Case 4 - Headaches Flashcards
What are the 2 main types of headaches?
- Primary
- Secondary
What are the 3 types of primary headaches?
- Tension
- Cluster
- Migraine
What is the site of tension headache?
Band around the forehead (bilateral)
What is the site of cluster headache?
Peri-orbital pain (unilateral)
What is the site of migraine?
Variable (unilateral/bilateral- usually unilateral)
What is the onset of tension headache?
Worsens at the end of the day with stress
What is the onset of cluster headache?
Occurs at night during sleep
What is the onset of migraine?
In bright light / Related to periods - can be variable
What is the character of tension headache?
Dull, aching, persistent, tightening, pressing
What is the character of cluster headache?
Sharp, stabbing, excruciating
What is the character of migraine?
Pulsatile/throbbing,
What is the frequency/duration of tension headache?
30 min to 7 days
3 - 4 attack/week to 1 - 2 attacks/year
What is the frequency/duration of cluster headache?
15 - 180 mins/attack
1 - 8 attacks/day for 3 - 16 weeks
1 - 2 bouts/year
What is the frequency/duration of migraine?
2 - 72 hours/attack
1 attack/year to >8 per month
What are the associated symptoms with tension headache?
- Mild photophobia
- Mild phonophobia
- Anorexia
What are the associated symptoms with cluster headache?
- Sweating
- Facial flushing
- Nasal congestion
- Ptosis
- Lacrimation
- Conjunctival injection
- Pupillary changes
What are the associated symptoms with migraine?
- Visual aura
- Phonophobia
- Photophobia
- Pallor
- Nausea/vomiting
What are the risk factors for tension headaches?
- Mental tension
- Stress
- Missing meals
- Fatigue
- Female
- Family history
What are the risk factors for cluster headaches?
- Males
- Heavy smoking
- Heavy drinking
How to treat tension headache?
Acute - analgesics (paracetamol, ibuporfen)
Prophylactic - Amitriptyline
How to treat tension headache?
Acute - analgesics (paracetamol, ibuprofen)
Prophylactic - Amitriptyline
How to treat menstrual migraines?
- Occur prior to menstruation due to fall in oestrogen levels.
- May benefit from transdermal oestrogen patches 3 days before menstruation.
What is needed for diagnosis of cluster headaches?
At least 1 autonomic pain feature:
- conjunctival injection
- Facial sweating
- Lacrimation
- Redness
- Nasal stuffiness
- Eyelid and facial swelling
How to treat mild/moderate migraines?
- NSAIDs (paracetamol, ibuprofen)
- Don’t give opiates as it increases N+V