Headache Flashcards
What are the different types of primary headache?
Migraine
Tension-type headache
Trigeminal autonomic cephalalgias:
- Cluster Headache
What are secondary headaches?
Headaches precipitated by another condition/disorder - can be local or systemic
What types of headaches are long-lasting headaches?
Duration >4 hours
- Migraine
- Tension-type headache
What types of headaches are short-lasting headaches?
Duration <4 hours
- Trigeminal autonomic cephalalgias - Cluster headache
What other type of headache can fall under long-lasting headache?
Medication overuse headache
Headache from pain relief overuse
Outline the clinical approach to headaches
History and examination:
Red flag present?
- If no, go down primary headache route
- If yes, go down secondary headache route and carry out diagnostic tests
What are four key red flags suggesting secondary headache?
Age: New onset or different headaches in a person >50 years
Onset: Sudden, abrupt onset of a severe headache (thunderclap headache)
Systemic symptoms: Fever, neck stiffness, rash, weight loss
Neurological signs: Confusion, impaired consciousness, focal neurology, swollen optic discs
What are the characteristics of a migraine?
Episodic/chronic disorder
Unilateral location
Pulsating quality
Moderate or severe pain intensity
Aggravation by routine physical activity
Lasts hours and sometimes days
What other symptoms are migraines often associated with?
Nausea and/or vomiting
Photophobia and/or phonophobia
What is an aura?
Complex array of symptoms reflecting focal cortical or brainstem dysfunction
Both positive and negative symptoms - e.g. black spots (negative)
When do auras usually occur and how long do they last for?
Usually before a headache
Gradual evolution: 5-30 mins (<60 minutes)
What does this image show and what condition is it associated with?
Expanding ‘C’s
Migraine with aura
What are the phases of a migraine?
Premonitory
Aura
Headache
Resolution
Recovery
What may occur in the premonitory phase of a migraine?
Yawning
Polyuria
Mood changes
Irritability
Light sensitivity
Neck pain
Concentration difficulty
What may occur in the aura phase of a migraine?
Visual changes
Sensory aura - numbness, paraesthesia
Weakness
Speech arrest
What may occur in the headache phase of a migraine?
Head and body pain
Nausea
Photophobia
What happens in the resolution phase of a migraine?
Rest and sleep
What happens in the recovery phase of a migraine?
Mood disturbed
Food intolerance
Feeling hungover
Can take up to 48 hours
Describe lifestyle management of migraines
- Avoid triggers - e.g. certain foods - cheese, red wine
- Diet, sleep, exercise - having a regular schedule may help prevent migraines
- Mindfulness
What are the two types of pharmacological therapy for migraines?
Acute/abortive
Long term preventative
Give examples of acute/abortive management of migraines
Paracetamol
NSAIDs (high dose & soluble)
Prokinetics (typically anti-emetics) - Increases gut motility during migraines - can provide relief
Triptans (5-HT (serotonin) receptor agonists)
When is long term preventative management of migraines considered and how is it administered?
Migraines >/= 5 days/month
“Low and slow” approach with doses until optimal dose is reached
How do patients typically describe tension type headaches?
Tight muscles around the head and neck, as though head is in a vice
Describe the features of a tension type headache
Tends to last around 30 mins but can be longer
Bilateral
Mild/moderate
Not aggravated by movement
What features are typically absent in a tension type headache?
Nausea/vomiting
Photophobia/phonophobia
What are the treatments for tension type headaches?
Reassurance may suffice with majority of patients
Can be treated with analgesics, e.g. aspirin or paracetamol
Preventative measures rarely required
Describe the nature and frequency of cluster headaches
Severe unilateral pain (never bilateral)
Lasts 15-180 minutes if untreated
1-3 attacks per day (up to 8) and usually daily for 2-3 months at a time
What other symptoms are cluster headaches associated with?
At least one of the following ipsilaterally:
- Conjunctival redness and/or lacrimation
- Nasal congestion and/or rhinorrhoea
- Eyelid oedema
Forehead and facial sweating
Miosis and/or ptosis
Restlessness/agitation
Not associated with a brain lesion on MRI
What are the acute treatments for cluster headaches?
Triptans - nasal or subcutaneous
High flow oxygen - oxygen inhibits neural activation in trigeminocervical complex
What are the preventative treatments for cluster headaches?
Verapamil (calcium channel inhibitor)
- Must get an ECG first - contraindicated in patients with heart block etc
Greater occipital nerve block
Compare the different types of headache
