Headache Flashcards
Headaches can be split into Primary and Secondary Types, what would be signs of a secondary headache?
- Trauma
- First or worst ever headache
- Thunderclap onset
- A new daily & persistant headache
- A change in the headaches pattern or type
- Other symptoms such as jaw claudication, fevers, neuro signs/symptoms or worsened by position
List 2 things that could cause a thunderclap style headache?
Sub arachnoid haemorrhage
What causes most subarachnoid haemorrhages?
Aneurysms
How would we approach a subarachnoid haemorrhage?
Immediately CT the brain and do an LP after 12 hours from onset
Early coiling or clipping
Define a thunderclap headache?
High intensity peaking instantly or within 1 minute of onset
What would indicate a thunderclap headache to be caused by CNS infection?
If the patients headache comes with fever, rash or:
Meningitis - STiff neck, photo/phonophobia, n&V
Encephalitis - Altered mental state, seizures, focal neuro symptoms/signs
What could raise or lower Intracranial pressure?
Raised ICP:
- Hydrocephalus
- Cerebral Abscess
- Glioblastoma/Meningioma
- Venous sinus infarct
Lowered ICP:
- Dural CSF leak either spontaneously or after LP
What are the specific signs of raised ICP?
Progressively worse headache
Worse in morning/wakes them up
Worse on flat, valsalva (shit/cough/strain) or on exertion
Neurological symptoms
Seizures
Visual Obscurations and pulsatile (whooshing) tinnitus
What indicates a intracranial hypotension and how do appraoch it?
Headache appearing/worsening on standing and lessening/resolving on lying down
Sagittal MRI of brain and spine will show an empty subarachnoid space
Bed rest, fluids, analgesia, caffeine
Epidural Blood patch (to stimulate healing of a CSF leak)
What is an epidural blood patch?
A treatment for leaking CSF leading to lowered ICP
Put some of the patietns blood in their epidural space which will cause irritation leading to healing of the leak
What is Giant Cell Arteritis and what about a headache would indicate it?
Giant cell granulomatous inflammation of the arteries causing narrowing which can cause an infarction to the brain and/or optic nerve
The headache is diffuse persistant and may be severe
What are the symptoms of giant cell arteritis?
- Diffuse, persistant and maybe severe headache
- Jaw claudication
- Visual Disturbance
- Scalp Tenderness
What investigations and treatment are there for suspected GCA?
ESR/CRP/Platelets all elevated
Treat with high dose prednisolone and confirm with a temporal artery biopsy
What are the main types of Primary Headache?
- Tension-Type
- Migraine
- Medication Overuse Headache
- Trigeminal Neuralgia
And the Trigeminal Autonomic Cephalagias:
!) Cluster HEadache
“) Paroxysmal Hemicrania
£) SUNA/SUNCT
Define a Tension-Type HEadache?
- Most frequent Primary headache
- Mild, bilateral
- Often pressing or tightening
What are the subtypes of Tension Type HEadache?
Episodic - <15 days a month
Chronic - >15 days a month