CONDITION : MIGRAINES
PATHOPHYSIOLOGY : RISK FACTORS :
CORTICAL SPREADING DEPRESSION Genetic
of
S
depolarisation
Trigger
CGR
Spread release
of stance D
-
came ac tivation all
of m a st
Oral Contraception
↓
Release thistamines
prostaglanding
↓ Alcohol
Exacerbatedba
cause vasodilation -
Pain
sensation ↓ Stress
thalamuadto
Seudosiguat
Leadstone nocioceptor
corte
-
a si
activation
say
REDFLAGS AND COMPLICATIONS : SIGNS : SYMPTOMS :
RED FLAGS
Yadia set
CHRONIC : >15
days of
each month Unilateral pain
ge
EPISODIC
Pulsating
15 headache
days
: (
e
or new aut
AAAin
vomiting
Naurea +
Excacerbating cough , sneeze or when
standing
one
a
ge 5Yesa
Neoplasia-Cancer
Poor
balanel of conciones
Photo/Phonophobia
Swollen optic dis
Auras
URGENT REFERAL
Immunosuppressed
< 20 ye a rs
of malignancy
in brain
History
vomiting with no came. .
VESTIGATION : TREATMENT :
ICHD-3 WITHOUT AU R A
SYMPTOMATIC RELIEF
Attack lasting 4 - 7 2 hours to at least 5 a t t a c ks
SIMPLE ANALGESIA NSAIDS- Ibuprofen
S
400mg
-
Attack with at l e a st t wo characteristics
·
Unilateral -> Aspirin omg One dose as soon as it develops
OR
Pulsating
·
- Paracetamol locous
·
Moderate or severe
TRIPTANS - Alone i n Combination With NSAIDs
Aggravation
· or
During
headache they experience ·
Ist line : ORAL Sumatriptan
50-100mg
O Photos Phono
·
Naproxen most effective combination
RULE OUT NtE
ANTI-EMETICS Used i n absonce
of
- e ve n
MENINGITIS >
-
Neck Stifness
·
Prochlorperazine long
>
- Feuer OR
metoclopramide
long
·
>
-
Photophobia
PapileT h e
VENOUSSNUTRombosis
- PREVENTION
PROPANOLOL i n divided doses
80-240mg daily
-
>
-
Dizziness
for
daily dose
ICHD-3 7 Nin incriments 50-100
AURA
TOPIRAMATE-15mg days 25mg we e k total
>
WITH On to
every my
-
Visual
symptoms
Sensary symptoms AMITRIPTYLINE-15-75mg On
Motor
Symptoms CGRPANTAGONISTS Frenumab Specalist i f
Forg every
4 weeks 24
migrains per week
- to
Au r a fo r accompanied 2 2 a t t a c ks
? Sminutes
by headache -
, CONDITION : CLUSTER HEADACHE
PATHOPHYSIOLOGY : RISK FACTORS :
DYSFUNCTIONAL HYPOTUALAMUS Stress
Stimulate l a c r i m a l t nasal
>
glands
-
Activated
by trigger
- Stimulate
parasympathetic NS . Vasodilation of blood vessels
Smoking
↑ Blood f l ow to
Conjungtivitis
inflammation Stress
Neurogenic
·
↓
Activate
nocioceptor
and i a
Male
REDFLAGS AND COMPLICATIONS : SIGNS : SYMPTOMS :
RED FLAGS
Head
injuy Duration 5 minutes to 3 1-8 Unilateral
day
- h o u rs a near
eyes
-
yeDanS set
↳
Can reappear at same time o f
day
·
Cyclical patter n
ge
Stabbing , burning and shar p pain
e
or new aut
Rhinnorhea + nasal
congestion
Excacerbating cough , sneeze or when
standing
ge 5Yesa Restlessness
Nati
Immunosuppressed
< 20 ye a rs
of malignancy
in brain
History
vomiting with no came. .
