Headache

Tension headache

Symptoms

  1. precipitant
  2. symmetrical
  3. not disabling
  4. no photophobia

Treatment

Analgesia. ?benzodiazepines ?tricyclics

Migraine

Demographics

20% women, 15% men at some point. First attack usually <30 aet.

Symptoms

  1. Paroxysmal
  2. Prodrome (24 h)
  3. Aura (30 min)
  4. Severe unilateral pulsating pain
  5. Photophobia
  6. N&V
  7. Possibly hemiplegia
  8. Sleep terminates headache
Attacks last 1 or 2 days.

Treatment

Acute:
  1. Analgesia (aspirin, paracetamol, codiene)
  2. Antiemetic (metoclopramide, doperidone)
  3. Ergotamine PR or Sumatriptan PO
Prophylaxis:
  1. Amitriptyline (if stress related)
  2. β-blockers (propranolol, atenolol, metopralol)
  3. 5HT inhibitors (cyproheptamine, pizotifen, methysergide)
  4. Ca antagonists (flunnarizine)
  5. anticonvulsants (valproate)

Cluster headache

 = Horton's cephalgia

Demographics

M:F 10:1 20–50 aet.

Symptoms

  1. Precipitated by EtOH, GTN, cold
  2. Daily in clusters 4&nash;16/52
  3. Occurs an hour after sleep
  4. Severe unilateral pain, centred on one orbit
  5. Ipsilateral eye turns red, bloodshot, waters
  6. Transient Horner's

Treatment

Ergotamine PR 1 h before anticipated attack. O2 aborts and attack. Steroids may abort a cluster.

Giant cell arteritis