Headache Flashcards
what are the subtypes of acute headache
- Vascular
- Infective/inflammatory
- Opthalmic
- Situational
give some vascular causes of headaches
- Haemmorage:
1. subarachnoid
2. subdural
3. extradural - Thrombosis
1. venous sinus thrombosis
give some infective causes for a headache
- Meningitis A&E
- Encephalitis A&E
- Abscess A&E
- Temporal arteritis A&E
give an opthalmic reason for a headache
glaucoma
build up of fluid, in front part of eye
what are some situational reasons for a headache
- Cough
- Exertion
- Coitus
what are three reasons for chronic headaches
- migrane
- cluster headaches
- tension headaches
what are cluster headaches
Drug side effects
* Analgesics
* Caffeine (particularly withdrawal)
* Vasodilators
what are examples of tension headaches
Trigeminal neuralgia (difficult to classify but probably secondary
due to a vascular anomaly)
Raised intracranial pressure (e.g. tumours) A&E
Temporal / giant cell arteritis A&E
Systemic
* Hypertension A&E
* Pre-eclampsia A&E
* Phaemochromocytoma – rare A&E
what history would you take with someone suffering from headaches
- SQUITARS
- triggers?
- PMH of headache
- drug history (cause headaches)
- FH: migrane with aura has heritability
- SH: stress, diet, hydration, caffeine
what are some examinations that need to be done when assessing a headache
Vital signs / obs
* E.g. raised ICP can cause bradycardia / hypotension.
Hypertension itself can cause headache
Neurological examination
* Full peripheral and cranial nerve
Other relevant systems as guided by history (e.g. if associated
feelings of faintness then examine CVS)
what are some red flag features of headaches
- systemic signs and disorders (meningitis or hypertension)
- neurological symptoms
- onset new >50 (malignancy)
- thunderclap presentation (vascular)
- papilloedema
what features fo headaches caused by space occupying lesions (tumoir) be caused from
o Gradual onset
o Progressive
o Associated neurological features
E.g. visual disturbance or focal signs o Additional features of raised ICP
Early morning headache
Nausea and vomiting
Worse on coughing and bending
what are the features of migranes
2% of population
females x2 males
early to mid life
severity decreases as age does
sight of migrane
frontal, unilateral
Quality of migranes
sudden or gradual
throbbing/pulsating
- moderate to severe
timing of migrane
4-72 hours, can have a cyclical character
aggravating factors of migrane
photophobia
phonophobia (loud noises)
-> cheese and chocolate
stress and lack of sleep
what helps relieve migrains
sleep
meds (triptans)
secondary characteristics of migrains
aura (shivering, visual loss, sensory loss)
nausea and vomiting
what is the pathophysiology of migranes
not sure but vasodialation
neurogenic inflammation of trigeminal sensory neurones innervating vessels and meningies
tension headache features
most common type
females> males
young>old
over 50s
site of tension headache
bilateral frontal
can radiate to neck
what is the pain described as in tension headaches
squeezing like a band and non-pulsatile
mild-moderate
what is the timing of tension headaches
- worse at end of day
- chronic > 15 times a month
- episodic <15 month
what are some aggravating factors that can cause tension headaches
- stress
- poor posture
- lack of sleep
what are some things that can releive a tension headache
analgesic
what is the pathophysiology of tension headache
tension in muscles of head and neck (occiputo-frontalis)
no family history
what are some features of medication overuse headaches
3rd most common
20% headaches are due to medication overuse
30-40
females
what are some clinical features of medical overuse headache
- 15 days of month
- no improvement after meds
- patient is using analgesic at least 10 days a month
- headache comes about in people taking analegisc meds for headache in first place
- co-exist with sleep and depressio.
managment of medication overuse headaches
stop meds
what is the pathophysiology of medication overuse headaches
upregulation of pain receptors
what are features of cluster headaches
1/1000
males
20-40 yr
site of cluster headaches
behind one eye and no radiation
what is the pain described as in cluster headaches
sharp and penetrating
(makes patient want to die, being stabbed
intensity of cluster headaches
severe and constantly intense
they will be very agitated
what is the timing in cluster headaches
rapid onset
15mins-3hrs and occur 1-2 times a day
night
2-12 weeks
remission 3months - 3years
what are aggravating factors of cluster headaches
head injury
alcohol and smoking
heat
exercise
lack of sleep
what can help in cluster headaches
analgesic
high flow oxygen
secondary symptoms with cluster headaches
red, water eye
nasal congestion
ptosis
what are features of trigeminal neuralgia
50-60
25/100000 uk population
females
what is the site of trigeminal neuralgia
unilateral, over one eye
radiates to lip, nose, eyes and scalp
what is the pain described in trigeminal neuralgia
sharp and stabbing
electric shock feeling
how intense is TN headache
severe
what is the timing of TN headache
sudden
last few seconds to minutes
What are aggrivating factors of TN
light touch to face
eating
cold winds
vibrations
relieveing factors of TN headaches
hard to alleviate
secondary symptoms of TN
numbness and tingling preceding an attack
pathophysiology of TN headache
- compression of trigeminal nerve by vascular malformation
- tumours, MS, skull base anomalies
- chronic pain
when do headaches need to be referred
Suspicion of a tumour
Suspicion of raised ICP
Recent onset seizures
Previous cancer
Unexplained focal deficit
Unexplained cognitive/personality changes
what are some examples of secondary headaches Vs primary
Primary
1. tension type
2. migraine
3. cluster
**Secondary **
1. space occupying lesion (tumour)
2. Intercranial haemmorage
3. meningitis
4. medication overuse headaceh
what does a space occupying lesion present as
temporal arteritis
what are some secondary causes of headaches that can cause vision loss too
glaucoma and giant cell (temporal) arteritis
