Headache Flashcards
List some vascular causes of headache.
Haemmorhage - subdural, extradural, subarachnoid
Thrombosis - venous sinus thrombosis
List some infective causes of headache
Meningitis
Encephalitis
Abscess
Temporal arteritis
List some ‘situational’ / normal causes of headache.
Cough
Exertion
Sex
List some chronic causes of headache (there are a lot)
Primary headache = migraine, cluster, tension
Secondary causes = Drug side effects (caffeine, analgesics, vasodilators), Trigeminal neuralgia, Raised ICP, temporal/giant cell arteritis.
Also systemic causes - hypertension, pre-eclampsia, phaeochromocytoma.
What are the red flag features of headaches?
SNOOP
Systemic signs / disorders (meningitis)
Neurological symptoms
Onset new or changed and patient >50yo (malignancy)
Onset in thunderclap presentation (SAH)
Papilloedema (raised ICP)
What clinical features would emerge if a patient presented with a headache caused by a space occupying lesion, such as a tumour?
Gradual onset
Progressive
Associated neurological features - visual disturbance, focal signs…
Features of raised ICP - early morning headache, N&V, worse on coughing and bending.
What options would you recommend for the investigation of headaches?
Depends on cause…
Acute headaches / red flags (SAH) - CT asap
Chronic headaches - Headache diary
What examinations and history would you take from a patient complaining of headache?
Full history of presenting complaint (SQUITARS)
PMH of headache?
Drug history important.
FH - migraine with aura
SH - stress, diet, hydration
Examination= vital signs / obs, full neurological examination, other relevant systems exams (CVS if feeling faint…)
Describe the epidemiology of migraine.
More common in females than males 2:1
First onset before 30
Severity decreases with age
Complete SQITARS for migraine.
Site = unilateral, frontal
Quality = sudden or gradual onset, throbbing/ pulsating
Intensity = moderate
Timing = lasts between 4-72 hrs, cyclical character
Aggravating factors = photophobia, phonophobia
Relieving factors = sleep
Secondary symptoms = aura, nausea and vomiting.
Name some triggers of migraine
Foods - cheese, chocolate
Stress
Lack of sleep
Describe the epidemiology of a tension headache.
Most common type of headache
Affects females more than males
Occurs in young people more than old
Onset in over 50’s rare - consider malignancy.
Complete SQITARS for tension headache
Site = bilateral frontal, band like, can radiate to neck
Quality = Squeezing / band-like constriction, non-pulsatile
Intensity = mild- moderate
Timing = 10/15 mins - 48hrs, worse at end of day, chronic >15x/month, episodic <15x/month.
Aggravating factors = stress, poor posture, lack of sleep
Relieving factors = simple analgesia
Secondary symptoms = mild nausea
Describe the clinical features and management of a medication overuse headache.
3rd most common type of headache
Females more than males
Headache present on atleast 15 days/ month
Patient taking analgesic pain relief atleast 10 days/ month
No relief from OTC medication.
Management = discontinue medication. Symptoms should subside after around 2 months.
Describe the epidemiology of a cluster headache.
Males > females
Usual onset 20-40yo
Complete SQITARS for a cluster headache
Site = around/behind one eye, no radiation
Quality = Sharp and penetrating
Intensity = very severe, constant intensity
Timing = rapid onset, lasts 15min-3hrs, 1-2 x /day. Cluster headaches period lasts 2-12 weeks.
Aggravating factors = alcohol, head injury, smoking
Relieving factors = high flow oxygen, simple analgesia
Secondary symptoms = Red, watery eye, nasal congestion, ptosis.
Name some triggers for cluster headaches
Alcohol Allergy (histamine) GTN Heat Exercise Lack of sleep
Complete SQITARS for trigeminal neuralgia
Site = unilateral, over one eye, can radiate to eyes, lip, nose and scalp
Quality = sharp and stabbing, electric shock feeling
Intensity = severe
Timing = sudden onset, lasts seconds to 2 minutes.
Aggravating factors = light touch to face, eating, cold wind, vibrations.
Relieving factors = difficult to alleviate
Secondary symptoms = numbness and tingling preceding an attack.
