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Neurosciences Y3 > Headache > Flashcards

Headache Flashcards

1
Q

What are the primary headaches?

A
  1. Migraine
  2. Tension
  3. Cluster
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2
Q

What are secondary headaches?

A

When headache is caused by another condition/ disorder- local onset systemic

serious causes of secondary headache are uncommon

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3
Q

Are primary headaches short or long lasting?

A

Short (duration < 4 hrs):
- Cluster
Long (duration> 4 hrs):
- Migraine
- Tension

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4
Q

Why is further treatment sometimes needed after diagnosis of primary headache?

A

Can develop into a secondary headache
- look for red flags

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5
Q

What are the 4 key red flags suggesting secondary headaches?

A

Age:
- New onset or different headaches in a person >50yrs

Onset:
- Sudden, abrupt onset of a severe headache (thunderclap headache)

Systemic symptoms:
- Fever, neck stiffness, rash, weight loss

Neurological signs:
- Confusion, impaired consciousness, focal neurology (weakness concentrated on one side of the body), swollen optic discs

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6
Q

What causes headaches?

A
  1. Abnormal cortical hyper-excitability & excitation of the brain stem contribute to…
  2. Activation of the trigeminovascular system, which leads to…
  3. Vasodilation, neurogenic inflammation & central sensitisation = HEADACHE
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7
Q

What is a migraine headache?

A
  • episodic neurological disorder that has a strong genetic component and usually presents in early-to-mid life (can be chronic)
  • Primary headache characterized by recurrent episodes of unilateral, localized pain
  • Can be classified as:
    1. Migraine with aura (classical migraine)
    2. Migraine without aura (common migraine)
    3. Migraine variants (e.g. familial hemiplegic, ophthalmoplegic)
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8
Q

What are the risk factors for migraine headache?

A
  • family history of migraine
  • female sex
  • menstruation
  • stress
  • obesity
  • sleep disorders
  • medication overuse
  • COCP
  • foods (caffeine, chocolate, cheese)
  • exercise
  • hormonal
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9
Q

What presenting symptoms of a migraine can be found in the history?

A
  • Prolonged Unilateral Headache → lasts 4-72 hrs, recurrent episodes (may be up to several times per month)
  • Throbbing / Pulsatile Pain
  • Nausea → most common associated symptom
  • May get aura beforehand → flashing lights, tingling
  • Sensitivity to light (Photophobia) & sound (Phonophobia) → may have to lie down in quiet, dark room
  • Headache worse with activity
  • Ask about interference with daily living in history
  • Decreased ability to function
  • Abdominal pain is common in children with migraines

memory aid:
“POUND”:
Pulsatile headache
One-day duration
Unilateral
Nausea
Disabling.

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10
Q

Summarise the epidemiology of migraine

A

Prevalence:
Males - 6%
Females - 15-20%
-Usually occurs in adolescence and early adulthood

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11
Q

What signs of a migraine can be found on physical examination?

A

NO specific physical findings
- Exclude secondary causes with MMSE, neurological examination, fundoscopy etc.

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12
Q

Identify appropriate investigations for migraine

A
  • Diagnosis is usually based on HISTORY
  • Investigations may be useful for excluding other diagnoses
  • Bloods, CT/MRI, lumbar puncture (abnormal in patients with SAH or Meningitis), ESR (raised in Temporal Arteritis),
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13
Q

How are migraines managed?

A

NOTE: analgesia overuse can cause headaches
1. ACUTE:
- Sumitriptan (oral triptans are first line agents for migraines- Ischaemic heart disease, hypertension and previous stroke or TIA are all contraindications) + NSAIDs + metoclopramide (antisickness if nauseus)
- the recommended advice is to take Sumatriptan only once the headache starts and not during the aura phase
2. Prophylaxis/ prevention (>2 attacks per month)
- Remove triggers
- 1st line: Beta-blockers (propranolol- unless asthma, diabetes, raynauds) or Topiramate (can cause pregnancy complications, used if pt is not getting preg)
- 2nd line: Amitriptyline
- Menstrual migraines can be controlled with the oral contraceptive pill
3. Advice
- Avoid triggers
- Rest in a quiet dark room during episodes

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14
Q

Identify possible complications of migraine

A
  • Disruption of daily activities
  • Can lead to analgesia-overuse headaches in people who use analgesia regularly
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15
Q

Summarise the prognosis for patients with migraine

A
  • Usually CHRONIC
  • Most cases can be managed well with preventative/early treatment measures
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16
Q

What is a tension headache?

