Headache Flashcards
1
Q
What patterns of pain can be seen in a headache?
A
- Acute onset= secs-mins, SAH, intra-cranial haemorrhage, coital, thunderclap
- Evolving= hours-days, infection, inflammation, inc ICP
- Chronic= weeks-months, chronic daily headache, inc ICP
- Episodic= migraine, cluster
- Chronic= medication overuse, chronic migraine, hemicrania continua
2
Q
What are red flags signs for headaches?
A
- Seizures
- Cognitive effects
- Fever
- Vomiting
- Visual disturbances
- Weight loss
3
Q
What are associated symptoms with headaches?
A
- Nausea & vomiting
- Diurnal variation/ postural element
- Photophobia/ phonophobia
- Autonomic features (horner/red eye/lacrimation)
4
Q
Name some primary headache syndromes
A
- Migraine
- Tension
- Cluster
- Coital
- Hypnic
- Ice-pick
- Exertional
- Paroxysmal hemicrania
5
Q
Name some secondary headache syndromes
A
- SAH
- Intra-cranial haemorrhage/stroke
- Giant cell arteritis
- Meningoencephalitis
- Intracranial venous thrombosis
- Benign intracranial hypertension
- Tumour with raised ICP
- Cervicogenic
6
Q
What are signs & symptoms of raised intracranial pressure?
A
- Papilloedema
- Lateralising signs
- Headache (worse lying or awakening)
- Vomiting
- Seizures
7
Q
What is raised intracranial pressure due to?
A
- Mass effect (brain tumour, abscess)
- Brain swelling (hypertensive encephalopathy)
- Inc venous pressure
- CSF outflow obstruction (hydrocephalus)
- Inc CSF production (meningitis/SAH)
8
Q
What is temporal arteritis?
A
- Temporal (cranial arteritis)
- Patients 60+ and female
- Association with PMR
- Weight loss
- Myalgia
- Jaw claudication
- Tender non-pulsatile temporal artery
- Transient loss of vision
9
Q
How is temporal arteritis managed?
A
- Commence immediate high dose steroids (prednisolone)
- Arrange temporal artery biopsy
- Check ESR
10
Q
What are the clinical features used to diagnose a migraine?
A
- Prodrome (fatigue/change in mood)
- Aura (typically visual) lasting up to 60mins
- Unilateral headache
- Nausea/dizziness photophobia
- Triggers: sleep deprivation/hunger/stress/ oestrogen
- Cortical spreading depression
- Hemiplegic
- Basilar: cranial neuropathies/ cerebellar signs
11
Q
How is pain felt in a migraine?
A
- Spreading depression
- Releases chemically active irritants
- Trigger sensory fibres in meninges
- Felt as pain
12
Q
How is a migraine managed?
A
- Brain imaging
- Conservative measures
- Analgesia
- Preventative treatment
13
Q
What is trigeminal autonomic cephalgias?
A
- Activation of trigeminal/ parasympathetic systems
- Short-lasting headaches
- Variable autonomic features
- Cluster headaches
- Paroxysmal hemicrania
- SUNCT
14
Q
How is trigeminal autonomic cephalgias managed?
A
- Pain relief (high flow O2)
- Prevention (prednisolone, verapamil, indomethacin)
15
Q
Describe tension headaches
A
- Featureless headache
- Constricting/tight band
- Relaxation & massage
- Acupuncture
- Frequent = small dose of amitriptyline
16
Q
Describe new daily persistent headaches
A
- Similar to tension headaches
- No previous history
- Caused by: Raised ICP (idiopathic intracranial hypertension) Low ICP (spontaneous intracranial hypotension), post head injury, chronic meningitis
17
Q
Describe chronic daily headaches
A
- Causes: De novo, previous (transformed migraine, hemicrania continua, chronic tension)
- Treatment limited
- Amitriptyline for transformed migraine
