Headache Flashcards
What is the 1st most disabling conditions in people <50?
Migraines
What points should be asked determined taking a headache history?
- Can I classify the headache?
- Do I need to investigate?
- How do I explain the diagnosis?
- What are the patients expectations?
- What treatment is the most appropriate?
What is a ‘thunderclap’ headache?
Thunderclap headaches strike suddenly like a clap of thunder. The pain of these severe headaches peaks within 60 seconds.
They can warn of potentially life-threatening conditions — usually having to do with bleeding in and around the brain.
When taking a history headache, what questions should be asked regarding the pain?
- Pain onset
- Pain periodicity
- Associated features
Pain onset of headaches can be acute (seconds to minutes), evolving (hours to days) or chronic (weeks to months).
What can an acute onset indicate?
SAH / Intra-cerebral haemorrhage / coital / thunderclap
What is a coital headache?
Sex headaches are brought on by sexual activity — especially an orgasm. You may notice a dull ache in your head and neck that builds up as sexual excitement increases. Or, more commonly, you may experience a sudden, severe headache just before or during orgasm. Most sex headaches are nothing to worry about.
What can an evolving headache indicate?
infection, inflammation, increased ICP
What can a chronic headache indicate?
increased ICP
What are the 2 categories of pain periodicity?
Episodic or chronic
What are examples of episodes vs chronic headaches?
o Episodic: migraine, cluster headache
o Chronic: medication overuse, chronic migraine, hemicrania continua
What is hemicrania continua?
Hemicrania continua is a chronic and persistent form of headache marked by continuous pain that varies in severity, always occurs on the same side of the face and head
What is a 2ary headache?
For this type, another disease or condition is the cause. The headache is a symptom.
What other symptoms can be associated with a headache?
o Diurnal variation o Postural element o Nausea and vomiting o Photophobia and phonophobia o Autonomic features (lacrimation, Horners, red eye)
What are the red flags for a potentially life-threatening headache?
(SNOOP)
S: Systemic symptoms; fever, night sweats, rash, weight loss, vomiting, comorbid systemic disease (e.g. HIV) etc
N: Neurological symptoms; change in mental state or consciousness, abnormal cranial nerve function, loss of sensation, collapse, visual disturbance, seizures etc
O: Onset sudden; sudden or first ever, severe or ‘worst headache of life, thunderclap (pain reaches maximal intensity after onset)
O: Older onset; after 50 years of age e.g. giant cell arteritis
P: Pattern change; progressive headache, postural aggravation etc
What is a cluster headache?
Cluster headaches are excruciating attacks of pain in one side of the head, often felt around the eye.
Other questions to ask:
• Behaviour o Lies down in dark room: migraine o Agitation/pacing: cluster • Family history: migraine • Medication/self-medication
When doing a headache examination, what systemic signs should be looked for?
- Fever, rash, stiff neck, increase BP, organomegaly
- Fundal changes (papilloedema)
- Cranial nerve signs/ Horner’s syndrome
- Focal abnormalities
- Long tract signs
What is organomegaly?
Organomegaly is the abnormal enlargement of organs
What can a fever/rash/neck stiffness indicate?
Meningitis/encephalitis
What is papilloedema?
Optic disc swelling that is caused by increased intracranial pressure due to any cause.
Name 7 primary headaches
- Migraine
- Tension
- Exertional headache
- Ice-pick headache
- Coital headache
- Hypnic headache
- Trigeminal autonomic cephalgias
Migraine:
a) symptoms
b) investigations
c) treatment?
a) Episodic, nausea, dizziness, aura, unilateral, triggered by sleep deprivation, hunger, stress
b) CT/MRI is focal symptoms
c) Avoid caffeine, increase water, avoid tyramine foods, sleep hygiene
Tension headache:
a) symptoms
b) treatment?
A tension headache is the most common type of headache.
a) Bilateral, no aura, tight band
b) Relaxation, massage, amitriptyline, acupuncture, optician check
What is trigeminal autonomic cephalgias?
TACs are primary headaches with a common clinical phenotype consisting of trigeminal pain with autonomic signs, which may include lacrimation, rhinorrhoea and miosis.