Headache Flashcards
Name some differential diagnoses for a headache
Acute - haemorrhage, SAH, intracranial bleed, sinus venous thrombosis, meningitis, encephalitis, abscess, acute glaucoma
Chronic - migraine, cluster headache, drugs, tension headache, neuralgia, raised ICP, giant cell arteritis, hypertension/systemic
What are the red flags for serious pathology if a patient presents with a headache
Systemic signs and disorders
Neurological symptoms
Onset new or changed, patient >50yrs
Onset in thunderclap presentation
Papilloedema
Pulsatile tinnitus
Positional provocation
Precipitated by exercise
Name some symptoms of a space occupying lesion
Graudal onset with progressive headache
Associated neurology
Features of a raised ICP - early morning headahce, nausea, vomiting, worse on coughing or bending
Name some causes of a chronic primary headache
Migraine
Tension type headache
Medication overuse headache
Cluster headache
Trigeminal neuralgia
Describe migraines including length and triggers
Migraine - most have first episode by 30
Severity decreases with age
Lasts 4-72hrs and can have cyclical pattern
Triggers - food, sleep, stress
Describe the symptoms of a migraine
Unilateral moderate pain - often frontal
Throbbing or pulsating pain
Preceeded by aura, paraesthesia or spots in vision
Nausea and vomiting
Describe a tension type headache and triggers
Most common headache. Common in women and young
Onset >50 unusual
Triggers - stress, poor posture, lack of sleep
Either episodic or chronic
Describe the symptoms of a tension type headache
Bilateral frontal pain worse at the end of the day
Squeezing, non-pulsatile pain
May last up to 24hrs
Nausea
Describe a medication overuse headache
Medication overuse headaches occur at least 15 days/mth and do not improve after OTC medication
More common in females and 30-40yrs
Unlikely unless taking medication for headache constantly - don’t get headache if taking medication chronically for another condition
May get rebound headache with treatment
What medications can cause a medication overuse headache
Triptans or opioids - at least 10 days/month
Paracetamol, aspirin or NSAIDs - at least 15 days/month
Describe a cluster headache and how often they occur/last
Usually between 20-40yrs. Affect males more
Episodic or chronic
Have rapid onset, last 15mins-3hrs, occur 1-2 times a wk
Come in clusters lasting 2-12wks with remission of 3mths-3yrs
Describe the symptoms of a cluster headache
Sharp penetrating pain around/behind one eye
Very severe
Does not radiate
Have red, watery eye due to increased SNS activation
Possible nasal congestion and partial ptosis
Name some triggers of cluster headaches
GTN
Heat
Exercise
Solvents
Lack of sleep
Cigarette smoke
Head injury
Histamine
Describe trigeminal neuralgia and name some triggers
More common in females
Most causes of trigeminal neuralgia are due to compression of CN V by loop of artery or vein. Other causes: tumour, MS, skull base abnormalities, AVMs
Triggers - light touch to face, eating, cold wind, vibrations
Describe the symptoms of trigeminal neuralgia
Unilateral, sharp, stabbing pain over the eye
Sudden onset lasting seconds to minutes
Radiates to eyes, lips, nose, scalp
