Headache Flashcards
What are the common types of 1o headache disorders?
Tension headache
Migraine
Cluster headache
What are the common causes of 2o headache syndrome?
Raised ICP Idiopathic intracranial HTN HTN Meningeal irritation (SAH/meningitis) Post-traumatic Giant cell arteritis Sinusitis Metabolic disturbances Drugs (nitrates, vasoactive agents)
What are the common causes of facial pain?
Trigeminal neuralgia
Postherpetic neuralgia
Atypical facial pain
How does a tension headache present?
Continuous severe pressure
Bilateral over vertex, occiput, eyes
Occurs every day, persists for months/years
In what groups are tension headaches most common?
Middle-aged woman
Associated w/ depression
What is the management of tension headaches?
If episodic (<15d/mo) –> paracetamol & aspirin/NSAIDs, can lead to overuse headache
Prophylactic –> Amitriptyline (75mg)
Reassurance, relaxation techniques, address underlying stressors
How does a cluster headache present?
Short (30-120mins) episodes, several times/day for weeks/mo
Severe, unilateral pain, centered on one eye
Comes on suddenly, often wakes pt
Autonomic features on affected side (ptosis, red eye, eye watering, vomiting)
Aura (20%)
In what groups are cluster headaches most common?
Males (3:1)
Alcohol as a precipitant
What is the management of cluster headaches?
Exclude 2o causes
s.c./nasal triptan
O2 –> 12L/min through non-rebreather
Prophylactic –> Alcohol avoidance, verapamil
What are the risk factors for migraine?
10% population Females (3:1) Menstruation, OCP use Exercise Alcohol Food (cheese, chocolate, red wine) Emotional stress
What is the underlying pathology behind migraine?
Vasodilation after a period of vasoconstriction (aura)
Mediated by vasoactive peptides
What are the subtypes of migraine?
Classical migraine w/ aura
Migraine w/o aura (common migraine)
Ophthalmoplegic migraine (Migraine + 3rd/6th nn palsy)
Hemiparetic migraine (Migraine + temp hemiparesis)
Facioplegic migraine (Migraine + unilat facial weakness)
How does classical migraine w/ aura present?
Starts w/ sense of ill health (sev hours), followed by visual aura (contralateral to succeeding headache, 1hr)
Sensory aura/speech disturbance rare
Throbbing headache w/ anorexia, N/V, photophobia
-begins locally, spreads bilaterally
-aggravated by movement
-can last hrs/days
How does migraine w/o aura present?
Visual/sensory aura absent
Pts feel non-specifically unwell prior to onset of headache
What investigations are appropriate in suspected migraine?
Examination - focal neurology, raised ICP, meningism, temporal arteritis, retinal haemorrhage (SAH)
Headache diary - fre/sev, precipitants, exac/reliev factors
What is the acute management of suspected migraine?
Oral NSAID/paracetamol + anti-emetic (metoclopramide)
Oral triptan if attacks severe (avoid if IHD/HTN/coronary artery spasm)
Avoid opioids
What is the preventative management of migraine?
Topiramate/Propranolol
Amitryptiline/anti-convulsants
Mefanamic acid (menstrual-related)
Use if >2/mo
How can migraine be distinguished from TIA?
In TIAs max deficit present immediately
Headache unusual
In what group is Idiopathic Intracranial HTN (IIH) most common?
Young, obese women
How does IIH present?
Sx/signs of raised ICP w/ no mass lesion on imaging
Visual disturbances (diplopia/obscurations)
Headaches
Pulsatile tinnitus/6th nn palsy
Bilateral papilloedema
What is the underlying pathology behind IIH?
Disorder of CSF resorption
What investigations are appropriate in suspected IIH?
CT/MRI (normal)
LP (raised CSF pressure)
What is the management of IIH?
Wt loss may cause spontaneous remission
Corticosteroids
Surgical shunt
What is the main complication of prolonged IIH?
Optic atrophy due to prolonged raised pressure
