Headache Flashcards
Is most headache primary or secondary?
primary
What does primary headache mean and give 3 examples
no underlying cause
migraine, cluster headaches and tension type headaches
What does secondary headache mean?
identifiable structure or biochemical cause
Give some causes of secondary headache
tumour, meningitis, raised IC, head injury, vascular disease, drugs, medication, systemic infection
Which is the most frequent primary headache?
tension type
Describe a tension type headache
Mild, bilateral headache which is pressing/tightening with no significant features and not precipitated by activity
How many days a month does tension type headache occur to be chronic?
> 15
Absorptive treatment of tension type headache (how often is too often to give these and why?)
paracetomol or aspirin
NSAIDS
>10 days/month - do not want to cause medication overuse headache
Which is the most frequent disabling primary headache?
migraine
What is migraine?
A chronic disorder with episodic attacks and complex changes in the brain
Migraine: during attacks
nausea, photophobia, phonophobia, headache, functional disability
Migraine: in between attacks
fatigue, anticipatory anxiety
Triggers for migraine
diet, stress, oestrogen changes, hunger, sleep disturbance, environmental stimuli
What is aura?
Transient neurological symptoms resulting from cortical or brainstem dysfunction
What systems can be affected in aura?
visual, sensory, motor or speech
What can aura be confused with and why?
TIA
15-60 minutes, sudden onset, loss of function
Criteria for a chronic migraine
> 15 days a month and 8 have to be migraine and this for more than 3 months
Transformed migraine changes
history of episodic migraine
increasing frequency of headaches over time and migrainous symptoms become less
How is medication overuse headache treated?
stopping the medication
What is medication overuse headache?
> 15 days a month which has developed or worsened since starting regular symptomatic medication
What can cause medication overuse headache?
analgesics and caffeine
Migraine - absorptive treatment
NSAIDS, aspirin
triptans
Tension type headache - prophylactic treatment
Rarely needed - tricyclic antidepressants eg amytriptiline
Migraine - prophylactic treatment
propranolol
anti epileptics eg valproate
tricyclic antidepressants
Does migraine with or without aura get better in pregnancy?
without aura
Treatment in pregnant women for migraine
paracetomol
propranolol/amytriptiline
4 trigeminal autonomic cephalalgias
cluster headache
paroxysmal hemicranias
SUNCT
SUNA
What are the cranial autonomic symptoms?
lacrimation, sweating on forehead, eyelid oedema, miosis/ptosis, nasal congestion
In trigeminal autonomic cephalalgius where is the pain?
unilateral - usually V1 - very severe
Do autonomic symptoms occur on the contralateral or ipsilateral side?
ipsilateral
Where is pain mostly in cluster headaches?
temporal and orbital
3 cycles of cluster headache
episodic
circadian
chronic
Cluster headaches - pain description
unilateral, rapid onset, 15mins-3hours, rapid cessation
How often do paroxysmal hemicranias last?
2-30minutes
What can paroxysmal hemicranias be precipitated by?
turning or rotating head
Treatment for paroxysmal hemicranias
nitric oxide
SUNCT - pain and duration
unilateral, supraorbital, orbital and temporal
10-240s
cutaneous triggers of SUNCT and trigeminal neuralgia
cold, wind, chewing, touch
Are autonomic features common in SUNCT or trigeminal neuralgia?
SUNCT
What type of headaches do tablets not work quick enough?
cluster
Secondary headaches - sinister if..
recent onset, recent head trauma, change in character or pattern, sudden onset and new headache
What groups would you be particularly aware of secondary headaches in?
over 50s
immunosuppression and cancer
Neck stiffness/fever red flag of?
meningitis, subarachnoid haemorrhage
High pressure headaches worse when?
lying down, valsava manoeuvre
Causes of low pressure headaches
epidural
lumbar puncture
When are low pressure headaches worst?
standing up
Giant cell arteritis - 3 signs/symptoms
visual disturbance
prominent temporal artery
jaw claudication
What is thunderclap headache?
A high intensity headache running at maximal intensity in less than a minute and is a whole head headache which can be primary or secondary
Differential diagnosis of thunderclap headache
primary eg migraine, cluster
haemorrhage
TIA/stroke
meningitis
Main cause of subarachnoid haemorrhage?
aneurysm
Investigation of subarachnoid haemorrhage?
CT brain, lumbar puncture, angiography
Meningism symptoms
Nausea with or without vomiting, photo/phonophobia, stiff neck
Encephalitis symptoms
Altered consciousness/mental state, focal symptoms, signs, seizures
Always look for what in suspected CNS infection?
rash, fever, headache
Causes for raised ICP
glioblastoma multiforme, abscess, venous infarct, haemorrhage, hydrocephalus, meningioma, papilloedema
Space occupying lesion features
Progressive headache with associated symptoms and signs
Warning symptoms of raised ICP
worse in morning and awakens from sleep
worse lying flat
seizures
What can cause intracranial hypotension (with examples)
dural CSF leak
idiopathic or iatrogenic eg lumbar puncture
Intracranial hypotension investigation and treatment
MRI brain and spine
bed rest, fluids, caffeine, epidural blood patch, analgesia
GCA - blood findings and investigations/treatment
ESR and CRP
temporal artery biopsy and prednisolone
