1b// Headaches Flashcards
How are headaches classified?
Primary headache syndromes
secondary headaches
What are primary headaches?
long lasting:
- migraine
- tension-type headache
- medication overuse headache
short lasting:
- trigerminal autonomic cephalagia
- cluster headahce
What are secondary headaches?
Headache is spercipitated by another condition / disorder - local os systemic. Serious causes of secondary headache are uncommon.
Describe the clinical approach to headaches.
What are the 4 key red flags suggesting secondary headache?
age: new onset or different headaches in a person over 50
onset: sudden, abrupt onset of a severe headache (thunderclap headache)
systemic symptoms: fever, neck stiffness, rash, weight loss
neurological signs: confusion, impaired consciousness, focal neurology, swollen optin discs
Describe migraine central hypothesis pathophysiology.
probably not in exam
What type of migraine issue can you have?
episodic or chronic (10/15+ a month)
What are the characteristics of migraines? (5)
- Unilateral location
- Pulsating quality
- Moderate or severe pain intensity
- Aggravation by routine physical activity
- Last hours and sometimes days
What are the symptoms of migraines?
nausea and/or vomiting
photophobia and/or phonophobia
+/- auras
What is an aura and when do they occur and how long do they last?
sensory disturbance
Complex array of symptoms reflecting focal cortical or brainstem dysfunction
Gradual evolution: 5-30minutes (<60minutes)
Usually before headache (migraine)
What do you see/ experience during auras?
expanding Cs
elemental visual disturbances
What are the pahses of migraines?
premonitory
aura
headache
resolution
recovery
What is the premonitory phase of a migraine?
yawning, polyuria, mood change, irritable, light sensitive, neck pain, concentration difficulty
What is the aura phase of a migraine?
Visual, sensory (numbness/paraesthesia), weakness, speech arrest
What is the headache phase of migraines?
head and body pain, nausea, photophobia
What is the resolution phase of a migraine?
rest and sleep
What is the recovery phase of migraines?
mood disturbed, food intolerance, feeling hungover Can take up to 48 hours
what is papilloedema?
optic disk swelling due to raised ICP
What are the management types ofr migraines?
lifestyle
pharmacological therapy= acute/ aborative or long term preventative
What are the lifestyle management advice for migraines? (5)
Avoid triggers
Diet
Sleep
Exercise
Mindfulness
What is the acute/ aborative management of migraines? (4)
- Paracetamol
- NSAIDs (high dose & soluble)
- Prokinetics
- Triptans (5-HT1B/1D/1F receptor
agonists)
hard and fast
What are the long term preventative therapies for migraines? And what should be avoided?
> 5 days/month
“low and slow” with
doses until at optimal dose
Opiate-based and mixed analgesics should be avoided.
What are the types of medications you can give for migraine prevention?
Tricyclic anti-depressants (TCA):
Serotonin and norepinephrine reuptake inhibitors (SNRIs):
Β-blockers
Serotonin antagonists
Anticonvulsants
Calcium Channel blockers
Angiotensin-converting enzyme inhibitor Angiotensin II receptor blockers
Parenteral
CGRP antibodies- new medications on the block for preventing migraines
Are tension type headaches chronic or episodic?
episodic
What do patients say tension tpye headaches usually feel like?
Tight muscles around head and neck, as though head is in a vice.
How long do tension type headaches last, and what is their severity? And where are they in the head
Lasts 30mins (but can be hours long):
– Bilateral
– Mild or moderate
Does movement aggrevate tension type headaches?
No
What are the added features of tension type headaches?
No added features typically
– No nausea or vomiting
– No photophobia or
phonophobia
What is the treatment of tension type headaches?
- Reassurance may suffice in the majority of patients.
- Individual attacks can be treated with simple analgesics
such as Aspirin or Paracetamol. - Preventative medications rarely required
What are cluster headaches and how long can they last?
severe unilateral pain (nop switching, but the next one can be on the other side)
last 15-180 mins if untreated
1-8x a day short but come in bursts
What must there at least be one of for cluster headaches?
At least one of the following, ipsilaterally:
- Conjunctival redness and/ or lacrimation
- Nasal congestion and/ or rhinorrhoea
- Eyelid oedema
What are other possible symptoms of cluster headaches? And what there must not be?
- Forehead and facial sweating
- Miosis and/ or ptosis
- A sense of restlessness or agitation
- Not associated with a brain lesion on MRI
What is the acute treatment for cluster headaches? and why?
Triptan. Nasal or subcutaneous route
High flow oxygen. Oxygen inhibits neuronal activation in the trigeminocervical complex
How do you prevent cluster headaches?
Verapamil (Calcium channel inhibitor)
- Get an ECG first!
Greater occipital nerve block
Are you happy with this table?
Y/ N
how do you investigate brain tumours?
head CT or MRI
typical SOCRATES for a migraine
S- unilateral
O- sudden recurrence/intensification of symptoms
C - pulsating/throbbing
R- none
A- nausea/vom, aura (lights, halluc), tingling, tinitis, paralysis, photophobia, phonophobia
T - 4-72 hrs
E - physical activity, foods, bad sleep, hormones
S - moderate/severe
lifestyle recommendations for migraines
dietary - fresh foods, avoid MSG takeaways hormonal - OCP drink plenty of water dont have late nights or oversleep avoid caffeine
what are positive and negative auras
positive - flashes, zigzags
negative - blindspots
what is the SOCRATES of a tension headache
S - generalised, bilateral O - gradual onset usually C - dull, tight band-like R - neck/shoulders A- pericranial muscle tenderness, NO NAUSEA/vomiting/photophobia etc T - 3-4hrs E - analgesics, rest S - moderate
SOCRATES for cluster headaches
S - strictly unilateral, behind eye common, usually same side each time
O- acute onset, same time of day
C - excruciating, steady pain
R - none
A - eye watering, nose blocked, ptosis, eye redness, sweating, restlessness (autonomic features), photophobia, phonophobia
T - 15min-3hr, same length each time, often nocturnal, come in clusters with long remissions
E -
S - worst pain ever experienced