A
  • Tension-type headaches can be either episodic or chronic.
  • They are rarely disabling or associated with any significant autonomic phenomena, thus patients do not usually seek medical care and usually successfully self-treat.
  • The attacks are generalised throughout the head with a predilection for involving the frontal and occipital regions.

*Episodic - occurs on < 15 days per month
*Chronic - occurs on > 15 days per month

17
Q

What are the triggers for a tension headache?

A

Stress/anxiety
Squinting
Poor posture
Fatigue
Dehydration
Missing meals
Bright sunlight
Noise

18
Q

What presenting symptoms of a tension headache can be found in the history

A
  • Mild-moderate in severity
  • Pressure/tightness around the head like a tight band
  • Pain tends to be bilateral
  • Non-pulsatile
    +/- scalp muscle tenderness
  • Often a relationship with the neck
  • Can be disabling for a few hours but does not have specific associated symptoms (unlike migraines)
  • Gradual onset
  • Variable duration
  • Usually responsive to over-the-counter medication
  • IMPORTANT: check for possible triggers when taking history (e.g. stress)
  • Examination is usually NORMAL
  • Headache does not increase with exertion. No nausea, vomiting or aura (unlike migraines)
19
Q

Summarise the epidemiology of tension headache

A

MOST COMMON type of headache
More common in WOMEN
Most common in YOUNG ADULTS
Most people will experience a tension headache at some point in their lives

20
Q

Identify appropriate investigations for tension headaches

A

NO investigations necessary

21
Q

Generate a management plan for tension headaches

A

Episodic Tension Headaches:
- Reassurance
- Address triggers (e.g. stress, anxiety)
- Advice on avoiding medications that can cause medication-induced headaches (e.g. opioids)

  • Simple analgesia (e.g. ibuprofen, paracetamol, aspirin):
    *1st Line (Acute) → aspirin, paracetamol or NSAIDs (ibruprofen)
    *Prophylaxis → amitriptyline (not NICE recommended but widely used) or acupunture (NICE recommended)
  • Tricyclic antidepressants (amitriptyline) may be considered in frequently recurrent episodic tension headaches or chronic tension headaches
22
Q

Identify possible complications of tension headaches

A

NONE

23
Q

Summarise the prognosis for patients with tension headaches

A

GOOD
Not very severe or disabling
Recurs

24
Q

What are cluster headaches?

A

Cluster headache refers to a type of headache that is primarily unilateral and typically more severe around the eye region. The headache episodes occur in clusters, with patients experiencing numerous attacks within a condensed timeframe.

25
Q

What are the signs/ symptoms of cluster headache?

A

Unilateral, severe headache, often around the eye
A bloodshot or teary eye on the affected side
Vomiting
Nasal congestion
constricted pupil/ drooping eyelid

26
Q

How are cluster headaches treated?

A

Acute treatment: Administering 100% oxygen and sumatriptan can provide relief during an acute episode.
Prophylactic treatment: Potential prophylactic treatments include verapamil and steroids, which may help reduce the frequency and severity of attacks.

27
Q

In what cases is Sumatriptan contraindicated?

A

Sumatriptan is contraindicated in ischaemic heart disease, hypertension, peripheral vascular disease, previous strokes, and previous myocardial infarctions. This is because sumatriptan is a serotonin receptor agonist that constricts cerebral blood vessels to reduce the release and movement of substances involved in the pain pathways. Narrowing the cerebral blood vessels presents a serious risk in someone with a previous stroke as it suggests that they already have narrowed blood vessels.

Neurosciences Y3 (22 decks)

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