VESTIGATION : TREATMENT :
At least 5 a t t a c ke with c l u s te r p at te r n SY M P TO M AT I C RELIEF
· With at least I
Symptom with headache SHORT BURST O2 THERAPY
Rhinnorhoea
·
Re st l e ss n e ss T R I P TA N S I n te r n a s a l / I M / S C
Eyelid
-
· oedema
Sumatriptan
Ging
·
-
per d o s e S/C
10-20mg repeat after 2 h ou s inter-naval
·
Episodic : Multiple a t t a c ks
lasting 7
days -
I
year with pain free interval
of 3 months PREVENTION
140-960ng daily
CCB- Verapamil (-3 divided doses
Chronic Attacke ove r 1 without remission 3 months
year m o re than
ANTI-CONVULSANTS -
Topiramate
PREDNISOLONE
, CONDITION : TENSION HEADACHE
PATHOPHYSIOLOGY : RISK FACTORS :
MUSCLE TIGLITNESS STIFNESS NECK M u s cl e
tightness
+ IN
Activation lame activation of nocioceptors
of vessels muscles Signals to
trigeminal system
>
blood near > sent
- -
↓
Dehydration
Sends to thalamus then
Cereberal Cortex
↓ Stress
Pain sensation
Central
sensitisation Lack
of sleep
overtimecaa
REDFLAGS AND COMPLICATIONS : SIGNS : SYMPTOMS :
RED FLAGS
Duration -
> 4-6 hours >
-
Can last up to a we e k Bilateral - Frontal + temporal
Head
injuy
yeDanS set
No Non
pulsating
N +t or photo/phanophobia
ge
e
aut Not B an d -l i ke
aggravated by activity
or new
Excacerbating cough , sneeze or when
standing
ge 5Yesa
Nati
Immunosuppressed
< 20 ye a rs
of malignancy
in brain
History
vomiting with no came. .
VESTIGATION : TREATMENT :
E2 of EPISODIC
symptomsas SIMPLE ANALGESIA NSAIDS- Ibuprofen
S
400mg
-
Non
pulsating
·
·
No photophobia/phonophobia
-> Aspirin omg One dose as soon as it develops
OR
Not wo rs e on exertion CAFFIENE - Paracetamol locous
Increased PREVENTION
light
+ sound
sensitivity No aura
>
-
TCA
Amitriptylline
-
l ow dose
Episodic - 30 m i n s -
7
days OTHER ANTI-DEPRESSANTS
for CBT
episodes days
·
10 1-14 a month 23 months
Chronic -215 for 2 3 months
days per month
PATHOPHYSIOLOGY : RISK FACTORS :
CORTICAL SPREADING DEPRESSION Genetic
of
S
depolarisation
Trigger
CGR
Spread release
of stance D
-
came ac tivation all
of m a st
Oral Contraception
↓
Release thistamines
prostaglanding
↓ Alcohol
Exacerbatedba
cause vasodilation -
Pain
sensation ↓ Stress
thalamuadto
Seudosiguat
Leadstone nocioceptor
corte
-
a si
activation
say
REDFLAGS AND COMPLICATIONS : SIGNS : SYMPTOMS :
RED FLAGS
Yadia set
CHRONIC : >15
days of
each month Unilateral pain
ge
EPISODIC
Pulsating
15 headache
days
: (
e
or new aut
AAAin
vomiting
Naurea +
Excacerbating cough , sneeze or when
standing
one
a
ge 5Yesa
Neoplasia-Cancer
Poor
balanel of conciones
Photo/Phonophobia
Swollen optic dis
Auras
URGENT REFERAL
Immunosuppressed
< 20 ye a rs
of malignancy
in brain
History
vomiting with no came. .
