4. Headaches Flashcards
What is a primary headache? What is the most common cause?
A primary headache is when there is no known underlying secondary pathology, with the most common example being migraines.
What is a secondary headache?
This is when there is a headache secondary to a clear pathological cause
What are some causes of secondary headaches?
- an underlying medical condition (ex. space occupying lesions in the head, intracranial hypertension, vasculitis/arteritis)
- Alcohol
- Head Injury
- Carbon Monoxide Poisoning
What can a patient do to help with a diagnosis of primary headaches?
They can keep a headache diary for at-least 8 weeks.
What information should be kept in a headache diary?
- Frequency, duration and severity of headaches
- Any associated symptoms
- All prescribed and over the counter medications taken to relieve headaches
- Possible triggers
- Relationship of headaches to menstruation
Answer the following questions for a tension-type headache.
Pain Location? Character? Intensity? Effect on activities? Associated symptoms? Duration? Frequency?
Location - Bilateral
Character - Pressing/tightening (non-pulsating) in a band like pattern around the head
Intensity - Mild to moderate
Effect on activities - not aggravated by routine activity / daily activity
Associated symptoms - None
Duration - Anywhere from 30 mins to continuous
Frequency - If less than 15 days per month, its episodic tension-type headache. If its 15 days or more per month for more than 3 months, its chronic tension-type headache
Answer the following questions for a migraine.
Pain Location? Character? Intensity? Effect on activities? Associated symptoms? Duration? Frequency?
Location - Unilateral or bilateral
Character - Pulsating (throbbing or banging in young people aged 12–17 years)
Intensity - Moderate or severe
Effect on activities - Aggravated by, or causes avoidance of, routine activities of daily living
Associated symptoms - Unusual sensitivity to light, sound, nausea and aura
Duration - 1-72 hours in 12-17 year olds, and 4-72 hours in adults
Frequency - If its less than 15 days per month, its episodic migraine (with or without aura). If its 15 days or more per month for more than 3 months, its chronic migraine (with or without aura)
Answer the following questions for a cluster headache.
Pain Location? Character? Intensity? Effect on activities? Associated symptoms? Duration?
Location - Unilateral (around the eye, above the eye and along the side of the head/face)
Character - Variable (can be sharp, boring, burning, throbbing or tightening)
Intensity - Severe or very severe
Effect on activities -
Restlessness or agitation
Associated symptoms - On the same side as the headache: - red and/or watery eye - nasal congestion and/or runny nose - swollen eyelid - forehead and facial sweating - constricted pupil and/or drooping eyelid
Duration - 15–180 minutes
What is aura?
Symptoms of aura
- can occur with or without headache
- are fully reversible
- develop over at least 5 minutes
- last 5-60 minutes
Typical aura symptoms include - visual symptoms such as flickering lights, spots or lines and/or partial loss of vision
- sensory symptoms such as numbness and/or pins and needles
- speech disturbance
What physiological event is believed to cause tension headaches?
muscle ache in the frontalis, temporalis and occipitalis muscles
What are tension headaches though to be caused by?
- Stress
- Depression
- Alcohol
- Skipping meals
- Dehydration
What is characteristic about cluster headaches in the context of timing?
Comes in clusters of attacks and then disappears for a while. For example, a patient may suffer 3 – 4 attacks a day for weeks or months followed by a pain free period lasting 1-2 years.
Who is the typical individual who suffers from cluster headaches?
A 30-50 year old made smoker
What brings up cluster headache attacks?
- Alcohol
- Strong smells
- Exercise
What else are cluster headaches known as, and why?
They are sometimes referred to as suicide headaches, as they are described as one of the most severe and intolerable pains in the world.
What are the symptoms of cluster headache?
Symptoms are typically all unilateral:
- Red, swollen and watering eye
- Pupil constriction (miosis)
- Eyelid drooping (ptosis)
- Nasal discharge
- Facial sweating
What are the different types of migraines?
- Migraine without aura
- Migraine with aura
- Silent migraine (migraine with aura but without a headache)
- Hemiplegic migraine
What percentage of migraine cases go undiagnosed?
50%
What percentage of migraine suffers report aura?
20-30%
What is a hemiplegic migraine?
It is a migraine, but mimics stroke. Therefore it is important to act fast and exclude a stroke
What are the symptoms/features of a hemiplegic migraine?
- Typical migraine symptoms
- Sudden or gradual onset
- Hemiplegia (unilateral weakness of the limbs)
- Ataxia
- Changes in consciousness
What are the triggers for a migraine?
- Stress
- Bright lights
- Strong smells
- Foods containing tyramine (e.g. chocolate, cheese, red wine and citrus fruits). This affects no more than 20% of migraine suffers
- Caffeine
- Dehydration
- Menstruation
- Abnormal sleep patterns
- Trauma
- Contraceptive pills
- Change in sleep pattern ie. jet lag
How does mensuration trigger a migraine?
Migraine may be precipitated by the fall in oestrogen concentration just prior to onset of menstruation.
Who are the combined contraceptive pills contraindicated in? Why?
The combined contraceptive pill is contraindicated in women who suffer migraine with aura, and for all women with migraine over the age of 35. This is due to potential increased risk of cardiovascular events (particularly ischaemic stroke).
What are the 5 stages of a migraine?
- Premonitory or prodromal stage (can begin 3 days before the headache)
- Aura (lasting up to 60 minutes)
- Headache stage (lasts 4-72 hours)
- Resolution stage (the headache can fade away or be relieved completely by vomiting or sleeping)
- Postdromal or recovery phase
How does sinusitis cause a headache?
Sinusitis causes a headache associated with inflammation in the ethmoidal, maxillary, frontal or sphenoidal sinuses.
Where abouts is the pain reported in sinusitits?
There is facial pain behind the nose, forehead and eyes. There is often tenderness over the effected sinus, which helps to establish the diagnosis.
How is sinusitis managed?
- Normally resolves itself within 2-3 weeks
- Most of the time its viral
- Nasal irrigation with saline can be helpful
- Prolonged symptoms can be treated with steroid nasal spray
- Antibiotics are occasionally required
What is an analgesic headache?
It is a secondary headache, caused by long term analgesia use.
Coming off the analgesia helps, but this is difficult to achieve in patients with chronic pain
How do individuals with analgesic headaches present?
Symptoms are similar non-specific features of a tension headache. This is a mild to moderate pain that is described as pressing/tightening (non-pulsating) in a band like pattern around the head.
What are hormonal headaches?
They are secondary headaches that are related to estrogen. They produce a generic, non-specific, tension-like headache.
When do hormonal headaches normally present?
Two days before and first three days of the menstrual period
Around the menopause
Pregnancy. It is worse in the first few weeks and improves in the last 6 months. Headaches in the second half of pregnancy should prompt investigation for pre-eclampsia.
What can improve hormonal headaches?
Oral combined contraceptive pill
What is cervical spondlyosis?
It causes a secondary headache, and is a condition caused by degenerative changes in the cervical spine
How does cervical spondylosis present? What other conditions have a similar presentation?
- Headache
- Neck pain
- Made worse by movement
Similar presentation to inflammation, malignancy and meningitis
What is trigeminal neuralgia?
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