9.2 headaches Flashcards
what are the differential diagnosis of acute?headache
vascular
- haemorrhage (subarachnoid, sub and extradural)
- thrombosis
infective
- meningitis
- encephalitis
- abscess
- temporal arteritis
opthalmic
- glaucoma
situational
- cough
- exertion
- coitus
what is the difference between a primary and a secondary headache?
primary = due to the headache itself, not another cause e.g migraine
secondary = headache is present with another condition e.g meningitis/sinusitis
what are the differential diagnosis of a chronic headache?
- migraine
- cluster headaches
- drug side effects
- tension headaches
- trigeminal neuralgia
- raised intracranial pressure
- temporal/giant cell arteritis
what are the red flag symptoms of headaches?
SNOOP
Systemic signs or disorders e.g hypertension Neurological symptoms Onset new or changed and patient >50yrs Onset in thunderclap presentation Papilloedema
what are the symptoms of a headache caused by a space occupying lesion?
gradual onset
progressive
associated neurological features
additional features of raised ICP
- early morning headache
- nausea and vomiting
- worse on coughing and bending
what are the SQITARS for migranes?
S - unilateral, often frontal Q - sudden or gradual onset, throbbing I - moderate T - 4-72 hours, may be cyclical A - photophobia R - sleep improves, mediation also S - aura and nausea and vomitting
what are the triggers for migraines?
food, sleep, stress
what are the SQITARS for tension type headaches?
S - bilateral frontal Q - squeezing, non pulsating I - less severe T - worse at end of day, chronic is 15+ a month A - stress, poor posture, lack of sleep R - analgesics S - mild nausea
over 50yrs = typical onset
what is medication overuse headache?
headache present on at least 15 days a month
regular overuse greater than 3 months of
- triptans or opioids for 10 days a month
- paracetamol, aspirin or NSAIDS on at least 15 days a month
- resolves after 2 months following discontinuation of medicine
- gets worse before it gets better
- often co existing with depression/sleep disturbance
what are the SQITARS for cluster headaches?
S - around/behind one eye Q - sharp, penetrating I - very severe and constant intensity T - rapid onset, 15mins-3hrs, 1-2 a day, nocturnal. Last 2-12 weeks, remission lasts 3mo-3yrs. A - head injury, alcohol, cigarettes R - no radiation S - red, watery eye, nasal congestion
onset is 20-40yrs
what are the SQITARS for trigeminal neuralgia?
S - unilateral, over the eye
Q - stabbing, sharp, electric shock
I - severe
T - sudden onset, lasts a few seconds-2mins
A - light touch to face eating, cold wind, vibrations
R - radiates to eyes, lips nose and scalp
S - numbness and tingling before attack
onset is 50-60
what can trigger a cluster headache?
alcohol, histamine, GTN, heat, exercise, solvents, lack of sleep
what is the pathophysiology of trigeminal neuralgia?
most cases caused by compression of trigeminal nerve by a vascular malformation
can be found to be caused by neurones or skull base anomalies
what investigations can be done for headaches?
dependant on cause e.g if subarachnoid haemorrhage then do a CT scan etc.
headache diary may be useful for chronic headaches
imaging if there are any red flags
what treatment can be given for headaches?
Dependant on underlying cause
simple analgesia
triptans for migraine
cluster headaches may respond to high flow oxygen
