Headache Flashcards
What are acute causes of headaches?
Haemorrhage
- SAH
- Subdural
Meningitis
Encephalitis
Acute glaucoma
Increased ICP
What are chronic causes of headaches?
Migraine Cluster headaches Drugs Tension headache Trigeminal neuralgia Increased ICP Giant cell arteritis
What is a primary headache?
Headache due to the headache condition itself
What are examples of a primary headache?
Migraine
Tension
Cluster
What is a secondary headache?
Headache that is present due to another condition
What are examples of a secondary headache?
Meningitis
Sinusitis
SAH
Medication overuse
What is a pneumonic for red flag symptoms of headaches?
SNOOP
What are red flag symptoms of headaches?
Systemic signs Neurological symptoms Onset - new or changed in patient >50 Onset - thunderclap Papilledema
What are clinical features of a space occupying lesion?
Pain on one side
Gradual onset
Progessive symptoms
Change in vision
Features of raised ICP
- early morning headache
- N+V
- worse on coughing
What is the epidemiology of migraines?
F>M
Younger patients
What is the site of a migraine?
Unilateral
Often frontal
What is the quality of a migraine?
Throbbing/pulsating
What is the intensity of a migraine?
Moderate
What is the timing of a migraine?
Sudden or progressive onset
Last between 4-72 hours
What makes migraines worse?
Light - photophobia
What makes migraines better?
Sleep
Pain relief
What are associated symptoms with a migraine?
+/- aura
N+V
Photophobia
What can trigger a migraine?
Lack of sleep
Stress
Types of food
What is the epidemiology of tension headaches?
Most common type of headache
F>M
Young>old
What is the site of a tension headache?
Bilateral
Frontal
What is the quality of a tension headache?
Squeezing, non-pulsatile
What is the intensity of a tension headache?
Mild-moderate
What is the timing of a tension headache?
Worse at the end of the day
What can make a tension headache worse?
Stress
Poor posture
Lack of sleep
What can make a tension headache better?
OTC pain relief
What are associated symptoms with a tension headache?
Mild nausea
What is the epidemiology of medication overuse headache?
30-40 years old
F>M
How is a medication overuse headache defined?
Headache on at least 15 days per month - not improved by OTC medication
What medications can bring on a medication overuse headache?
> 3 months
- triptans
- opioids
- paracetamol
- aspirin
- NSAIDs
How are medication overuse headaches managed?
Discontination of medication
How long does it take to resolve a medication overuse headache?
2 months
What advice do you give to patients with a medication overuse headache?
Gets worse before it gets better
What is the epidemiology of cluster headaches?
M>F
20-40 years old
What the site of a cluster headache?
Around/behind one eye
What is the quality of a cluster headache?
Sharp
Penetrating
What is the intensity of a cluster headache?
Very severe
What is the timing of a cluster headache?
Rapid onset
Attacks = 15 mins - 3hours (1-2x day)
Clusters last 2-12 weeks
What are associated symptoms of a cluster headache?
Red watery eye
Nasal congestion
What can trigger a cluster headache?
Alcohol Histamine GTN Heat Exercise Lack of sleep
What is the epidemiology of trigeminal neuralgia?
50-60 years old
F>M
What is the main cause of trigeminal neuralgia?
Compression of CNV by loop of artery or vein
What is the site of trigeminal neuralgia?
Unilateral
Often over the eye
What is the quality of trigeminal neuralgia?
Stabbing
Sharp
‘Electric shock’
What is the intensity of trigeminal neuralgia?
Severe
What is the timing of trigeminal neuralgia?
Sudden onset
Lasts few seconds - 2 mins
What can make trigeminal neuralgia worse?
Light touch to face
Eating
Cold wind
Vibrations
Where can trigeminal neuralgia radiate?
Eyes
Lips
Nose
Scalp
What symptoms can precede the pain in trigeminal neuralgia?
Numbness
Tingling
