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Heartaches to Happy Bunnies

Heartaches to Happy Bunnies. Sorting out your Headache patients. Patient Perception. Doctor’s Dilemma. Diagnosis. History History History History History History History History Examination. Primary Headaches. Tension type headache Migraine Cluster and other TACs.

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Heartaches to Happy Bunnies

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  1. Heartaches to Happy Bunnies Sorting out your Headache patients Dr John G Hughes BASH for FDA 2014

  2. Patient Perception Dr John G Hughes BASH for FDA 2014

  3. Doctor’s Dilemma Dr John G Hughes BASH for FDA 2014

  4. Diagnosis • History • History • History • History • History • History • History • History • Examination Dr John G Hughes BASH for FDA 2014

  5. Primary Headaches • Tension type headache • Migraine • Cluster and other TACs Dr John G Hughes BASH for FDA 2014

  6. Secondary Headaches • Head/neck injury • Subarachnoid haemorrhage • CSF pressure – high or low • Brain tumour • Chemical – CO or medication Dr John G Hughes BASH for FDA 2014

  7. Tension Type Headache • Featureless • Band like ache • Mild photo/phonophobia/nausea Dr John G Hughes BASH for FDA 2014

  8. Migraine • Throbbing pain • Sensitivity to stimuli • Exacerbated by activity • Associated features • Aura? Dr John G Hughes BASH for FDA 2014

  9. Migraine Dr John G Hughes BASH for FDA 2014

  10. Dr John G Hughes BASH for FDA 2014

  11. HIT 3 (migraine) • Nausea • Photophobia • Disability (functional impairment) • 93% predictive for migraine Dr John G Hughes BASH for FDA 2014

  12. Aura • Evolving neurological phenomenon • Visual • Speech • Sensory Dr John G Hughes BASH for FDA 2014

  13. Migraine treatment • Aspirin • Triptans • Avoid triggers • Prophylaxis • B Blockers • Topiramate • Tricyclics Dr John G Hughes BASH for FDA 2014

  14. Cluster • Very severe 30-120 min • Agitation and autonomic features • Mainly men • Diurnal and seasonal synchronicity Dr John G Hughes BASH for FDA 2014

  15. Cluster Dr John G Hughes BASH for FDA 2014

  16. Cluster autonomic features Dr John G Hughes BASH for FDA 2014

  17. Cluster Treatment • Triptan injections • Steroids • High flow 100% oxygen • Prophylaxis • Verapamil • Lithium Dr John G Hughes BASH for FDA 2014

  18. Scan • New onset headache >50 • Increased severity =/- frequency • Exacerbation with exertion/Valsalva • Patient pressure Dr John G Hughes BASH for FDA 2014

  19. Resources • BASH Guidelines • www.bash.org.uk/guidelines/ • 3 minute neurological examination • www.youtube.com/watch?v=fgwN1P5PDaA • SIGN Guidelines • www.sign.ac.uk/guidelines/fultext/107/ Dr John G Hughes BASH for FDA 2014

  20. Remember.... Dr John G Hughes BASH for FDA 2014

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