Headache Flashcards
What is giant cell/temporal arteritis?
Systemic immune mediated vasculitis usually affecting medium and large arteries usually in the head and neck.
The aetiology is unknown.
How does temporal arteritis present, what are the signs and what are the complications?
Severe unilateral headache usually over the temporal region. Usually relatively acute onset (weeks).
Scalp tenderness.
Jaw claudication.
Visual disturbances.
Easily palpable temporal aa, but not pulsatile.
Shoulder weakness.
Complications: Permanent sight loss.
Which ethnicity and age groups are most at risk for Giant Cell arteritis?
More common in europeans and there is a decreased incidence in afro-carribeans.
Usually affects patients that are older than 60 years old peak incidence is in patients in their 80’s.
Which inflammatory condition is associated with temporal arteritis?
Polymyalgia rheumatica (1 in 5 people with PMR will get Giant Cell Arteritis)
How should a patient with temporal arteritis be investigated?
Bloods:
ESR and CRP both are usually elevated.
FBC: may have a normocytic normochromic anaemia.
LFT: ALP may be elevated
Invasive:
Temporal aa biopsy within 2 weeks of starting treatment
How should temporal arteritis be treated?
High dose steroids + long term maintenance steroids.
Initially 40mg prednisolone daily unless there are symptoms of claudication or visual symptoms in which case use 60mg.
Taper dosage down once clinical and biochemical improvement.
As well as low dose aspirin 75mg daily.
As using long term steroids consider side effects and treat with bisphosphonates and adcal.
Outline the key features of tension headaches?
Generalised bilateral headache.
Mild-moderate in severity.
Non pulsatile often described as a tight band.
Pain may extend to neck.
No red flag symptoms.
Often responsive to over the counter medication.
Outline the key features of medication overuse headaches?
MOH is defined as:
- Headache present on at least 15 days per month.
- Headache which has developed or markedly worsened during medication overuse.
- Headache which resolves or reverts to its previous pattern within two months of discontinuing overused medication.
-Regular overuse for three months or more of one of the following drugs for headache:
Has taken triptans or opioids preparations on at least 10 days per month OR
Has taken paracetamol, aspirin (or other non-steroidal anti-inflammatory drugs (NSAIDs)) or combinations of these on at least 15 days per month.
What is thought to cause medication overuse headaches?
It is thought to be due to sensitisation of headache medication causing an increase in headache pain receptors.
What are the key features of a migraine headache?
Unilateral severe pulsating headache. (may be bilateral)
Aggravated by light and movement.
Nausea.
10% occur with an aura usually visual but may be olfactory.
Headaches last between 4 and 72 hours.
May have clear triggers: stress, red wine, cheese, chocolate, certain smells etc.
What are cluster headaches and what are their key features?
Are a rare type of severe headache also known as migranious neuralgia.
Symptoms:
Very severe* unilateral headaches.
Often occurring around the eye.
The headache comes on acutely over about 10mins without aura.
The headache typically occurs at night, 1-2 hours after falling asleep, although this is not always the case.
Headaches typically occur in bouts which last 6-12 weeks, once a year or two years, often at the same time each year.
*thought to be one of the most painful conditions often described as suicide headaches
Treatment is with Oxygen therapy during an attack
What are some red flag symptoms in headaches?
Meningism’s (neck stiffness, photophobia)
Very sudden severe headache around the occiput: SAH
New onset headache in someone that has never suffered from them before. Every day getting gradually worse. More painful when coughing/sneezing. Classically worse in the morning. Suggestive of raised intercranial pressure.
Focal neurology + headache: SOL/subdural
