Headache Flashcards
What is meant by a primary headache?
A headache with no underlying medical cause
What is meant by a secondary headache?
A headache with an identifiable structural or biochemical cause
Name some types of primary headache
Migraine
Tension type headache
Cluster headache
Name some underlying causes of secondary headache.
Tumour
Meningitis
Vascular disorders
Systemic infection
Head injury
Drugs
What is the most common type of secondary headache?>
Medicine overdose headache
Describe the pathophysiology of primary headache.
Sensitisation of normal pain pathways
Which neuropeptide is released in headaches and can cause worsening of pain and increases headache length?
CGRP
(Calcitonin gene related peptide).
What are some of the factors to consider in management of primary headache?
Any modifiable lifestyle triggers
Abortive treatment
Transitional treatment
Preventative treatment
In which type of primary headache is modifying lifestyle changes particularly important?
Migraines
In which type of primary headache is transitional treatment particularly important?
Cluster headaches
If there is concern that a headache may be secondary cause, which investigation may be carried out?
MRI is more sensitive but more likely to show incidental findings
-> incidental findings are findings on investigation that were completely unexpected and potentially could lead to further unnecessary investigations
In secondary headaches, which type of investigations can be used to diagnose and guide treatment?
CT
CT angiogram
What is the most common type of primary headache?
Tension type headache
Describe the presentation of tension type headache.
Mild bilateral headache, often pressing or tight feeling.
Acute treatment for tension type headache?
Paracetamol, NSAIDs
Preventative treatment for tension type headache?
Tricyclic antidepressants e.g. amitriptyline
What are some of the symptoms of a migraine?
Headache
Nausea, vomiting
Photophobia
Phonophobia
Functional disability
What are some of the premonitory symptoms of a migraine?
Mood changes
Fatigue
Cognitive changes
Muscle pain
Food cravings
What are the symptoms of early headache in migraine and what is the treatment for this stage?
Symptoms- dull headache, nasal congestion, muscle pain
Treatment- acute treatment e.g. NSAIDs, paracetamol
What are the symptoms of advanced headache in migraine?
Symptoms- unilateral, throbbing, nausea, photophobia, phonophobia, osmophobia
What are the symptoms of the postdrome in migraine?
Fatigue
Muscle pain
Cognitive changes
A 44yo male presents with a migraine. He describes his symptoms as causing him to feel sick and needing to lie still in a dark room. What stage of migraine is he likely to be in?
Advanced headache
Aura?
Transient neurological symptoms resulting from cortical brainstem dysfunction
->affects a third of migraineurs
What may a migraine with aura affect?
Visual, sensory, motor or speech issues