Headache Flashcards
What are the three categories of headaches?
Primary
Secondary
Other: cranial neuropathies, face pains
Give some examples of primary headaches?
Migraine
Cluster headache
Tension type headache
Give some examples of secondary headaches?
Menigitis
Subarachnoid haemorrhage
Giant cell arteritis
Idiopathic intracranial
hypertension
Medication overuse headache
What are some systemic signs that point to a secondary headache?
Fever, neck stiffness, altered consciousness
History of cancer, trauma, HIV
Vomiting
Cognitive dysfunction, abnormal neurological exam
What features of a headache make it likely to be secondary?
Jaw claudication
Visual disturbance
Changing in frequency or character
Sudden onset/thunderclap headache
Increased pain on exercise, laughing, sneezing
A patient presents with a history of a 1 week headache, with a temperature and vomiting.
Primary or secondary?
Secondary
A patient presents with a headache and on examination you notice sensory dysfunction in his lower limbs.
Primary or secondary?
Secondary
A patient presents with frequent, severe headaches over the past 6 months. When she gets them she cannot stand up or look at light.
No systemic or neurological signs.
Primary or secondary?
Primary
In what situations would you refer a patient immediately?
Thunderclap headache
Seizure and a new headache
Suspected meningitis or encephalitis
Red eye: glaucoma
Headache + focal neurological sign
Name the red flag symptoms associated with headache?
New headache with a history of cancer
Cluster headache
Seizure
Altered consciousness
Papilloedema
What should you ask about a headache when taking a history?
Type + frequency
Time: onset, duration, how long
Pain: severity, type, spread
Associated: aura, systemic features
Triggers: aggravating + relieving factors
During attack: medication, can you function normally
Between attacks: normal or persistent headache
Examination of a patient with headache?
Blood pressure
Altered consciousness
Neck stiffness and fever
Focal neurological signs
What types of migraine are there?
With aura
Without aura
Chronic
What does ‘aura’ mean?
A sensation perceived just before a migraine or seizure
Could be anything: visual disturbance, olfactory, sensory
Describe what a visual aura could look like?
Flashing lights
Zigzag patterns
Bits of visual field missing or blurred
What other symptoms do people get with a migraine, besides headache?
Visual, sensory, language, motor aura
Nausea
Vomiting
Photophobia and phonophobia
How long do migraines usually last?
4-72 hours
Give an example of sensory aura?
Tingling in hand that spreads up the arm
What would language aura present like?
Dysphasia
What is the name of the headache that we consider a normal headache, that everyone gets from time to time?
Tension headache
What does a tension headache feel like?
Dull ache on both sides of head
Pressure behind the eyes
How long do tension headaches last?
30 minutes to several hours
What causes tension headaches?
stress and anxiety squinting poor posture tiredness dehydration missing meals lack of physical activity bright sunlight noise certain smells
How would you usually treat a tension headache?
NSAIDs
Prevention: hydration, getting enough sleep etc.
What does a cluster headache feel like?
Pain on unilateral orbital
Or temporal pain
Usually quite severe
How long do cluster headaches last?
15-180 mins
Are there any other features of a cluster headache besides pain?
Sometimes people get ipsilateral cranial autonomic features
And a sense of restlessness / agitation
What are cranial autonomic features?
Lacrimation
Eyelid oedema
Nasal stuffiness
Rhinorrhoea
What is classical trigeminal neuralgia?
Irritation of the trigeminal nerve resulting in loss of myelin from the sensory fibres within the nerve
This results in severe pain
Clinical presentation of trigeminal neuralgia?
Sudden, explosive, severe pain that radiates along the trigeminal nerve
Periods of pain-free remission between attacks
One of the most painful conditions known to man
What are the branches of the trigeminal nerve?
Ophthalmic
Maxillary
Mandibular
How long does an attack of trigeminal neuralgia last?
From seconds to hours
Is an attack of trigeminal neuralgia triggered by anything or is spontaneous?
It varies between patients
Often triggered by talking, chewing, brushing teeth
Sometimes the slightest pressure on the area or even air blowing can trigger an attack
In others it is spontaneous
Why is trigeminal neuralgia so debilitating?
An attack is triggered by activities of daily living
People often become anorexic, and socially withdrawn in the fear that eating or talking might bring on an attack
Management of trigeminal neuralgia?
Anti-convulsants: carbamazepine
Anti-depressants: amitriptyline
Surgery: if drug treatment is ineffective
Microvascular decompression
What two methods of attack should you take when treating migraine?
Abortive: stop the migraine once it’s started
Preventative: prevent a migraine happening
Abortive treatment of migraine?
Combination therapy:
- oral triptan and NSAID or
- oral triptan and Paracetamol
Anti-emetic
Don’t use opioids
What is triptan?
A class of drugs used to treat symptoms of a migraine attack
Preventative treatment of migraine?
Topiramate or Propanolol
Riboflavin
Botulinum toxin
What is idiopathic intracranial hypertension?
Raised ICP of unknown cause
It commonly affects overweight young women
Can be very serious
What is a medication overuse headache?
Headache caused by regular use for over 3 months of a drug that is known to have headache as a side effect
To manage headache pain in patients, the WHO analgesic ladder should be used.
True or false?
False
Management of cluster headache?
High flow oxygen via NRB mask for 15 mins
Sumatriptan
Prevention:
Verapamil
Lithium
Steroid injection sub-occipital
