Headache Flashcards by Kayla Halliwell

What are the types of headaches?

Primary- No underlying medical cause
Secondary- identifiable cause

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What are examples of primary headaches?

Tension type headache
Migraine
Cluster headache

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What are examples of secondary headaches?

Tumour
Meningitis
Vascular disorders
Systemic infection
Head injury
Drug induced

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What is the treatment basis for primary headache?

Modify lifestyle
Abortive treatment
Transitional treatment
Preventative treatment

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What is tension type headache?

Most frequent primary headache
Not disabling

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What is the treatment of tension type headache?

Acute: paracetamol, NSAIDs
Prevention: Tricyclic antidepressant

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What does a rapid onset headache suggest?

SAH
Meningitis
Encephalitis

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What does gradual onset headache suggest?

Venous sinus thrombosis
Sinusitis
Tropical illness
Intracranial hypotension

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What is migraine?

Most frequent DISABLING primary headache

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What are the symptoms of migraine?

Headache
Nausea
Photophobia (light)
Phonophobia (sound)
Functional disability

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What are the features of migraine?

Premonitory
Aura
Early headache
Advanced headache
Postdrome

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What is aura?

Transient neurological symptoms resulting from cortical or brainstem dysfunction
- Visual
- Somatosensory
- Motor
- Speech

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What are the features of visual aura?

Chaotic distorting
Jumbling of lines
Hemianopia

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What are the features of somatosensory aura?

Paraesthesia

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What are the features of motor aura?

Dysarthria
Ataxia
Ophthalmoplegia
Hemiparesis

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What are the causes of migraine?

CHOCOLATE
C- hocolate
H- angovers
O- rgasms
C- heese/caffeine
O- ral contraceptives
L- ie-ins
A- lcohol
T- ravel
E- xercise

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What is the lifestyle treatment for migraine?

Stress
Hunger
Sleep disturbance
Dehydration
Diet
Environmental stimuli
Changes in oestrogen levels in women

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What is the acute treatment for migraine?

Oral triptan + paracetamol or NSAID (aspirin)
Anti emetics

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What is the prophylactic treatment of migraine?

Propranolol, Candersartan
Anti-epileptics
Tricyclic antidepressants
Flunarizine
Botox
CGRP monoclonal antibodies

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What is MOH?

Headache present on >15 days/month which has developed or worsened whist taking regular symptom meds
Can occur in any primary headache

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What are the common culprits in MOH?

Mixed analgesics: paracetamol + codeine/opiates
Ergotamine
Triptans

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What is cranial neuralgia?

Secondary headache caused by irritation of the nerves that mediate sensation in the head:
Intense burning or stabbing pain

What is the most common type of cranial neuralgia?

Trigeminal neuralgia
Unilateral pain in maxillary or mandibular division

What is the common cause of trigeminal neuralgia?

Vascular compression of the trigeminal nerve

What is the medical treatment of trigeminal neuralgia?

- Carbamazepine - Oxcarbazepine - Lamotrigine

What is the surgical treatment of trigeminal neuralgia?

- Glycerol ganglion injection - Stereotactic radiosurgery - Microvascular decompression

What are Trigeminal Autonomic Cephalalgias (TACs)?

Primary headaches characterized by severe unilateral head pain, typically trigeminal distribution, with ipsilateral cranial autonomic symptoms

What are the types of TACs?

Cluster headache Paroxysmal Hemicrania/ Hemicrania continua SUNCT/SUNA

What is SUNCT?

Short lasting unilateral neuralgiform headache with Conjunctival injection and Tearing

What is SUNA?

Short lasting Unilateral Neuralgiform headache with Autonomic Symptoms

What are the main characteristics of TACs?

Strictly unilateral pain Predominantly V1 Excruciating pain Cranial autonomic symptoms - Conjunctival lacrimation - Nasal congestion - Eyelid oedema - Forehead and facial swelling - Miosis/ptosis (Horner’s) Restless

What is the attack frequency and duration of cluster headache?

1-8 daily 15-180 mins

What is the attack frequency and duration of paroxysmal hemicrania?

1-40 daily 2-30 mins

What is the attack frequency and duration of SUNCT?

3-200 5-240 secs

Where is the pain in cluster headache?

Orbital and temporal

Where is the pain in Hemicrania?

Orbital and temporal

Where is the pain in SUNCT/SUNA?

Orbital Supraorbital Temporal

What is the treatment for cluster headaches?

Abortive: s/c triptans, oxygen Transitional: oral prednisolone taper, greater occipital block Preventative: verapamil, lithium, melatonin

What is the treatment of Hemicrania?

Absolute response to indomethacin (NSAID)

What is the treatment of SUNCT/SUNA?

Abortive: lamotrigine, carbamazepine Transitional: GO block Surgical: occipital nerve stimulation

What are examples of sinister secondary headaches?

- Head injury - First or worst - Sudden thunderclap onset - New daily persistent headache - Change in headache pattern or type - Returning patient

What are specific secondary headache patterns?

Thunderclap (SAH) Meningitis and encephalitis High pressure Low pressure Giant cell arteritis

What is thunderclap headache?

High intensity headache reaching maximum intensity in less than 1 minute Aneurysmal rupture and bleeding into subarachnoid space

What is the treatment of subarachnoid haemorrhage?

Early treatment of aneurysm: coiling/clipping Nimodipine- CCB for vasospasm Treat complications HHH therapy - Hydration - Hyperoxia - Hypertension

What are the symptoms of meningitis headache?

Nausea Vomiting Photophobia Phonophobia Stiff neck

What are the symptoms of encephalitis headache?

Altered mental state/consciousness, Seizures Look for a rash

What are the symptoms of high-pressure headache?

- Headache wakens patient up - Cough or other Valsalva headache - Visual obscuration's, pulsatile tinnitus - Seizures - Progressive focal symptoms - Cognitive changes - Drowsiness - Loss of consciousness - Papilledema

What can cause high pressure headache?

Space occupying lesion e.g. tumour Brain swelling e.g. infection Raised CSF pressure e.g. hydrocephalus, intracranial HTN

What are the features of low- pressure headache?

Postural Venous enlargement Subdural hygromas

What is giant cell arteritis?

Inflammation of large arteries

What are the features of giant cell arteritis?

Non specific headache Scalp tenderness Jaw claudication Visual disturbance Prominent, beaded or enlarged temporal arteries Patient may be systemically unwell Elevated ESR Raised CRP and platelet count

When should giant cell arteritis be considered?

In any patient >50 years presenting with new headache

What is the treatment of giant cell arteritis?

High dose prednisolone immediately Temporal artery ultrasound and biopsy

What is the complication of untreated giant cell arteritis?

Complete loss of vision or stroke