Headache Flashcards
What is a primary headache? Give the 3 examples
Not the result of another medical condition / no underlying medical cause.
Can be:-
Tension type headache
Migraine
Cluster headache
What is a secondary headache?
Has an identifiable structural or biochemical cause ie
Causes of secondary headaches?
Tumour Meningitis Vascular disorders Systemic infection Head injury Drug-induced
however not all secondary headache is sinister
Tension type headache
Most frequent primary headache but is not disabling and rarely presents to doctors
Mild, bilateral headache
often pressing or tightening in quality
no significant associated features and is not aggravated by routine physical activity
Treatment for tension type headache: abortive and preventative
Abortive treatment:-
Aspirin or paracetamol
NSAIDs
Preventative treatment:-
Rarely acquired
Tricyclic antidepressants
Migraine: general info
most frequent disabling primary headache
affects 6 million in UK, aged 20-50
What is a migraine?
A chronic disorder with episodic attacks
Complex changes in the brain. Origin of which cannot be pinpointed to a single brain site or mechanism.
Symptoms associated with migraines (5)
Headache
Nausea
photophobia phonophobia
Functional disability
What can trigger a migraine (7)
Sleep disturbance Dehydration Diet Environmental stimuli Changes in oestrogen level in women Hunger Stress
Clinical phases of migraine
A migraine attack can take days to develop and resolve; headache is only 1 of several symptoms associated with migraine
Although the symptoms of migraine often overlap, the classic view is to separate an attack into phases.
- The Premonitory Phase
- Aura phase
- Headache phase - early and advanced
- Postdrome - symptoms beyond the resolution of the headache (1-2 days)
What is the Aura phase
Affects 33% of migraineurs
Transient neurological symptoms resulting from cortical or brainstem dysfunction
May involve visual, sensory, motor or speech systems
slow evolution of symptoms. Symptoms last 15-60 mins
can be confused with TIA
Define chronic migraine
Headache on ≥ 15 days per month, of which ≥ 8 days have to be migraine, for more than 3 months
Medication overuse headache
Headache present on ≥15 days / month which has developed or worsened whilst taking regular symptomatic medication
Can occur in any primary headache
Migraineurs taking pain medication for another reason can develop chronic headache
Abortive treatment for migraines (2)
Aspirin or NSAIDs
Triptans
Limit to 10 days per month to avoid the development of medication overuse headache
Prophylactic treatment for migraines (4)
Propranolol, Candesartan
Anti-epileptics - Topiramate, Valproate, Gabapentin
Tricyclic antidepressants - amitriptyline, dothiepin, nortriptyline
Venlafaxine
Specific issues in women
Migraine without aura gets better in pregnancy
First migraine can occur
during pregnancy
The combined OCP is contraindicated in active migraine with aura
Avoid anti-epileptics in women of child bearing age
Treatment is more difficult in pregnancy
Acute attack: Paracetamol
Preventative: Propranolol or Amitriptyline
What does the group of headache disorders known as Trigeminal Autonomic Cephalalgias comprise of? (4)
cluster headache - most frequent attacks and longest duration
Paroxysmal Hemicrania
SUNCT
SUNA
What does SUNCT stand for? and what is it?
Short-lasting Unilateral Neuralgiform headache with Conjunctival injection and Tearing
strictly unilateral, generally orbital, supraorbital or temporal pain
stabbing or pulsating pain
cutaneous triggers - wind, cold, touch, chewing
What does SUNA stand for?
Short-lasting Unilateral Neuralgiform headache with Autonomic Symptoms
What are the shared symptoms of trigeminal autonomic cephalagias
Unilateral head pain
Very severe / Excruciating
Cranial autonomic symptoms include:-
Conjunctival injection / lacrimation
Nasal congestion / rhinorrhoea
Eyelid oedema
Forehead & facial sweating
Miosis / ptosis (Horner’s syndrome)
Attack frequency and duration differs
Treatment responses differ
Cluster headache
Pain: mainly orbital and temporal
Excruciatingly severe (“suicide headache”) Patients are restless and agitated during an attack
Attacks are strictly unilateral
Rapid onset (max within 9 mins in 86%)
Duration: 15 mins to 3 hours
Rapid cessation of pain
Cluster headache: re-occurrence
Attacks “cluster” into bouts typically lasting 1-3 months with periods of remission lasting at least 1 month
Attack frequency: 1 every other day to 8 per day
May be continuous background pain between attacks
alcohol is a trigger during a bout but not in remission
attacks occur at same time each day and bouts at same time each year
Paroxysmal Hemicrania
Pain: mainly orbital and temporal
Attacks are strictly unilateral
rapid onset - duration = 2-30 minutes
80% have chronic PH, 20% have episodic PH
Frequency: 2-40 attacks per day (no circadian rhythm)
Absolute response to indometacin
Trigeminal neuralgia
unilateral maxillary or mandibular division pain
stabbing pain
cutaneous triggers - wind, cold, touch, chewing
