Headache Flashcards
What is primary headache disorder?
Non life or sight threatening headache
Mainly chronic or recurrent
What headaches fall under primary headache disorder?
- Tension headache
- Migraine
- Cluster headache
What is secondary headache disorder?
Headache due to another condution
Some are life or sight threatening
Many are ‘acute’
Gives some examples of things that can cause a secondary headache?
- Subarachnoid/ intracranial haemmorhage
- Tumour/ Space occupying lesion
- Hydrocephalous
- Meningits / intra cranial infections
- Temporal giant cell arteritis
- Acute, closed angle glaucauma
- Medication related
- Systemic hypertension/ pre-eclampsia
What are some of the flags for potentially life or sight threatening headaches?
SNOOP mneumonic
- Systemic signs e.g. meningitis fever, neck stiffness. Pregnant, cancer?
- Neurological symptoms e.g. SoL, ICH, glaucoma (visual)
- Onset (new or changed & patient >50 years) e.g. Malignancy, closed angle glaucoma
- Onset thunderclap e.g. vascular haemorrhage
- Papilledema, pulsatile tinnitus, positional provication, precipitated by exercise → raised ICP
How may a patient desribe a tension type headache?
- Generalised to the frontal / occipital regions
- Tight, band like +/- radiating to the neck
- Mild- moderate intensity
- Worse at the end of the day
- Recurrent (30mins-1 hr)
- Aggrevated by stress, poor posture, lack of sleep
- Often responds to simple analgesics
- Few associated symptoms
- Clinical examination is normal
What is the pathophysiology behind a tension type headache?
Thought to be due to tension in the muscles of the head and neck
What demographics do tension type headaches affect?
- More common Female > Male
- Young adults and teens
- First onset >50 years unusual
What are the demographics of a migraine patient?
- More common females > males (1 in every 5 females)
- Common (15 in 100)
- Presents early- mid life
- Most have had first attack by age 30
How may a patient with migraine present?
- Unilateral (temporal or frontal lobes)
- Throbbing/ pulsating
- Moderate- severe, often disabling
- Prolonged headache, between 4-72 hours
- Triggers; certain foods, menstrual cycle, stress, lack of sleep, often have family history
- Can respond to simple analgesics
- Associated symptoms; photophobia, nausea + vomiting, aura, neurological symptoms
- Clinical examination is normal
Explain what occurs to cause a medication over use headache
- Regular use of analgesics to treat preexisting headache and headache not responding
- Most common caused by cocodamol
- Co-exists with depression and sleep disturbance
- Female > Male
- Headache present on at least 15 days/month
How do you treat a medication over use headache?
Stop medication
Heache will worsen before it improves
Typically resolved completely by 2 months
What are the demographics of a cluster headache?
- Affect Males > Females
- Rare 1 in 1000
- Usually begin age 30-40 years
What is thought to be the underlying pathophysiology behind a cluster headache?
Possibly due to hypothalamic activation with secondary trigeminal and autonomic involvement
How would a patient with cluster headache present?
- Headache around/ behind the eye, unilaterally
- Sharp, stabbing, penetrating pain often at night
- Severe, intense, often disabling, agitated
- Last 15mins- 3 hours
- Occur in clusters with periods of remission
- Triggers; alcohol, cigarettes, volatile smell, warm temp, lack of sleep
- Ipsilateral autonomic symptoms; red watery eye, runny nose, ptosis, constricted pupil
- Simple analgesics often ineffective → need O2 and triptans
- Will have evidence of autonomi symptoms on examination (only if having headache at time)
What is the pathophysiology of trigeminal neuralgia?
- Mainly caused by compression of trigeminal nerve due to a loop of blood vessel
- 5% are due to tumours/ skull base abnormalities or AV malformations
Which artery is most commonly affected by temporal (giant cell) arteritis?
Superficial temporal artery
