Headache Flashcards
Describe a Tension headache?
- Tends to affect frontal and occipital regions
- ‘Tight band around the head’
- Does not worsen with routine physical activity
Cause of tension headaches?
- Psychological stress
- Disturbed sleep pattern
Case history of tension headaches
Clinical features of a tension headache?
- Bilateral
- Dull and non-pulsatile
- Worsen as the day progresses
- Mild nausea, photophobia, phonophobia can occur
Risk factors for a tension headache?
- Mental tension
- Stress
- Missing meals
Differentials for tension headaches?
- Chronic migraine
- Medicine overuse headache
Management of acute tension headache?
- Simple analgesics
- Aspirin
- Paracetamol
- Ibuprofen
- Naproxen
Management of persistent tension headache?
> 7-9 headache days/month
- 1st:
- Amitriptyline (antidepressant)
- 2nd:
- Mirtazipine
- CBT may help
Complications of tension headache?
Peptic ulcer from NSAID use
Describe a migraine?
- Chronic, genetically determined, episodic, neurological disorder
- Nausea, photophobia and disability with the headache
Describe migraine aura?
- Reversible visual, sensory or speech symptoms
- Precedes the headache
Describe a screening method for migraine?
- ID migraine
- Has a headache limited your activities for a day or more in the last 3 months?
- Do you feel nauseous or do you vomit when you have a headache?
- Does light bother you when you have a headache?
Read the case histories for migraine
Risk factors for migraine?
- Family history
- High caffeine intake
- Female sex
- Obesity
Differentials for migraine?
- Tension headache
- Cluster headache
- Medication overuse headache
Describe the management of a migraine patient with persistent symptoms?
- Sumatriptan
- Adjuvant high-flow oxygen
- Adjuvant IV corticosteroid
Management of mild-moderate migraine symptoms?
- Aspirin (or Ibuprofen)
- Adjunct anti-emetics
- Adjunct hydration
Management of severe migraine symptoms?
- Triptan
- Adjunct anti-emetics
- Adjunct hydration
- Adjunct NSAID
Complications of migraines?
- Status migrainosus
- Migraine attack lasting >72 hours
- Assess for medication overuse
- Depression
Describe a cluster headache?
- Unilateral headache lasting 15-180 minutes
- Orbital, supra-orbital or temporal
- Associated with autonomic symptoms
- Ptosis, rhinnorhoea
What are the 3 cardinal features of cluster headaches?
- Trigeminal distribution of pain
- Ipsilateral cranial autonomic symptoms
- Circadian pattern of attacks
Case history of someone with a cluster headache
Risk factors for cluster headaches?
- Male sex
- Family history
- Head injury
- Smoking
- Heavy drinking
Diagnostics tests which should be ordered for cluster headaches?
- CT or MRI head
- ESR (normal)
- Pituitary function tests
- Normal in primary cluster headache
- Abnormal = secondary to pituitary adenoma
Management of an Acute attack of cluster headache?
- Subcutaneous sumatriptan
- Oxygen
- Adjunct Greater occipital nerve block
Management of episodic/chronic cluster headaches?
- Verapamil
- 2nd: Lithium or gabapentin
- 3rd: Valproate
- 4th: Surgery
Surgical options for cluster headaches?
- Occipital nerve stimulation
- Deep brain stimulation of posterior hypothalamic region
Complication of cluster headache
Depression and anxiety
Partial triggers for migraines?
- CHOCOLATE
- Chocolate
- Hangovers
- Orgasms
- Cheese/caffeine
- Oral contraceptives
- Lie ins
- Alcohol
- Travel
- Exercise
Symptoms of trigeminal neuralgia?
- Paroxysms of intense, stabbing pain
- Lasting seconds in trigeminal distribution
- Unilateral in mandibular or maxillary divisions
- Face screws up with pain
Triggers for Trigeminal neuralgia?
- Washing affected area
- Shaving
- Eating
- Talking
Typical patients with trigeminal neuralgia?
- Male >50
- Female Asians
Secondary causes of trigeminal neuralgia?
- MS
- Tumour
- Chronic meningeal inflammation
Investigations into trigeminal neuralgia?
MRI to exclude secondary causes
Treatment for Trigeminal neuralgia?
- Carbamazepine
- Lamotrigine
- Phenytoin
- Gabapentin
- Surgery
Describe the surgical management of trigeminal neuralgia?
- Microvascular decompression
- Anomalous vessels are separated from the trigeminal root
