1: Headaches Flashcards
What is the most common cause of headaches
Tension-type headache
What. are the 6 types of sudden-onset headaches
Meningitis SAH Encephalitis Acute Glaucoma GCA Head trauma
How does encephalitis present
- Odd behaviour
- Decrease consciousness
- Fever
How does acute glaucoma present
Red injection eye
Severe eye pain radiating to the forehead
Reduced vision and halos
What are the 8 sub-acute headaches
- Venous sinus thrombosis
- Tension Type Headache
- Cluster Headache
- Sinusitis
- Migraine
- Trigeminal Neuralgia
- Raised ICP
- Medication over-use headache
How does venous sinus thrombosis present
Papilloedema
How does sinusitis present
- Pain over frontal and maxillary sinuses
- Pain is worse on learning forwards
- Post-nasal drip
How do tension headaches present
Tight band across the head
Explain cluster headache presentation in acute-stage
Sudden-onset painful eye, erythematous with lid welling.
When are cluster headaches more common
Pain is more common at night
Explain timing of cluster headaches overall
Cluster headaches may occur several weeks in a row followed by months without symptoms
How will raised ICP as a cause of headache present
- Chronic progressive headache
- Worse in the morning
- Worse on leaning forward, sneezing and coughing
Describe pain in tension headache
Bilateral tight-band around the head
What intensity is tension headache
Mild-Moderate
How long do tension headaches usually last
30-minutes
What defines episodic tension headache
Less than 15-days a month
What defines chronic tension headache
More than 15-days a month
Describe pain in migraine
Unilateral throbbing pain
How long do migraine typically last in
a. Adults
b. Children
a. 4-72h
b. 1-48h
What symptoms may be associated with migraine
- Aura
- Nausea and Vomitting
- Phonophobia
- Photophobia
What is time-frame for episodic migraine
Less than 15 episodes a year
What is time-frame for chronic migraine
More than 15 episodes a year
Describe pain in cluster headache
Unilateral severe pain focused around one eye
How long do cluster headaches last
50-180 minutes
What features are associated with cluster headaches
- Red, Swollen Eye
- Nasal congestion
If suspecting a primary headache what is done
Ask individual to keep a headache diary for 8-Weeks
Who created diagnostic criteria for migraines
International Headache Society
Outline International Headache Society, Diagnosis of migraines
A. Required at least 5-headaches fulfilling B-D
B. 4-72h
C. Two Of: Unilateral, Throbbing, Moderate-Severe, Exacerbated by physical exercise
D. One of: phonophobia. photophobia, N+V
What is a mnemonic to remember triggers of migraines
CHOCOLATES
What are the triggers of migraines
Cheese Hangover Orgasm Caffeine, Chocolate, Change weather Oral contraceptive Lie-ins Alcohol Travel Exercise Stress
What are three risk factors for migraines
- FH
- Female
- Obese
What % patients present with migraine with aura
25%
How long does aura usually last
15-30 minutes (Can continue during headache)
What does aura involve
Visual: Zig-zags, Scintillating scotoma
How does the headache present in migraine
- Unilateral, pulsating
- Nausea and Vomitting
- Phonophobia
- Photophobia
What is different about migraines in children
Shorter
GI Disturbance
Explain investigations in migraines
Clinical Diagnosis
Any investigation is to exclude secondary causes headache
What conservative management is given for management
- Avoid triggers
- Keep headache diary (8W)
- Sleep hygiene
- Maintain Fluid
- Regular exercise
What is first-line for acute migraine
NSAIDs and oral sumatriptan
In 12-17 year-olds what is given opposed to oral sumatriptan
Nasal sumatriptan
What is given second-line if suffering from nausea in headaches
Metclopramide
Prochlorperazine
What should not be given in migraines and why
Opioids - as can worsen headache
When is prevention in migraines indicate
More than two migraines a month
What is first-line for prevention of migraines
Topiramate
When is topiramate contraindicated
Pregnant Women
What is used as an alternative to topiramate in women of child-bearing age
Propanolol
What are two alternative therapies recommended for migraines
- Acupuncture
- Riboflavin (Vitamin B12)
What is given for menstrual migraines
- zolmatriptan
- frovatriptan
What is an absolute contraindication to COCP
migraines with aura
what ‘surgical’ management can be used for migraines
botox type A
when is botox type A injection used for
- Headaches great 15-days a month
- More 8 episodes
- Tried three weeks prophylaxis
- Being managed for medication over-use headache
during pregnancy how should migraines be used an why
Paracetamol.
