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Headache (Primary (Tension (No nausea + bandlike, persistent, mild to mod…
Headache
Primary
Tension (No nausea + bandlike, persistent, mild to mod intensity, not worse with activity - any 2)
- chronic tension - amitriptyline
Cluster (urgent referral)
- Brief <3h
- intense pain
- unilateral
- ipsilateral watery eyes/watery nose/ptosis/miosis
- injected conjunctivitis
acute (analgesia, TCA), prevention (verapamil), bridging (steroids)
Migraine (POUND x 5, photophobia/phonophobia, sensory/visual aura)
- occasional pulsatile, keep still, can be bilateral with occasional unilateral
- 2 out of 4 PUMA
- check for trigger/lifestyle, acute tx, preventive measures
ABCDE (topimax for obesity), riboflavin for pregnancy (urine yellow)
- do not use tramadol (got better agents)
- can have some dizzyness
Idiopathic stabbing headache
- similar to migraine but very transient/short live
- mx: gabapentin/pregab
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Others
- primary cough headache
- primary exercise headache
- primary headache associated with sexual activity
- nummular headache
- hypnic headache (happens during sleep, wakes patient up)
- new daily persistent headache (lasts 72h, daily for 3 months) - use migraine prophylaxis but poor prognosis
Secondary
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Cranial
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Pseudotumour cerebri (fat/recent weight increase, female, OCP/tetracycline/retiniods) - pulsatile tinnitus, CN6 palsy
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GCA/ temporal arteritis (scalp tenderness, jaw claudication, amaurosis fugax, fever/LOA/LOW, polymyalgia rheumatica, aortic dissection/limb claudication/reduced or absent pulse/unequal BP)
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Medication overuse headache/procedure LP/med withdrawal headache (caffeine, opioid, COCP)
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S(initial+now)OOCRATES + nocturnal awakening
- meningitis: fever, neck stiffness, photophobia, rash
- stroke/ICH: neuro deficits, dysphagia, head injury, COCP
- tumour: BOV/eye pain/migraine aura, N/V, LOA/LOW
- Worse on raised ICP/movement
- FHx migraine, brain tumour
TAKE BP
In children:
- abdominal migraine (no GI/renal disease)
- migraine with benign paroxysmal vertigo (no head turning)
- migraine with benign paroxysmal torticollis (TRO dystonia, seizure, GERD)
-cyclical vomiting syndrome (vomit 4x/h, last 1h to 10 days, recurrent after 1 or more week, well in between)
Giddiness + headache: neuro, vascular, infection (including ear)