic
Abdominal...
Hyperacusis: abnormal (Central or peripheral) sound sensitivity arising from within the auditory system
Misophobia: dislike of sound
Phonophobia (aka ligyrophobia): fear of sound
- treat hyperacusis if present then psychiatry
Migraine treatment
- Acute and severe
- Progressive chronic headaches
- Focal neurology
- Age under 3yrs
- Headache/vomiting on waking
- Consistent location of recurrent headaches
- Presence of VP shunt
- Hypertension
Fever from any infection > vasodilation
Meningism
> viral meningitis
> Pharyngitis
> OM
> sinusitis
> dental
Trauma > bleed
Chronic progressive > Tumour
Occipital > ?tumour
> CO poisoning
> HTN
Chronic and remitting
- Aura > migraine
Severe, unilateral frontal/orbital <3h: ? Cluster headache
Worse with eating, mandibular condyle pain > TMJ disfunction
Papilloedema (w N Scan + raised opening pressure)
(good article in uptodate to finish reading)
Migraine
- last 2-72 hours AND
- without aura (diagnosed after 5th)
- + 2 of Mod/sev OR pulsating OR worse with exertion OR unilateral (usually bilateral until adolescence)
- + 1 of nausea OR photophobia and hyperacusis
- with aura (diagnosed after 2nd)
- individual aura symptom last 5-60 mins (one must be unilateral, can occur in succession)
- headache starts within 60 mins
- typical: 1 aura of
- Visual (white lights or scotomata)
- Sens (unilateral tingling then numbness)
- Speech/language: dysarthria
- atypical: 1 of (+/- above typical)
- Motor (hemiplegic) CAN have brain stem (classified as familial or sporadic)
- brain stem (aka basilar type): vertigo, tinnitus, diplopia, decreased level of consciousness, bilateral typical symptoms NO MOTOR
- Ocular (aka retinal): sudden loss of vision OR photopsia OR scintillations in one eye only (Ophthalmoscope > constricted vessels and pale retinal)
- typical: 1 aura of
- without aura (diagnosed after 5th)
Alice in wonderland syndrome:
.....Complications
Chronic
Abdominal...
Hyperacusis: abnormal (Central or peripheral) sound sensitivity arising from within the auditory system
Misophobia: dislike of sound
Phonophobia (aka ligyrophobia): fear of sound
- treat hyperacusis if present then psychiatry
Migraine treatment
- general measures
- education
- Hydration, don't miss meals
- Avoid caffeine, alcohol
- Diary (triggers: stress/poor sleep habits/irregular meals/odors, features, response to treatment)
- abortive treatment
- rest or sleep in a dark, quiet room with a cool cloth applied to the forehead
- Abortive medicine (more effective if given early) see RCH (ensure not pregnant)
- Analgesia: Paracetamol, NSAIDs
- antiemetics (ondansetron)
- <12y
- ibuprofen
- >12y
- aspirin 1g PO
- triptans (first line for severe or poor responders to analgesia): sumatriptan IN
- Chlorpromazine IV
- IF FREQUENT NEED PREVENTION TO AVOID medication overuse headache
- limit to <10d / month (<15d for paracetamol/NSAIDs)
- preventive
- Cyproheptadine (antihistamine and serotonin antagonist with anticholinergic effects)
- Propranolol (b-blocker) only one that DOESNT cause wt gain (Contraindicated in Asthma)
- Amitriptyline (TCA)
- Dihydroergotamine (NOT for Motor (hemiplegic)/Brainstem (Basilar) migraines)
- Sodium Valproate
- Topiromate
- (Pizotifen ineffective in children)