headache Flashcards
what is a primary headache?
headache with no underlying medical cause
what is a secondary headache?
headache with an identifiable structural or biochemical cause
what are some types of primary headaches?
tension type headache
migraine
cluster headache
what are some characteristics of tension type headaches?
mild, bilateral headache which is often pressing or tightening in quality, has no significant features and is not aggravated by routine physical activity
what is the treatment for a tension headache?
aspirin or paracetamol
NSAIDS
what are some features of a migraine attack?
headache nausea photophobia phonophobia functional disabilty
what are some triggers for a migraine?
dehydration sleep disturbance diet hunger environmental stimuli stress
what are some premonitory features of a migraine?
mood changes
fatigue
muscle pain
food craving
what are some post-attack features of a migraine?
fatigue
cognitive changes
muscle pain
what is “aura” with regard to migraines?
transient neurological symptoms resulting from cortical or brainstem dysfunction
what are some features of “aura”
loss of function
sudden onset
symptoms all start at the same time and can be localised to a specific vascular area
what is the criteria for a chronic migraine?
headache on more than 15 days of the month of which 8 days have to be a migraine for more than 3 months
what is a medication overuse headache?
headache present on more than 15 days of the month which has developed or worsened whilst taking regular symptomatic medication
what types of medication may predispose someone to developing a MOH?
use of opioids for more than 10 days of the month
caffeine overuse
use of simple analgesics for more than 15 days of the month
how is a migraine treated?
aspirin or NSAIDS
triptans
limit to 10 days per month to avoid development of MOH
what are some prophylactic treatments for migraine?
propranolol
anti epileptics
tricyclic antidepressants
how is the OCP affected with regards to migraine with aura?
contraindicated
how are migraines treated in pregnant women?
paracetamol for attacks
propranolol or amitriptyline for prevention
what does SUNCT stand for?
short lasting unilateral neuralgiform headache with conjunctival injection and tearing
what does SUNA stand for?
short lasting unilateral neuralgiform headache with autonomic symptoms
are cluster headaches unilateral or bilateral?
strictly unilateral
where is the pain located in cluster headaches?
mainly orbital temporal
what is the typical duration for a cluster headache?
45-90 mins
what is the frequency of cluster headache attacks?
1 every other day to 8 per day
attacks occur at the same time each day
what are 3 trigeminal autonomic cephalagias?
cluster headache
paroxysmal hemicrania
SUNCT
where is the pain typically located in paroxysmal hemicrania?
mainly orbital and temporal
how long do paroxysmal hemicrania attacks typically last?
2-30 mins
what drug does paroxysmal hemicrania absolutely respond to?
indometacin
what are some cutaneous triggers of SUNCT?
wind
cold
touch
chewing
what kind of pain is associated with SUNCT?
stabbing/pulsating
what kind of pain is associated with cluster headaches/paroxysmal hemcrania?
sharp/throbbing
what branches of the trigeminal nerve are more commonly affected in trigeminal neuralgia?
maxillary or mandibular division pain is more common than opthalmic
what is abortive treatment for cluster headaches?
subcutaneous sumatripan
occipital depomedrone
what is preventative treatment for cluster headaches?
verapamil
lithium
methysergide
topiramate
what is the preventative treatment for SUNCT/SUNA
lamotrigine
topiramate
gabapentin
carbamAzepine
what is the prophylactic treatment for trigeminal neuralgia?
carbamazepine
oxcarbamezipine
what are some presentations of headache that are more likely to have a sinister cause?
associated head trauma first or worst sudden onset change in headache pattern or type returning patient
what are red flags with regards to headaches?
new onset or change in headache focal or non focal neurological symptoms abnormal neurological exam neck stiffness/fever jaw claudication visual disturbance headache precipitated by sitting/standing up headache worse lying down
what is a thunderclap headache?
high intensity headache that reaches maximum intensity in less than 1 minute
what is the differential diagnosis for a thunderclap headache?
subarachnoid haemorrhage TIA/stroke carotid dissection meningitis intracerebral haemorrhage
what are most subarachnoid haemorrhages caused by?
aneurysm rupture
when should you suspect a SAH?
all patients presenting with a sudden severe headache that peaks within a few minutes and lasts for at least one hour
what investigations are appropriate in a suspected SAH?
CT brain
LP
when should you suspect a CNS infection?
any patient presenting with headache and fever
what are some symptoms of meningism?
nausea with or without vomiting photophobia phonophobia stiff neck rash
what are some symptoms of encephalitis?
altered mental state
seizures
focal symptoms/signs
what are features suggestive of raised ICP?
progressive headache that is worse in the morning or wakes patient up seizures visual obscuration focal neuro symptoms non focal symptoms such as drowsiness
what can cause intracranial hypotension?
dural CSF leak
what are some symptoms of intracranial hypotension?
clear postural component to the headache
headache develops or worsens soon after assuming an upright posture and lessens or resolves shortly after lying down
what investigations would be performed of intracranial hypotension was suspected?
MRI brain and spine
what is the treatment for intracranial hypotension?
bed rest
fluid
analgesia
caffeine
what is giant cell arteritis?
arteritis of large arteries
when should giant cell arteritis be considered?
any patient over 50 who presents with a new headache?
what are the characteristics of giant cell arteritis?
usually diffuse, persistent and may be severe patient may be systemically unwell scalp tenderness jaw claudication visual disturbance prominent temporal arteries
what investigations are useful in giant cell arteritis?
ESR
CRP
both of them being raised supports diagnosis
how is giant cell arteritis treated?
high dose prednisolone
temporal artery biopsy should be arranged
