Headache Flashcards
Where are pain receptors in brain?
-Almost none in brain substance itself
BUT
-In brain base, arteries, meninges, veins, scalp, muscles, sinuses, eyes and teeth
Types of headache?
Primary: migraine
Secondary: ICP or meningitis
Red flags for headaches?
- Any new onset headache in someone over 55
- Anyone with know/previous malignancy
- Anyone immunocompromised
- Early morning headache
- Assoc with nausea and vomiting
- Headache that wakes you
- Headache that is exacerbated by Valsalva manoeuvre
What is migraine?
Most common cause of episodic headache
Who gets migraines?
More common in women
Pathogenesis of migraine?
Primary neurogenic as opposed to vascular
Activation of trigeminal pain neurons
Diagnostic criteria for migraines?
- Headache lasting 4-72 hours in adults
- Unilateral pain
- Moderate or sever pain intensity
- Aggravation by routine activities (walking, climbing stairs)
- 1 of nausea and or vomiting OR photophobia
25% of people with migraine experience?
AURAS
-Visual eg scotomas, central fortification, hemianopia, sensory or motor disturbances
Auras usually last?
20-60 minutes
Triggers of migraine?
- Sleep deprivation
- Skipping meals
- Alcohol
- Hormones
- Physical exertion
Acute abortive treatments for migraines
-High dose NSAIDs (naproxen, triptans)
Supportive medication can be used for migraine episodes suhc as?
Amitriptyline - 1st line
Propranolol - 2nd line
Topiramate - 3rd line
What is tension headache?
Classic everyday headache
-Bilateral pain, tight band sensations, pressure behind the eyes, bursting sensation
Who gets cluster headaches?
Males aged between 20-40
Presnetation of cluster headache?
Excruciating unilateral headache with PS autonomic activation in sam e eye causing redness or tearing, nasal congestion or eveen transient Horner’s
Frequency of cluster headaches?
1-8 a day
Last 45-90 minutes
Bouts of 1-2 months
Acute treatment for clusters?
Oxygen 100% high flow
SC sumatriptan
Verapamil of steroids may help terminated bot of these
What is SUNCT?
Short Lasting Unilateral Neuralgiform Headache
with conjunctival injection and tearing
Attacks are v short lasting 5 seconds to 2 mins and in bouts
Treatment of SUNCT?
IV lidocaine for acute
Lamotrigine/gabapentin for prevention
Secondary headache disorders example?
Idiopathic intracranial HT
Trigeminal neuralgia
What does idiopathic intracranial HT result from?
Reduced CSF resorption
Who does idiopathic intracranial HT develop in typically?
Young
Overweight females
With Polycystic ovaries
Features of IIH?
Headache worse in morning
Headache with N&V
Headache with visual obscurations due to Papilloedema
Investigation for IIH?
MRI
Lumbar puncture: elevated CSF pressure but normal constituents
Treatment of IIH?
-Involves monitoring visual fields
Encouraging weight loss
Acetazolamide
Thiazide diuretics
What is sometimes necessary treatment of IIH?
Ventriculoperitoneal shunt insertion
Optic nerve sheath fenestration to protect vision
Who gets trigeminal neuralgia?
More common in elderly and HT main risk factor
What is trigeminal neuralgia due to?
Compression of trigeminal nerve or near the pons by ectatic vascular loop
What does trigeminal neuralgia cause?
Severe sharp, stabbing unilateral pain in 5th nerve distribution lasting seconds but attacks can occur 10-100x a day
What trivial stimuli can cause trigeminal neuralgia?
Washing, shaving, chewing
Treatment of trigeminal neuralgia?
Carbamazepine reduces severity of attacks, can do ablation or decompression of the blood vessel if very severe
