Headache Flashcards
what is the most common cause of headache
tension headache
what could be the causes of an acute single episode with meningism
if headache is severe, acute, felt over most of the head, neck stiffness- meningitis; encephalitis; subarach haemorrhage. admit urgently for CT head, do LP
symptoms meningitis
fever, photophobia, stiff neck, purpuric rash, coma
symptoms encephalitis
fever, odd behaviour, fits, decr conciousness
symptoms subarach haemorrhage
sudden onset, worst ever, often occipital, stiff neck, focal signs, consciousness decr
what happens to the headache in head injury
localised to site of injury but may be more generalised. often resistant to analgesia
symptoms venous sinus thrombosis
subacute or sudden headache, papilloedema
symptoms sinusitis
dull, constant ache- frontal and maxillary sinuses; tenderness and postnasal drip. pain worse on bending over.
what is low pressure headache due to
CSF leak
what can acute glaucoma cause
acute single episode headache
acute glaucoma symptoms
typically elderly, long sighted people. constant aching pain develops rapidly around one eye radiating to the forehead. reduced vision, N/V
signs acute glaucoma
red, congested eye; cloudy cornea; dilated non responsive pupil; decr acuity. treat- start acetazolamide 500 mg over several mins
what are headaches that recurrently attack
cluster headache, migraine, trigeminal neuralgia
headaches of subacute onset
giant cell arteritis- exclude in all >50 yrs- if headache lasted a few weeks. tender thickened pulseless temporal arteries, jaw claudication.
chronic headache types
tension, raised ICP, medication overuse (analgesic rebound)
what is tension headache
usual cause bilateral non pulsatile headache with scalp muscle tenderness without vomiting or sensitibity to head movement. stress relief
what happens in raised ICP
typically worse on waking, lying, bending forward, coughing. vomiting, papilloedema, seizures, false localising signs, odd behaviour.
what is contraindicated in raised ICP
LP until after imaging
what medications can cause headache
mixed analgesics- paracetemol + codeine/opiates, ergotamine and triptans.
what may be the cause of cluster headache
superficial temporary artery smooth muscle hyperreactivity to 5HT. hypothalamic grey matter abnormalities. commoner in smokers, onset any age. male: female 5:1
symptoms cluster headache
rapid onset excruciating pain around one eye that may become watery and bloodshot with lid swelling, lacrimation, facial flushing, rhinorrhoea, miosis and ptosis.
is pain uni or bilateral in cluster headache
strictly UNILATERAL- almost always affects the same side. lasts 15-160 min occurs once or twice a day often nocturnal.
how long can clusters last
4-12 weeks followed by pain free periods of months or even 1-2 years before the next cluster
treat acute attack cluster headache
100% O2 for 15 min via non re breathable mask, sumatriptan SC 6mg at onset
preventatives cluster headache
suboccipital steroid injections, intranasal civamide, verapamil, lithium, melatonin
trigeminal neuralgia symptoms
paroxysms of intense, stabbing pain lasting seconds in the trigeminal nerve distribution. unilateral affects mandibular and maxillary divisions. face screws up in pain
trigeminal neuralgia- triggers
washing affected area, shaving, eating, talking, dental prostheses
trigeminal neuralgia secondary causes
compression trigeminal root by aneurysmal intracranial vessels or a tumour, chronic meningeal inflammation, MS, zoster, skull base malformation
treatment trigeminal neuralgia
carbamazepine (100mg/12h PO), lamotrigine, phenytoin, gabapentin
