Head & Face Flashcards
Which 6 serious conditions need to be considered in a presentation of head or face pain?
CAD Stroke / haemorrhage Myocardial ischaemia Hypertensive crisis Intra-cerebral tumour Meningitis
Which signs indicate meningitis?
Severe throbbing headache with nuchal rigidity and photophobia, underlying fever and malaise
- may have a rash
- may have nausea / vomiting / anorexia
- may have joint pain
What are the signs of a CAD?
- acute onset unilateral head and neck pain
- dizziness
- asymmetrical CN findings
- speech / vision changes
- tinnitus
- ataxia / decreased co-ordination
- unilateral neuro deficit in limbs
What are the 3 types of primary headaches?
Migraine
Tension type
Trigeminal Autonomic Cephalgias (cluster)
What are the features of a migraine
- moderate to severe pulsating pain
- unilateral
- one or more of photophobia, phonophobia, nausea
- may have aura
- episodes last 4-72 hours
What are the features of a cervicogenic headache
- unilateral ‘rams horn’ pain pattern
- pain can begin in neck and is aggravated by neck movements
- moderate to severe non-pulsating pain
- episodes last one hour to one week
What are the features of a tension type headache
- bilateral
- mild to moderate pain (tight / pressing / tension quality)
- pain radiates from neck, upper back or eyes
- pain not agg. by movement
- lasts minutes to days
What is the pathology of cervicogenic headaches?
Referred pain from the trigeminocervical nucleus (sensory afferents from C1-3 spinal nerves) refer pain to areas of head and neck innervated by trigeminal nerve
What are the features of trigeminal autonomic cephalgias (cluster) headaches?
- severe unilateral pain
- episodes of 15-180 minutes in clusters (from every second day to 8 daily)
- one or more of: lacrimation, rhinorrhea, oedema of eyelid, forehead or face, miosis / ptosis, restlessness
What is the pathology of trigeminal autonomic cephalgias (cluster) headaches?
- dysfunction of hypothalamus / biological clock
What is the proposed pathophysiology of migraine?
- pathology not fully understood
- increased activity of trigeminocervical nucleus
- increased SNS activity
- increased blood floow to head and face
What is the pharmacological treatment of migraines?
First line - triptans with one of NSAIDs and/or paracetemol; can use anti-emetic if nausea present
- aim of pharma is to constrict dilated arteries and reduce blood flow to head and face
What is the pharmacological treatment of tension type headaches?
analgesics
What are the diagnostic criteria for a tension type headache?
10 or more attacks
consisting of 2 or more of: bilateral, pressure, mild to moderate pain, not aggravated by movement
no nausea
0-1 of photophobia or phonophobia
What is the pharmacological management of trigeminal autonomic cephalgias (cluster) headaches?
- during attack: 02
- preventive: triptans, corticosteroid
Other management:
- regular sleep cycles
- avoid triggers during cluster periods (anything that causes vasodilation ie: alcohol, heat, strenuous activity, stress)
What can act as a trigger for trigeminal autonomic cephalgias (cluster) headaches?
Anything that increases vasodilation:
- alcohol
- heat
- strenuous activity
- stress
- nitroglycerines (in CVD medication)
Also: disruption to sleep cycle
What are some common PROMs to use for headaches?
HIT-6 (Headache Impact Test)
HDI (Headache Disability Index)
MIDAS (Migraine Disability Assessment Test)
What are 4 common triggers for headaches?
Stress
Depression
Exertion
Posture
What are 8 common causes of iatrogenic headaches?
Alcohol Caffeine Nicotine Analgesics (aspirin, codeine, paracetemol) Antibiotics Combined COCP Vasodilators Substance use or withdrawal
What are 6 common causes of secondary headache?
URTI / sinusitis TMJ / dental disorder Eye disorder Trigeminal neuralgia Anaemia Metabolic disorders (thyroid / diabetes)
What are the 4 major types of unilateral headache?
CAD
migraine
cervicogenic
cluster
What are the 4 major types of bilateral headache?
Meningitis
Sinusitis
Hypertensive crisis
Tension type
Describe the presentation of a hypertensive crisis
- headache caused by a sudden severe increase in BP (180/120 or above)
- emergency: can cause a stroke
- bilateral severe pulsating pain
- SOB / dyspnoea
- blurred vision
- nausea / vomiting
- anxiety / confusion
- dizziness / vertigo
- seizures / loss of consciousness
- may have chest pain
Risk factors:
- CV disease or risk factors
- forgetting to take BP medication
- use of cocaine / amphetamines / stimulants
- kidney disease
Findings:
BP 180/120 or above
Describe the presentation of sinusitis
- tightness / pressure / throbbing pain over the frontal, orbital and maxillary regions
- accompanied by rhinorrhea, nasal congestion
- may be accompanied by fever, fatigue, unwellness
- typically occurs after a viral URTI / cold
Findings:
- pain aggravated by bending forward or lying down
- tenderness on palpation of paranasal sinuses
