Headache Flashcards
What are the 3 main types of primary headache?
Tension type
Cluster
Migraine
What sex is migraine more common in?
Women
What is the average age of sufferers of migraine?
20-50yrs
What are migraine features?
Headache Nausea Photophobia Photophonia Functional disability
What are the triggers of migraine?
Normal life events in predisposed people; Dehydration Diet Sleep disturbance Hunger Stress Environmental stimuli Changes in oestrogen levels in women
What is the preventative treatment for tension type headache?
Tricyclics antidepressants i.e. amitriptyline
When is best to treat migraines?
After aura but before the advanced headache has begun
What is aura?
Transient neurological symptoms resulting from cortical or brainstem dysfunction
Moves from 1 area of the cortex to another causing slow evolution of symptoms
I.e. vision - sensory - speech
What is defined as chronic migraine?
Headache on > 15 days per month of which >8 are migraine, for more then 3 months
They have a background tension type headache with attacks of migraine
What is the most common cause of chronic migraine?
Medication overuse
What is the maximum dose of analgesia given for treating headaches?
<15 per month (2 per week)
Over that then this will cause medication overuse headache
What is the abortive treatment for migraine?
Aspirin or NSAIDS
Triptans (2 days per week)
What are the prophylactic treatment for migraines?
Propanolol, candesartan
Anti-epileptics
Tricyclics antidepressants
Venlafaxine
What are the changes in migraine during pregnancy?
A major trigger for migraine is oestrogen cycles so when that stops during pregnancy then the migraines get better
- aura gets better in pregnancy
When is the oral contraceptive contraindicated?
In people with migraine with aura
It isn’t contraindicated in migraine without aura
What’s the difference in the location of trigeminal autonomic cephalalgias headaches and migraines?
TAC are unilateral whereas migraines are more widespread
What are the symptoms associated with trigeminal autonomic cephalalgias?
Conjunctival infection Lacrimation Nasal congestion Rhinorrhoea Eyelid edema Forehead and facial sweating Mitosis, ptosis (hornets syndrome)
What is the average duration of cluster headache?
15-180 mins
What is there pattern of cluster headaches compared to migraines
Migraine are slow onset lasts while and slowly settle
Cluster headaches have short severe attacks usually 2 per day
What’s the main difference between paroxysmal hemicrania and cluster headache?
PH is more frequent ands brief (2-30mins compared to 15-180mins)
What is the treatment for a paroxysmal hemicrania headache?
Non steroidal - Indometacin
Where is trigeminal neuralgia mostly felt?
Maxillary or mandibular pain
Lower part of the face
What are the triggers of trigeminal neuralgia?
Wind
Cold
Chewing
Touch
What are the red flag symptoms of headaches?
New onset headache New or change in headache (age over 50 or immunosuppressed) Change in frequency, characteristics or associated symptoms Focal neurological symptoms Non-focal neurological symptoms Abnormal neurological examination Neck stiffness/fever High pressure (worse when lying down) - Wakening up the patient - Precipitated by physical activity - Precipitated by valsalva maneuver - Risk factors for cerebral venous sinus thrombosis Low pressure - precipitated by sitting/standing up GCA - jaw claudication or visual disturbance - prominent or beaded temporal arteries
What is the definition of a thunderclap headache?
High intensity headache reaching maximum intensity in less than 1 minute
What are the main differential diagnoses of a thunderclap headache?
Subarachnoid haemorrhage Meningitis and encephalitis Space occupying lesion and/or raised ICP Intracranial hypotension Giant cell arteritis
What are the treatments for intracranial hypotension?
Bed rest
Fluids
Caffeine
Epidural blood patch
What is the pattern of intracranial hypotension?
Widespread headache which gets worse when standing up and lessens after lying down
If it becomes chronic then it loses it postural component
What are the specific features of giant cell arteritis?
Tender scalp
Jaw claudication
Visual disturbance
Prominent, beaded or enlarged temporal arteries
How do you diagnose giant cell arteritis?
Elevated ESR and CRP & platelet
What is defined as an infrequent, frequent and chronic tension type headache?
Infrequent <1day per month
Frequent 1-14 days per month
Chronic >15 days per month
What is the abortive treatment for tension type headache?
Aspirin or paracetamol
NSAIDS
What is the dose of Triptans that can result in medication overdose migraine?
> 10days /month
>2 per week
What does SUNCT stand for?
Short-lasting unilateral neuralgiform headache with conjunctival infection and tearing
What does SUNA stand for?
Short-lasting unilateral neuralgiform headache with autonomic symptoms
What is the main nerve involved in trigeminal autonomic cephalalgias?
V1 -ophthalmic nerve
What are the 3 trigeminal autonomic cephalagias?
Cluster headaches
Paroxysmal hemicrania
SUNCT
What is the difference between the attack frequency in SUNCT and trigeminal neuralgia?
SUNCT has no refractory period so ends up with no break between short-lasting attacks
Trigeminal neuralgia has refractory periods between attacks
What is the prophylactic treatment for trigeminal neuralgia?
Carbamezapine
Surgical intervention - glycerol ganglion injection, stereotactic radiosurgery and decompressive surgery
What is the prophylactic treatment for SUNCT?
Carbamezapine
Gabapentin
Topiramate
Lamotrigine
What is the pattern of paroxysmal hemicrania headaches?
Unilateral attacks
Rapid onset & cessation of pain
10% of attacks precipitated by bending or rotating the head
Mainly orbital and temporal pain
what is the average duration of SUNCT?
5 seconds to 4 mins
what is the pain like in trigeminal autonomic cephalalgies (SUNCT, paroxysmal hemicranial and cluster headaches) ?
SUNCT = sharp burning
P.H & cluster = sharp, stabbing
what defines a chronic cluster headache?
bout lasts <1 year without remission
remission lasts <1 month
what are the characteristics of a tension type headache?
pressure, tightening pain
aggravated by physical exertion
mild
bilateral
what are the characteristics of a cluster headache?
unilateral premonitory symptom = tiredness associated symptoms = photophobia, phonophobia, nausea typical aura prominent ipsilateral autonomic symptoms
in which headaches do you find ipsilateral autonomic symptoms?
cluster headaches
paroxysmal hemicrania
what is the average duration of trigeminla neuralgia?
5-10 seconds
what are the pre monitory symptoms of a migraine?
fatigue
muscle pain
mood changes
food cravings
what are the postdrome symptoms of a migraine?
fatigue
muscle pain
what prophylaxis drug can be used for all primary headaches?
topiramate
