12.10.29 Clinic notes

Headaches

    • Classification

      • Tension

      • Migraine

      • Trigeminal autonomic cephalgias

        • => Always scan

    • Chronic paroxysmal hemicrania

      • => Indomethacin

Refractory epilepsy - questions

    1. Is it epilepsy?

    2. Are they compliant with medication?

    3. Are you missing something (e.g. secondary cause)

Headache - 8 red flags

    • New onset or change in headache in patients who are aged over 50

    • Thunderclap headache

      • Rapid time to peak headache intensity (seconds to 5 mins)

    • Focal neurological symptoms

      • e.g. limb weakness, aura <5 min or >1 hr

    • Signs of raised ICP

      • Headache that changes with posture

      • Headache wakening the patient up or worse in morning

      • Papilloedema

    • Accompanied by nausea or vomiting

    • Visual disturbance

    • History of trauma

    • New onset headache in an immunosuppressed patient

Migraine

    • Try amitriptyline or propanolol first

    • Then topiramate (topomax)

Epilepsy - Classification

    • Localized (partial or focal onset seizures) or distributed (generalized seizures)

    • Partial seizures are further divided on the extent to which awareness is affected

      • If it is unaffected, then it is a simple partial seizure

      • Otherwise it is a complex partial (psychomotor) seizure

    • A partial seizure may spread within the brain - secondary generalization

Notes

    • Fingolimod

      • Immunomodulating drug, approved for treating multiple sclerosis

      • Reduces the rate of relapses in relapsing-remitting multiple sclerosis by over half, but has serious adverse effects

      • Sphingosine 1-phosphate receptor modulator

      • Sequesters lymphocytes in lymph nodes, preventing them from contributing to an autoimmune reaction

    • Acuity

      • FIRST NUMBER IS ALWAYS 6!

        • e.g. 6/12 means they can see at 6 metres what a normal person can see at 12

    • Tegretol = Carbamazepine

    • Topomax = Topiramate

    • Cholesteatoma

    • Atonic seizure

    • IIH / (BIH)