Headache Flashcards
What are the main groups of primary headaches?
What are secondary headaches?
What are cranial neuralgias?
Primary: Migraines Tension Cluster Others such as primary stabbing headache - Malfunction of neurones and their networks.
Secondary:
Symptomatic of some underlying pathology - RICP, SOL
Trigeminal and other central causes of facial pain
Describe tension headaches.
Symmetrical headache of gradual onset
Tightness, band, pressure
Describe migraine without aura. Aggravating/relieving factor?
90%
1-72 hour episodes
Bilateral but may be unilateral
Pulsatile over the temporal or frontal area
Unpleasant GI disturbance such as nausea, vomiting, abdominal pain, photophobia and photophobia.
Aggravated by physical activity
Relived by sleep
Describe migraine with aura.
What are other features of migraine?
10%
Headache preceded by an aura (visual, sensory or motor)
Features are the absence of problems between episodes and frequent presence of premonitory symptoms (tiredness, difficulty concentrating, autonomic features)
Describe types of aura.
Negative phenomena - hemianopia, scotoma (small areas of visual loss)
Positive phenomena- fortification spectra (seeing zigzag lines)
Rarely, unilateral sensory or motor symptoms
How long do migraines last?
Few hours
Give some triggers of migraine.
Late nights Early rises Stress Winding down after stress Cheese Chocolate Caffeine Orgasm Menstruation OCP
What are periodic syndromes? Describe.
Precursors of migraine
Cyclical vomiting - stereotyped episodes of vomiting and intense nausea associated with pallor and lethargy.
Abdominal migraine - idiopathic recurrent episodic midline abdominal pain.
Associated with vasomotor symptoms, nausea and vomiting
Benign paroxysmal vertigo of children
Brief episodes of vertigo without warning and resolving spontaneously. Examination normal.
describe headache secondary to SOL
Worse when lying down
Morning vomiting
Night-time waking
Change in mood, personality or educational performance.
What are features suggestive of a SOL?
Visual field defects - from lesions pressing on optic pathway - pituitary tumour causes bitemporal hemianopia Cranial nerve abnormalities - diplopia, squint, facial nerve palsy Abnormal gait Torticollis Growth failure Papilloedema Cranial bruits Early or late puberty
What are chronic daily headaches and what causes them?
Headache on 15+ days a month
Use of acute analgesics or triptans more than 2 days a week
Describe management of headaches.
History and examination to rule out sinister causes.
Reassure patient and parents.
Explain about good spells and bad spells.
No long term harm
Child friendly information provided
Medicine can only make bad spells more bearable
What are rescue treatments in headaches.
Analgesia: paracetamol, NSAIDs
Antiemetics: prochlorperazine or cyclising
Triptans (5HT1 agonists) Sumatriptan - nasal preparation
Physical treatments - cold compress, warm pads, topical forehead balms
What are red flag symptoms for headache?
Worse lying down or with coughing and straining
Wakes up child
Associated confusion and/or morning or persistent nausea/vomiting
Recent change in personality behaviour or educational performance.
Growth failure Visual field defect Squaint Cranial nerve Toritcollis Gait Coordination impaired
What are prophylactic treatments for headaches?
Sodium channel blockers - valproate
BEta blockers - propanolol (contraindicated in asthma)
Tricyclics pizotifen 5HT2 antagonist
Acupuncture
