Heartaches to Happy Bunnies

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