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Year 3 TCD > 4. Headaches > Flashcards

4. Headaches Flashcards

1
Q

What is a primary headache? What is the most common cause?

A

A primary headache is when there is no known underlying secondary pathology, with the most common example being migraines.

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2
Q

What is a secondary headache?

A

This is when there is a headache secondary to a clear pathological cause

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3
Q

What are some causes of secondary headaches?

A
  • an underlying medical condition (ex. space occupying lesions in the head, intracranial hypertension, vasculitis/arteritis)
  • Alcohol
  • Head Injury
  • Carbon Monoxide Poisoning
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4
Q

What can a patient do to help with a diagnosis of primary headaches?

A

They can keep a headache diary for at-least 8 weeks.

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5
Q

What information should be kept in a headache diary?

A
  • 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
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6
Q

Answer the following questions for a tension-type headache.

Pain Location? Character? Intensity? Effect on activities? Associated symptoms? Duration? Frequency?

A

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

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7
Q

Answer the following questions for a migraine.

Pain Location? Character? Intensity? Effect on activities? Associated symptoms? Duration? Frequency?

A

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)

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8
Q

Answer the following questions for a cluster headache.

Pain Location? Character? Intensity? Effect on activities? Associated symptoms? Duration?

A

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

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9
Q

What is aura?

A

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
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10
Q

What physiological event is believed to cause tension headaches?

A

muscle ache in the frontalis, temporalis and occipitalis muscles

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11
Q

What are tension headaches though to be caused by?

A
  • Stress
  • Depression
  • Alcohol
  • Skipping meals
  • Dehydration
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12
Q

What is characteristic about cluster headaches in the context of timing?

A

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.

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13
Q

Who is the typical individual who suffers from cluster headaches?

A

A 30-50 year old made smoker

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14
Q

What brings up cluster headache attacks?

A
  • Alcohol
  • Strong smells
  • Exercise
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15
Q

What else are cluster headaches known as, and why?

A

They are sometimes referred to as suicide headaches, as they are described as one of the most severe and intolerable pains in the world.

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16
Q

What are the symptoms of cluster headache?

A

Symptoms are typically all unilateral:

  • Red, swollen and watering eye
  • Pupil constriction (miosis)
  • Eyelid drooping (ptosis)
  • Nasal discharge
  • Facial sweating
17
Q

What are the different types of migraines?

A
  • Migraine without aura
  • Migraine with aura
  • Silent migraine (migraine with aura but without a headache)
  • Hemiplegic migraine
18
Q

What percentage of migraine cases go undiagnosed?

A

50%

19
Q

What percentage of migraine suffers report aura?

A

20-30%

20
Q

What is a hemiplegic migraine?

A

It is a migraine, but mimics stroke. Therefore it is important to act fast and exclude a stroke

21
Q

What are the symptoms/features of a hemiplegic migraine?

A
  • Typical migraine symptoms
  • Sudden or gradual onset
  • Hemiplegia (unilateral weakness of the limbs)
  • Ataxia
  • Changes in consciousness
22
Q

What are the triggers for a migraine?

A
  • 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
23
Q

How does mensuration trigger a migraine?

A

Migraine may be precipitated by the fall in oestrogen concentration just prior to onset of menstruation.

24
Q

Who are the combined contraceptive pills contraindicated in? Why?

A

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).

25
Q

What are the 5 stages of a migraine?

A
  1. Premonitory or prodromal stage (can begin 3 days before the headache)
  2. Aura (lasting up to 60 minutes)
  3. Headache stage (lasts 4-72 hours)
  4. Resolution stage (the headache can fade away or be relieved completely by vomiting or sleeping)
  5. Postdromal or recovery phase
26
Q

How does sinusitis cause a headache?

A

Sinusitis causes a headache associated with inflammation in the ethmoidal, maxillary, frontal or sphenoidal sinuses.

27
Q

Where abouts is the pain reported in sinusitits?

A

There is facial pain behind the nose, forehead and eyes. There is often tenderness over the effected sinus, which helps to establish the diagnosis.

28
Q

How is sinusitis managed?

A
  • 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
29
Q

What is an analgesic headache?

A

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

30
Q

How do individuals with analgesic headaches present?

A

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.

31
Q

What are hormonal headaches?

A

They are secondary headaches that are related to estrogen. They produce a generic, non-specific, tension-like headache.

32
Q

When do hormonal headaches normally present?

A

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.

33
Q

What can improve hormonal headaches?

A

Oral combined contraceptive pill

34
Q

What is cervical spondlyosis?

A

It causes a secondary headache, and is a condition caused by degenerative changes in the cervical spine

35
Q

How does cervical spondylosis present? What other conditions have a similar presentation?

A
  • Headache
  • Neck pain
  • Made worse by movement

Similar presentation to inflammation, malignancy and meningitis

36
Q

What is trigeminal neuralgia?

A

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37
Q

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A

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Year 3 TCD (36 decks)

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