Friday, April 27, 2012

Headaches

Migraine:  Female pt, Chronic, + aura, related to menses, N&V, may be pptatd by emotions, Acute tmt :ergotamine, triptans, DO NOT COMBINE ERGOT WITH TRIPTANS-risk of prolonging vasospasms.
Prevention: Propanolol, CCBs, TCAs, SSRIs, Botox


Cluster: Male pt, episodic, retro-orbital, wakes patient up at night, may not occur for months to yrs, red eye, Horner syndrome, Acute tmt: 100% Oxygen,  triptans, ergotamine, Lithium, Steroids . Prevention - Verapamil, Lithium, Steroids


Tension : diag of exclusion, tmt: NSAIDS


Raised ICP : Early morning headaches, worsened by tilting head forward, visual changes, papilledema


Pseudotumour cerebri: raised ICP + normal CT/MRI, normal CSF content, Obese female, OCPs, tmt: wt loss, acetazolamide, repeated LPs for acute reduction, VP shunt if no response..


Giant cell arteritis: visual disturbances, temporal area, systemic symptoms, jaw claudication. markedly elevated ESR. tmt: steroid. Start prednisone immediately without waiting for biopsy confirmation, to save vision.

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