9. Headache Flashcards

1
Q

What are the 3 main primary headache disorders?

A

Tension headache
Migraine
Cluster headache

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2
Q

What are the main headaches secondary to another condition?

A
Intracranial lesion - tumour, haemorrhage 
Meningitis 
Giant cell arteritis 
Acute glaucoma 
Sinusitis
Medication-overuse headache
Trigeminal neuralgia 
Drug side effect
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3
Q

What are the red flags in headaches?

A

Systemic signs and disorders - meningitis, pregnancy, cancer
Neurological symptoms - SOL, ICH, glaucoma
Onset new or changes and patient >50 - malignancy, GCA
Onset in thunderclap presentation - vascular
Papilloedema, positional provocation, precipitated by exercise - ICP

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4
Q

What is the pathophysiology of tension-type headache?

A

Due to tension in muscles of head and neck

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5
Q

What is the presentation of tension-type headache?

A

Generalised - predilection for frontal and occipital regions
Tight/band-like constricting, radiating into neck
Mild-moderate intensity
Worse at end of day, recurrent
Often respond to simple analgesics

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6
Q

What is a possible pathology of migraine?

A

Neurogenic inflammation of trigeminal sensory neurones innervation large vessels and meninges
Alters way pain processed by brain, sensitised to otherwise ignored stimuli

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7
Q

What is the presentation of migraines?

A
Unilateral, temporal or frontal
Throbbing, pulsating
Moderate-severe, often disabling 
Prolonged - 4-72 hrs
Can respond to simple analgesics
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8
Q

What are the triggers of migraines?

A
Certain food
Menstrual cycle
Stress
Lack of sleep
Strong familial links
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9
Q

What is an medication over-use headache?

A

Headache present on at least 15 days/month

Occurs in patients with pre-existing headache disorder

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10
Q

What is the character of medication over-use headache?

A

Can be dull, tension-type or migraine-like

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11
Q

What is a risk factor of cluster headache?

A

Smoking history

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12
Q

What is the presentation of cluster headache?

A

Unilateral, around or behind eye
Sharp, stabbing, penetrating, often at night
Severe, intense, often disabling, agitated
15mins-3hrs, occurs in clusters (3months to 3 years apart)

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13
Q

What are possible triggers of cluster headaches?

A

Alcohol, cigarettes, volatile smells, warm temp, lack of sleep

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14
Q

What can be used to treat cluster headaches?

A

Simple analgesics often ineffective

Oxygen ad triptans used

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15
Q

What is the presentation of space-occupying lesions?

A

Gradual, progressive
Dull, but often variably described
May be mild in severity, worse in mornings
Worsened with posture, cough, valsalver manoeuvre

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16
Q

What other signs and symptoms may be present with space occupying lesion headaches?

A

Nausea
Vomiting
Focal neurological or visual symptoms

17
Q

What is the cause of trigeminal neuralgia?

A

Most caused by compression of CNV due to loop of blood vessel
5% due to tumours/skull base abnormality

18
Q

What is the presentation of trigeminal neuralgia?

A

Unilateral, pain felt in more than 1 division of CNV
Sharp stabbing electric shock
Severe, lasts few seconds-2mins
Sudden onset

19
Q

What can aggravate trigeminal neuralgia headaches?

A

Light touch to face/scalp, eating, cold wind, combing hair

20
Q

Which artery is commonly involved in temporal arteritis?

A

Superficial temporal artery

21
Q

What is the risk in temporal arteritis?

A

Risk of irreversible loss of vision due to involvement of blood vessels supplying optic nerve