Headache Flashcards
Describe four categories for differentials for acute headaches. (4)
Give at least one example for each. (10)
Vascular - SAH, sinus venous thrombosis, intracranial bleed.
Infective / inflammatory - meningitis, encephalitis, abscess.
Ophthalmic - acute glaucoma
Situational - cough, exertion, sex.
Describe eight causes of chronic headaches. (7)
Migraine Cluster headaches Tension headaches Trigeminal neuralgia Raised ICP (tumour) Giant cell arteritis Drugs (analgesics, caffeine, vasodilator, side effects) Hypertension (pre-eclampsia, pheochromocytoma)
Describe the differences between primary and secondary headaches. (4)
Primary are caused by the headache condition itself (eg migraines).
Secondary are caused by something else (eg medication overuse/SAH/sinusitis)
List the six categories of headache for immediate hospital referral. (12)
Vascular (SAH, haemorrhage, thrombosis) Infective (meningitis, encephalitis) Ophthalmic (acute glaucoma) Increased ICP (tumour) Giant cell arteritis Hypertension (pheochromocytoma, pre-eclampsia).
Describe the red flags of headaches. Give a key cause of each of the red flags. (11)
SNOOP Systemic signs - meningitis, HTN. Neurological signs - SOL, glaucoma Onset recently and patient over 50 - tumour Onset with thunderclap - SAH Papilloedema - raised ICP
Describe the history of headaches caused by space occupying lesions. (4)
Gradual onset and progressive. Associated neurology (often vision changes) Features of raised ICP - early morning, N+V, worse on bending/coughing.
Describe the history of migraines. (13)
S - unilateral, often frontal Q - sudden/gradual onset, pulsating I - moderate T - between 4-72 hours, can be menstrual A - photo/phonophobia R - sleep, OTC medication S - Aura, N+V.
Describe migraines
Triggers (4)
Epidemiology (5)
Cause (1)
Foods, lack of sleep, stress, hormones.
2% of the population, more females, usually onset by 30, severity decreases with age, often has fHx.
Cause unknown.
Describe the history of tension headaches. (11)
S - bilateral, temporal Q - squeezing, non-pulsatile I - mild T - worse at end of day A - stress, poor posture, lack of sleep R - OTC painkillers S - mild nausea
Describe tension headaches
Epidemiology (3)
Females > males, young > old. No fHx.
Describe medication overuse headaches. (2)
Define medication overuse. (5)
A headache present on at least 15 days of the month that is not relieved by medication.
Overuse is (for longer than 3 months)
Triptans or opioids (inc codeine) for more than 10 days a month
Paracetamol, high dose aspirin, or NSAIDs for more than 15 days a month.
Describe medication overuse headaches.
Epidemiology (2)
Treatment (2)
Co-existing conditions. (2)
20% of all headaches, females > males.
Resolves in 2 months without pain killers, but will get worse before it gets better.
Often co-exists with depression or sleep problems.
Describe the history of cluster headaches. (14)
S - around or behind one eye
Q - sharp, penetrating
I - very severe and constant
T - rapid onset, attacks last 15mins - 3 hours, 1-2 per day, commonly nocturnal.
A - head injury, alcohol, smoking.
R - high flow oxygen
S - red and watery eye, nasal congestion.
Describe cluster headaches.
Pattern of episodic nature (2)
Definition of chronic (2)
Triggers. (7)
Clusters last 2-12 weeks, remission lasts 3mo-3 years
Described as chronic if you have no gap in 12mo or remission of less than 1mo.
Triggers: alcohol, histamine, GTN, heat, exercise, solvents (occupational), lack of sleep.
Describe the history of Trigeminal neuralgia. (14)
S - unilateral, over eye. Q - stabbing, “electric shock” I - severe T - sudden, lasts less than 2 minutes A - light touch, wind, eating, vibration R - nothing. S - preceding tingling or numbness. Can radiate to eyes, lips, nose or scalp.
