9. Headache Flashcards
What are the 3 main primary headache disorders?
Tension headache
Migraine
Cluster headache
What are the main headaches secondary to another condition?
Intracranial lesion - tumour, haemorrhage Meningitis Giant cell arteritis Acute glaucoma Sinusitis Medication-overuse headache Trigeminal neuralgia Drug side effect
What are the red flags in headaches?
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
What is the pathophysiology of tension-type headache?
Due to tension in muscles of head and neck
What is the presentation of tension-type headache?
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
What is a possible pathology of migraine?
Neurogenic inflammation of trigeminal sensory neurones innervation large vessels and meninges
Alters way pain processed by brain, sensitised to otherwise ignored stimuli
What is the presentation of migraines?
Unilateral, temporal or frontal Throbbing, pulsating Moderate-severe, often disabling Prolonged - 4-72 hrs Can respond to simple analgesics
What are the triggers of migraines?
Certain food Menstrual cycle Stress Lack of sleep Strong familial links
What is an medication over-use headache?
Headache present on at least 15 days/month
Occurs in patients with pre-existing headache disorder
What is the character of medication over-use headache?
Can be dull, tension-type or migraine-like
What is a risk factor of cluster headache?
Smoking history
What is the presentation of cluster headache?
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)
What are possible triggers of cluster headaches?
Alcohol, cigarettes, volatile smells, warm temp, lack of sleep
What can be used to treat cluster headaches?
Simple analgesics often ineffective
Oxygen ad triptans used
What is the presentation of space-occupying lesions?
Gradual, progressive
Dull, but often variably described
May be mild in severity, worse in mornings
Worsened with posture, cough, valsalver manoeuvre