NSAIDs in third-trimester can cause premature closure PDA
what is a complication of migraines
Medication over use headache
what is defined as medication over-use headache
Use of analgesia more than 15-days a month. Use of triptans more than 10-days a month
what is the most common cause of headaches
Tension-type headache
in which gender are tension headaches more common
Female
what triggers tension headaches
Stress
Anxiety
Sleep deprivation
how will a tension headache present
bilateral tight band across the head, no aura, 30-minutes
what is an episodic tension headache
<15-days a month
what is a chronic tension headache
> 15-days a month
how are tension headaches diagnosed
clinical
how are episodic TTH managed
Analgesia: NSAID, Paracetamol
Conservative: Sleep hygiene
how are chronic TTH managed
Acupuncture Amytryptiline (Off-Label)
what is a complication of TTH
medication over-use headache
what can cause TTH
- Use analgesia >15 days a month
- Use triptans over 10 days a month
how is medication-overuse headache prevented
Restrict analgesia 1-2W
what is a cluster headache
Intense headache that occurs in clusters lasting several weeks
in which gender are cluster headaches more common
Male
what is the main risk factor for cluster headaches
Smoking
what is the stereotype for demographic for cluster headache
Male smoker
what can trigger acute episodes of cluster headache
Alcohol
Worse at night
when are cluster headache attacks worse
Night-time
how do cluster headaches present clinically
- Sudden-onset severe unilateral pain around one eye
- Associated with lacrimation and lid swelling
- Rhinorrhoea
what are two eyes signs that may be present in cluster headaches
Miosis
Ptosis
how long do episodes usually occur
150-180 minutes
when are episodes more common
Night-time
how long do clusters usually last
Usually last 2-4W, then have several months without symptoms
how may patient present during a cluster attack
Irritable and agitated
how are cluster headaches managed acutely
- Short burst oxygen therapy: 15L via non-recreate for 15-20 minutes
- SC sumatriptan
explain short-burst oxygen therapy
15L is given for 15-20 minutes
what medication is given for acute cluster headaches
SC Sumatriptan
what is used for prophylaxis of cluster headaches
Verapamil
what is problem with cluster headaches
most disabling primary headache disorder
define trigeminal neuralgia
sharp intense stabbing pain over distribution of trigeminal nerve
which gender is trigeminal neuralgia more common
female
what is ‘classical’ trigeminal neuralgia
compression of trigeminal nerve due to adjacent structures
what structure most commonly compresses trigeminal nerve
superior cerebellar.a
what are other causes of trigeminal neuralgia
- Multiple Sclerosis
- Structural: arnold-chiari, tumour, cyst
- Ischaemia
what can trigger trigeminal neuralgia
Washing, shaving. brushing teeth, eating
explain presentation of trigeminal neuralgia
causes intense sharp-stabbing pain over distribution of the trigeminal nerve. Then later presents as burning
what divisions of trigeminal nerve are more commonly affected
Maxillary
Mandibular
why may face screw up in trigeminal neuralgia
Due to facial spasms
what is associated with trigeminal neuralgia
Suicidal Ideation
if a young female patient has bilateral trigeminal neuropathy, what is the likely cause
Multiple sclerosis
What investigation should always be ordered in trigeminal neuralgia and why
MRI - look for underlying lesion
What is assessed for in trigeminal neuralgia
Psychiatric assessment - for depression
What are red-flags for trigeminal neuralgia that indicate sinister cause
- Bilateral
- Skin Lesion
- Hearing Loss
- FH multiple sclerosis
- Onset before 40-years
- Pain in ophthalmic devision
- Sensory changes
- Optic neuritis
If no underlying sinister cause for trigeminal neuralgia, what is first-line
Carbamazepine
