Headache Flashcards
What are possible causes of acute, single headaches?
- febrile illness, sinusitis
- first attack of migraine
- head trauma
- subarachnoid haemorrhage
- meningitis
- tumour
- drugs, toxins
- stroke
- thunderclap
- low pressure
What are the possible causes of a dull headache, increasing in severity?
- benign
- overuse of medication
- contraceptive pill
- HRT
- neck disease
- temporal arteritis
- benign intracranial hypertension
- cerebral tumour
- cerebral venous sinus thrombosis
What tends to cause a dull headache, unchanged for months?
- chronic tension headache
- depressive, atypical facial pain
What are different forms of recurrent headaches?
- migraine
- cluster headache
- episodic tension headache
- trigeminal/post-herpetic neuralgia
What are the red flags for a secondary headache?
- age
- onset
- systemic symptoms
- neurological signs
What types of onset are red flags?
- thunderclap
- acute
- subacute
Which systemic symptoms are red flags?
- fever
- rash
- weight loss
- neck stiffness
Which neurological symptoms are red flags?
- confusion
- impaired consciousness
- focal neurological deficit
- swollen optic disc
What does orthostatic mean?
the headache is better when lying down
How does migraine disorder present?
- tendency of repeated attacks
- triggers
- easily hung over
- visual vertigo
- motion sickness
What are the different forms of migraine attacks?
- pain only
- pain and focal sings
- focal symptoms only
What are the 5 phases of a migraine?
- premonitory
- aura
- headache
- resolution
- recovery
What is the premonitory phase of a migraine?
- yawning
- polyuria
- mood change
- light sensitivity
- neck pain
- difficulty concentrating
What is the aura phase of a migraine?
- visual changes
- sensory numbness/paraesthesia
- weakness
- speech arrest
What is the headache phase of a migraine?
- head and body pain
- nausea
- photophobia
What is the resolution phase of a migraine?
- rest
- sleep
What is the recovery phase of a migraine?
- disturbed mood
- food intolerance
- hungover feeling
- can take up to 48hrs
What visual symptoms happen during the aura phase of a migraine?
positive and negative symptoms simulatenously:
- scintillations
- blindspots
- expanding C’s
- elemental visual disturbances
What is the treatment for an acute migraine attack?
- NSAIDS (aspirin, ibuprofen)
- Anti-emetic (paracetamol, metoclopramide)
- prokinetics
- triptans (tablets, melts, nasal sprays, sc injection)
How does TMS help treat acute migraine attacks?
interrupts complex networks that trigger and perpetuate migraines - caused by spreading electrical depression across the cerebral cortex
What are the long term treatments for migraines?
- lifestyle issues due to overstimulation
- identify and avoid triggers
- hydrate and avoid caffeine
- avoid ready meals and take-aways
- good sleep
- exercise
- mindfulness
What prophylaxis can be taken for migraines?
- over the counter
- tricyclic antidepressants
- beta-blockers
- serotonin antagonists
- calcium channel blockers
- anticonvulsants
- greater occipital nerve blocks
- botox
- suppress ovulation
- Erenumab
What is the new treatment for migraines?
CGRP antibodies
What is a risk of using painkillers for headaches?
Medication overuse headaches
What does a tension headache feel like?
tight muscles around the head and neck bilaterally
What is the treatment for tension headaches?
- simple analgesics e.g. paracetamol and aspirin
- reassurance that it will pass
What is a cluster headache?
- severe unilateral pain lasting 15-180 minutes untreated
- trigeminal autonomic cephalgia
How does a cluster headache present?
- forehead and facial sweating
- miosis and/or ptosis
- restlessness or agitation
- 1-8 daily
- (at least one) ipsilaterally:
conjunctival redness and/or lacrimation
nasal congestion and/or rhinorrhea
eyelid oedema
(most common site of pain is the eye)
What is the acute treatment of a cluster headache?
- inhaled oxygen (inhibits neuronal activation in the trigeminocervical complex)
- s/c or nasal sumatriptan
What can prevent a cluster headache?
- Verapamil (calcium channel inhibitor)
- greater occipital nerve block
- need ECG first
What is the difference in distribution between migraines and cluster headaches?
migraines are more common in women, vice versa for cluster headaches
What are the most common primary headaches?
- migraine
- tension headaches
- cluster headaches
What should NOT be given to treat cluster headaches according to NICE?
- paracetamol
- NSAIDS
- oral triptans
- ergots
- opioids
What are secondary headaches?
- Headache is percipitated by another condition / disorder - local os systemic
- Serious causes of secondary headache are uncommon
What are the two types of primary headache?
Long-lasting (>4 hours) and short lasting (<4 hours)
Which headaches are long lasting?
Migraine and tension headache
Which headaches are short-lasting?
Trigeminal autonomic cephalagias e.g cluster headaches
What are red flags for headaches?
Presences indicates secondary rather than primary headache
What are the age related red flags?
New onset or different headaches in a person >50yrs
What are the characteristics of migraines?
- Unilateral
- Pulsating
- Moderate or severe pain
- Aggravation by routine physical activity
- Last hours and sometimes days
- premonitory symptoms
- last 4-72hr
What causes aura?
Focal cortical or brainstem dysfunction
What are the characteristics of tension headaches?
- bilateral
- mild to moderate
- not aggravated by movement
- no added features
