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)