Headache

Question 1

What is the difference between primary and secondary headaches?

Answer 1

Primary headaches have no underlying conditions, secondary headaches are as a result of another condition (local or systemic)

Question 2

Name three types of primary headaches

Answer 2

Migraines, Tension Headaches, Trigeminal Autonomic Cephalagias (cluster headache)

Question 3

What are the two long lasting primary headaches?
>4hrs

Answer 3

Migraines and Tension Headaches

Question 4

What is another form of long lasting primary headache?

Answer 4

Medication overuse headache, from codeine-based medication that is used to treat pain
analgesia

Question 5

What are the 4 key red flags that suggest a secondary headache?

Answer 5

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)

Question 6

What is key to the diagnosis of a headache

Answer 6

History and examination

Question 7

What is a cluster headache?

Answer 7

trigeminal autonomic cephalalgia (branches of trigeminal nerve innervate ophthalmic, maxillary and mandibular regions, all feel pain so multiple areas of head are aching

Question 8

Migraine characteristics

Answer 8

unilateral location
pulsating
moderate to severe intensity
aggravation by physical activity

accompanied by 1/more of
nausea/vomiting/photophobia/

Question 9

What is a unique feature associated with migraines?

Answer 9

Aura - complex array of symptoms that show focal, cortical or brainstem dysfunction
- visual glimmering or hidden fields of view.
Usually occur before headaches

Question 10

What are the 5 phases of migraines?
can take up to 48hrs

Answer 10

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)

Question 11

What are the lifestyle managements for migraine?

Answer 11

Avoid triggers, diet, lifestyle, sleep, exercise, mindfulness
Try to stick to set routine

Question 12

What are the acute managements of migraines?

Answer 12

High dose very soon after onset -> paracetamol, NSAIDs, Prokinetics, Triptans (5-HT Agonists)
take meds in the first 30mins

Question 13

Migraine preventatives

Answer 13

TCA, B-blockers, serotonin antagonists, anticonvulsants, calcium channel blockers, ACE inhibitors,
parenteral: acupuncture, greater occipital nerve block

Question 14

Tension-type headache characteristics

Answer 14

episodic 30mins-1hr
tightening of muscles around head and neck
bilateral
mild to moderate pain
not aggravated by movement (not disabling)

Question 15

What is the treatment plan for tension headaches?

Answer 15

Reassurance for most of the headache, maybe aspirin or paracetamol in some cases

Question 16

What are the associated symptoms with migraines that are not present with tension-type headaches?

Answer 16

Nausea, Photophobia, Phonophobia

Question 17

Cluster headache characteristics

Answer 17

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

Question 18

What is responsible for the circadian routine of cluster headaches

Answer 18

the hypothalamus
may get them every couple hours or at certain times of day

Question 19

What is the acute treatment for cluster headaches?

Answer 19

Triptan (nasal or subcutaneous route),
High flow oxygen (inhibits neuronal activation in the trigeminocervical complex)
NSAIDs

Question 20

What is the prophylactic medication for cluster headache and what group of patients cannot use it?

Answer 20

Verapamil (calcium channel blocker) - exacerbates heart block .: get an ECG first

Question 21

What questions would you ask to diagnose type of headache?

Answer 21

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