headache Flashcards
What are the 2 types of headaches?
Primary, secondary
Give examples for primary headaches
Migraine
Tension type headaches
Trigeminal autonomic cephalgias (cluster headaches)
What are secondary headaches?
Headaches that are precipitated by another condition/ disorder- local or systemic
Serious causes of secondary headache are uncommon
How do you classify primary headaches based on duration?
Short lasting (<4 hours)
Long lasting (>4 hours)
Give examples for short lasting primary headaches
cluster headaches
Give examples for long lasting primary headaches
Migraine, tension type headaches, medication overuse headaches
What 4 red flags suggest secondary headaches?
Age- new onset/ different headache in a person >50 years
Onset- sudden, severe headache (thunderclap)
Systemic symptoms (fever, rash, neck stiffness weight loss, light sensitivity)
Neurological signs- impaired consciousness, confusion, focal neurology, swollen optic discs
Draw out the central hypothesis pathophysiology for migraine
you had better have done it
Are migraines episodic or chronic?
Either
What are migraine signs and symptoms
Unilateral pain- can be bilateral
pulsating pain
moderate/ sever intensity
last hours/ days (usually 4-72 hours)
aggravated by routine physical activity
usually associated with one or more of the following- nausea and/ or vomiting, photophobia and/ or phonophobia
+/- auras
What are auras?
Complex array of symptoms reflecting focal cortical/ brainstem dysfunction
gradual evolution: 5-30 minutes (<60 minutes)
Usually precedes a migraine
What are symptoms of auras?
expanding Cs
elemental visual disturbance
What are the phases of a migraine?
Premonitary- yawning, polyuria, mood changes, irritability, difficulty concentrating, light sensitivity, neck pain
Aura- visual/ sensory (numbness, parasthesia), weakness, speech arrest
Migraine- head and body pain, light sensitivity, nausea/ vomiting
Resolution- rest and sleep
Recovery- mood changes, food intolerance, feeling hungover, can last unto 48 hours
What are the two ways in which migraines are managed?
lifestyle changes
pharmacological therapy
What are the lifestyle-related treatments for migraine
Avoiding triggers, diet, exercise, sleep, mindfulness
What are the two approaches to pharmacological management of migraine
Acute/ abortive- hard and fast, paracetamol, NSAIDS (high dose and soluble), pro kinetics, triptans (5HT 1B/1D/1F receptor agonists)
Long term preventative- >=5 days a month, low and slow with doses till you find the optimal dose
What analgesics should be avoided in migraine?
Opiate-based and mixed analgesics
Types of migraine preventatives
Beta blockers
Calcium channel blockers
Tricyclic antidepressants
SNRIs
Serotonin antagonists
Anti-convulsants
ACEi/ARBs
Non prescription
Parenteral
CGRP Antibodies – new medications on the block for preventing migraine!
Are tension type headaches episodic or chronic
Episodic
What are the symptoms of a tension type headache?
Bilateral
Feels like: tight muscles around head an neck, like head is in a vice
Mild/ Moderate
Not aggravated by routine physical activity
No associated symptoms of nausea/ vomiting or photophobia/phonophobia
lasts 30 minutes but can last hours- days
How are tension type headaches treated?
Reassurance may suffice in the majority of patients.
Individual attacks can be treated with simple analgesics such as Aspirin or Paracetamol.
Preventative medications rarely required
Signs/ symptoms of cluster headaches
Unilateral (ALWAYS)
severe pain
last 15-180 minutes
associated with one/ more of the following ipsilaterally: eyelid oedema, conjunctival redness/ lacrimation, nasal congestion/ rhinorrhoea
can have facial/ forehead sweating, miosis/ ptosis, restlessness
not associated with a brain lesion on MRI
How are cluster headaches treated acutely?
Triptan. Nasal or subcutaneous route
High flow oxygen. Oxygen inhibits neuronal activation in the trigeminocervical complex
What are preventative treatments for cluster headaches?
Verapamil (Calcium channel inhibitor)- Get an ECG first!
Greater occipital nerve block
Migraine attack frequency
1-2 attacks per month
Cluster headache frequency
1-3 attacks per day can be upto 8, usually occur daily for 2-3 months at a time