VESTIGATION : TREATMENT :
ICHD-3 WITHOUT AU R A
SYMPTOMATIC RELIEF
Attack lasting 4 - 7 2 hours to at least 5 a t t a c ks
SIMPLE ANALGESIA NSAIDS- Ibuprofen
S
400mg
-
Attack with at l e a st t wo characteristics
·
Unilateral -> Aspirin omg One dose as soon as it develops
OR
Pulsating
·
- Paracetamol locous
·
Moderate or severe
TRIPTANS - Alone i n Combination With NSAIDs
Aggravation
· or
During
headache they experience ·
Ist line : ORAL Sumatriptan
50-100mg
O Photos Phono
·
Naproxen most effective combination
RULE OUT NtE
ANTI-EMETICS Used i n absonce
of
- e ve n
MENINGITIS >
-
Neck Stifness
·
Prochlorperazine long
>
- Feuer OR
metoclopramide
long
·
>
-
Photophobia
PapileT h e
VENOUSSNUTRombosis
- PREVENTION
PROPANOLOL i n divided doses
80-240mg daily
-
>
-
Dizziness
for
daily dose
ICHD-3 7 Nin incriments 50-100
AURA
TOPIRAMATE-15mg days 25mg we e k total
>
WITH On to
every my
-
Visual
symptoms
Sensary symptoms AMITRIPTYLINE-15-75mg On
Motor
Symptoms CGRPANTAGONISTS Frenumab Specalist i f
Forg every
4 weeks 24
migrains per week
- to
Au r a fo r accompanied 2 2 a t t a c ks
? Sminutes
by headache -
, CONDITION : CLUSTER HEADACHE
PATHOPHYSIOLOGY : RISK FACTORS :
DYSFUNCTIONAL HYPOTUALAMUS Stress
Stimulate l a c r i m a l t nasal
>
glands
-
Activated
by trigger
- Stimulate
parasympathetic NS . Vasodilation of blood vessels
Smoking
↑ Blood f l ow to
Conjungtivitis
inflammation Stress
Neurogenic
·
↓
Activate
nocioceptor
and i a
Male
REDFLAGS AND COMPLICATIONS : SIGNS : SYMPTOMS :
RED FLAGS
Head
injuy Duration 5 minutes to 3 1-8 Unilateral
day
- h o u rs a near
eyes
-
yeDanS set
↳
Can reappear at same time o f
day
·
Cyclical patter n
ge
Stabbing , burning and shar p pain
e
or new aut
Rhinnorhea + nasal
congestion
Excacerbating cough , sneeze or when
standing
ge 5Yesa Restlessness
Nati
Immunosuppressed
< 20 ye a rs
of malignancy
in brain
History
vomiting with no came. .
VESTIGATION : TREATMENT :
At least 5 a t t a c ke with c l u s te r p at te r n SY M P TO M AT I C RELIEF
· With at least I
Symptom with headache SHORT BURST O2 THERAPY
Rhinnorhoea
·
Re st l e ss n e ss T R I P TA N S I n te r n a s a l / I M / S C
Eyelid
-
· oedema
Sumatriptan
Ging
·
-
per d o s e S/C
10-20mg repeat after 2 h ou s inter-naval
·
Episodic : Multiple a t t a c ks
lasting 7
days -
I
year with pain free interval
of 3 months PREVENTION
140-960ng daily
CCB- Verapamil (-3 divided doses
Chronic Attacke ove r 1 without remission 3 months
year m o re than
ANTI-CONVULSANTS -
Topiramate
PREDNISOLONE
, CONDITION : TENSION HEADACHE
PATHOPHYSIOLOGY : RISK FACTORS :
MUSCLE TIGLITNESS STIFNESS NECK M u s cl e
tightness
+ IN
Activation lame activation of nocioceptors
of vessels muscles Signals to
trigeminal system
>
blood near > sent
- -
↓
Dehydration
Sends to thalamus then
Cereberal Cortex
↓ Stress
Pain sensation
Central
sensitisation Lack
of sleep
overtimecaa
REDFLAGS AND COMPLICATIONS : SIGNS : SYMPTOMS :
RED FLAGS
Duration -
> 4-6 hours >
-
Can last up to a we e k Bilateral - Frontal + temporal
Head
injuy
yeDanS set
No Non
pulsating
N +t or photo/phanophobia
ge
e
aut Not B an d -l i ke
aggravated by activity
or new
Excacerbating cough , sneeze or when
standing
ge 5Yesa
Nati
Immunosuppressed
< 20 ye a rs
of malignancy
in brain
History
vomiting with no came. .
VESTIGATION : TREATMENT :
E2 of EPISODIC
symptomsas SIMPLE ANALGESIA NSAIDS- Ibuprofen
S
400mg
-
Non
pulsating
·
·
No photophobia/phonophobia
-> Aspirin omg One dose as soon as it develops
OR
Not wo rs e on exertion CAFFIENE - Paracetamol locous
Increased PREVENTION
light
+ sound
sensitivity No aura
>
-
TCA
Amitriptylline
-
l ow dose
Episodic - 30 m i n s -
7
days OTHER ANTI-DEPRESSANTS
for CBT
episodes days
·
10 1-14 a month 23 months
Chronic -215 for 2 3 months
days per month
