Headache Flashcards
What is the difference between primary and secondary headaches?
Primary headaches have no underlying conditions, secondary headaches are as a result of another condition (local or systemic)
Name three types of primary headaches
Migraines, Tension Headaches, Trigeminal Autonomic Cephalagias (cluster headache)
What are the two long lasting primary headaches?
>4hrs
Migraines and Tension Headaches
What is another form of long lasting primary headache?
Medication overuse headache, from codeine-based medication that is used to treat pain
analgesia
What are the 4 key red flags that suggest a secondary headache?
Age (new onset in a person > 50 years)
Onset (sudden, severe - aka thunderclap headache) Systemic Symptoms (fever, neck, stiffness, rash, weight loss)
Neurological Signs (confusion, focal neurology - weakness in limbs, impaired consciousness, swollen optic disc- suggestive of raised intracranial pressure)
What is key to the diagnosis of a headache
History and examination
What is a cluster headache?
trigeminal autonomic cephalalgia (branches of trigeminal nerve innervate ophthalmic, maxillary and mandibular regions, all feel pain so multiple areas of head are aching
Migraine characteristics
unilateral location
pulsating
moderate to severe intensity
aggravation by physical activity
accompanied by 1/more of
nausea/vomiting/photophobia/
What is a unique feature associated with migraines?
Aura - complex array of symptoms that show focal, cortical or brainstem dysfunction
- visual glimmering or hidden fields of view.
Usually occur before headaches
What are the 5 phases of migraines?
can take up to 48hrs
Premonitory (yawning, polyuria, light sensitive, irritable) //
Aura (visual, sensory (numbness), weakness//
Headache (head and body, nausea, photophobia) //
Resolution (rest and sleep) //
Recovery (mood disturbed, food intolerance)
What are the lifestyle managements for migraine?
Avoid triggers, diet, lifestyle, sleep, exercise, mindfulness
Try to stick to set routine
What are the acute managements of migraines?
High dose very soon after onset -> paracetamol, NSAIDs, Prokinetics, Triptans (5-HT Agonists)
take meds in the first 30mins
Migraine preventatives
TCA, B-blockers, serotonin antagonists, anticonvulsants, calcium channel blockers, ACE inhibitors,
parenteral: acupuncture, greater occipital nerve block
Tension-type headache characteristics
episodic 30mins-1hr
tightening of muscles around head and neck
bilateral
mild to moderate pain
not aggravated by movement (not disabling)
What is the treatment plan for tension headaches?
Reassurance for most of the headache, maybe aspirin or paracetamol in some cases
What are the associated symptoms with migraines that are not present with tension-type headaches?
Nausea, Photophobia, Phonophobia
Cluster headache characteristics
SEVERE unilateral pain (sidelocked)
15-180mins
autonomic symptoms (ipsilaterally)
- red eyes/ crying from one eye
- nasal congestion or rhinorrhea
- eyelid oedema
- forehead/facial sweating
sense of restlessness/ agitation
What is responsible for the circadian routine of cluster headaches
the hypothalamus
may get them every couple hours or at certain times of day
What is the acute treatment for cluster headaches?
Triptan (nasal or subcutaneous route),
High flow oxygen (inhibits neuronal activation in the trigeminocervical complex)
NSAIDs
What is the prophylactic medication for cluster headache and what group of patients cannot use it?
Verapamil (calcium channel blocker) - exacerbates heart block .: get an ECG first
What questions would you ask to diagnose type of headache?
Where is the pain // What does the pain feel like // How bad is the pain, is it stopping your daily activities // Any other symptoms // How long does the headache last // How often does it happen
