Headache Flashcards
migraine + tension
Headache
What is a primary headache and secondary headache?
primary: headache is the primary problem
secondary: other condition precipitates the headache
Headache
Causes of secondary headaches include the following:
- D
- A
- M
- A
- T
- C
- H
- A
Drugs
Acute angular glaucoma
Meningitis
Giant cell Arteritis
Trauma
Cancer (space occupying lesions)
Haemorrhage (intracranial or venous thrombosis)
Anatomical (TMJ, ENT)
Headache
If the headaches were due to raised ICP, what would you expect the visual fields to show?
enlarged blind spots and constricted fields
Papilloedema is optic disc swelling due to raised ICP. In the subacute stages, this results in enlarged blind spots and peripheral constriction of the visual fields. In more advanced cases, there will be loss of central vision and visual acuity.
Headache
What time frame differentiates a short headache from a long headache?
Name some long lasting headaches and short lasting hedaches.
Long >4hr:
- migraine
- tension-type
Short <4hr:
- trigeminal autonomic cephalgia
- cluster headache
NB: medication can cause headaches (codeine)
Headache
What are 4 key red flags suggesting a secondary headache?
age: >50y (new or different)
onset: thunderclap headache
systemic symptoms: fever, neck stiffness, rash, weight loss
neurological signs: confusion, impaired consciousness, focal neurology, swollen optic discs
+ head trauma
Headache
Give a DDx:
headache + fever + neck stiffness + rash
What test might be indicated to further investigate this?
meningitis
lumbar puncture
Headache
Give a DDx:
headache, thunderclap
What test might be indicated to further investigate this?
subarachnoid haemorrhage
CT
Headache
Give a DDx:
headache + papilloedema
What test might be indicated to further investigate this?
- inflammation?
- pressure?
brain tumour
CT
Headache
Give a DDx:
headache + focal neurological symptoms (arm weakness)
What test might be indicated to further investigate this?
stroke
tumour
CT
Headache
Give a DDx:
headache with scalp tenderness or jaw claudication
What test might be indicated to further investigate this?
temporal arteritis
serum ESR
Headache
Give a DDx:
headache + wake up at night + worse in mornings + nausea/vomitting
What test might be indicated to further investigate this?
brain tumour
CT
Headache
What is the Valsava maneuvre? How is it used in relation to brain tumours?
the popping your ears thing
worsens headache in brain tumours
Headache
What is the maneuvre called which is popping your ears?
Valsava maneuvre
Migraine
Migraines can be an episodic or chronic disorder.
Name the characteristics of a migraine.
- unilateral location
- throbbing / pulsating
- moderate to severe pain
- aggravated by physical activity
- can last hours to days
usually also has 1+ of:
- nausea/vomitting
- photo/phonobobia
+/- auras
Migraine
What are some common triggers for migraines?
- Emotional stress
- Alcohol / chocolate / cheese
- Poor sleep
- Menstruation
- Physical activity
Migraine
When do we class a headache as chronic (rather than episodic)?
affects for 15+ days in a month
Migraine
What is a migraine aura?
How long do they usually last and when do they begin?
Complex array of symptoms reflecting focal cortical or brainstem dysfunction
Gradual evolution: 5-30minutes (<60minutes)
Usually before headache
Migraine
What do we can the aura that is described as “moving zigzag shapes”?
scintillating scotoma
Migraine
What do we call this migraine aura?
expanding Cs
Migraine
Name the 5 migraine headache phases and what each of them consist of?
-
premonitory / prodrome
- yawning, polyuria, mood change, irritable, light sensitive, neck pain, concentration difficulty -
aura
- Visual, sensory (numbness/paraesthesia), weakness, speech arrest -
headache
- Head and body pain, nausea, photophobia -
resolution (postdrome)
- rest and sleep -
recovery (postdrome)
- mood disturbed, food intolerance, feeling hungover Can take up to 48 hours
Migraine
How do we manage migraine?
- lifestyle
- pharmacological theraoy
- acute/abortive
- long term preventative
Migraine
What are some lifestyle managements for migraines?
- avoid triggers
- diet
- sleep
- exercise
- mindfulness
Migraine
What are some acute/abortive pharmacological therapies for migraines?
- paracetamol
- NSAIDs
- prokinetics
- triptans
Migraine
When might long term and preventative pharmacological therapy be offered to a pt with migraines?
if they struggle with migraines 5 or more days a month
