Headache Flashcards by MLG .

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

How well did you know this?

Not at all

Perfectly

List 2 things that could cause a thunderclap style headache?

Sub arachnoid haemorrhage

How well did you know this?

Not at all

Perfectly

What causes most subarachnoid haemorrhages?

Aneurysms

How well did you know this?

Not at all

Perfectly

How would we approach a subarachnoid haemorrhage?

Immediately CT the brain and do an LP after 12 hours from onset

Early coiling or clipping

How well did you know this?

Not at all

Perfectly

Define a thunderclap headache?

High intensity peaking instantly or within 1 minute of onset

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What are the symptoms of giant cell arteritis?

Diffuse, persistant and maybe severe headache
Jaw claudication
Visual Disturbance
Scalp Tenderness

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Define a Tension-Type HEadache?

Most frequent Primary headache
Mild, bilateral
Often pressing or tightening

How well did you know this?

Not at all

Perfectly

What are the subtypes of Tension Type HEadache?

Episodic - <15 days a month

Chronic - >15 days a month

How well did you know this?

Not at all

Perfectly

How do you treat tension type headache?

Aspirin, paracetamol or NSAIDs

Can prevent with Tricyclic Antidepressants

Define a Migraine?

A chornic disorder of episodic attacks featuring headaches, phono/photophobia, functional disability and nausea.
And in 33%, an aura
The most frequent disabling primary headache

What causes a migraine?

We dont know the cause but it can be triggered by lots including:

Stress
Oestrogen changes e.g. menstruation
Diet
Sleep Disturbance

What is an “aura”?

A set of transient neurological symptoms lastig 15-60 minutes.
It moves from one area to the next so might appear as vision then sensory then speech problems (can be mistaken for a TIA)

What defines a Chronic Migraine?

Headaches >15 days a month for >3 months

Of which atleast 8 a month must be migraines

How do we treat migraines?

Abortive:

Aspirin & NSAIDs
Triptans

Prophylactic:

Propanolol
Anti-epileptics
Tricyclic Antidepressants
Vanlafaxin

What should we be aware of in women with migraines?

Dont give antiepileptics to those of child-bearing age as they’re teratogenic

Treat pregnant women with paracetamol or propanolol/Amitriptyline prophylactically

Define a medication overuse headache?

HEadache >15days a month developed or worsened on regular symptomatic medications

What causes a medication overuse headache?

- Triptans - Erots - Opiods More than 10 days a month Or simple analgesics more than 15 days a month Also caffeine overuse

Where do Trigeminal Autonomic Cephalagias present with pain?

In the orbital, supraorbital and temporal regions

What do SUNA/SUNCT stand for?

Short Lasting Unilateral Neuralgiform headache With either Autonomic symptoms or Conjunctival injection and Tearing

Describe a cluster headache?

- Unilateral sharp/throbbing pain - Rapid onset and 15-180 minutes duration - Incredibly severe (nicknamed "suicide Headache") - Often comes with migranous symptoms such as nausea, aura and photo/phonophobia Also remember Autonomic symptoms with all TACs

Why are cluster headaches called cluster headaches?

They are episodic, occuring in clusters typically lasting 1-3 months wiht anything from 1-8 a day during a bout. The bouts may be triggered by alcohol and may feature continuous background level pain They may show circadian rythmicity with bouts coming the same time every year and attacks the same time each day

How do you treat a cluster headache?

100% O2 ro SC sumatriptan for the attack Occipital Depomedrone injection for the bout Verapamil for prevention

Describe a paroxysmal hemicrania?

``` Unilateral sharp/throbbing pain Rapid onset, duration 2-30 minutes Very severe Possible Continuous bacground pain 2-40 attacks per day without circadian rythm ```

How do we treat Paroxysmal Hemicrania?

Prophylactic Indometacin (An NSAID)

Describe SUNCT?

``` Unilateral Stabbing/pulsing pain Short 10-240 second duration Triggered by wind/cold/touch/chewing 3-200 attacks a day Comes with conjunctival injection (red eye) and tears ```

How do we treat SUNCT?

Lamotrigine prophylactically (an anti-epileptic, same for SUNA)

Describe Trigeminal Neuralgia

``` Unilateral stabbing pain, unlike TACs its to the maxillary/mandibular regions. 5-10 second duration Also triggered by wind/cold/touch/chew 3-200 a day unlikely to have autonomic symptoms ```

How do we treat Trigeminal Neuralgia?

Carbamazepine prophylactic | Surgical intervention

What kind of autonomic symptoms come with the Trigeminal Autonomic Cephalagias?

- NAsal Congestion/rhinorrhoea - Eyelid Oedema - Facial Sweating - Miosis (Constricted Pupil) /Ptosis (Drooping eyelid) [Horner's Syndrome]

Name a tricyclic antidepressant and what headaches its used for?

Amitriptyline

Name a tricyclic antidepressant and what headaches its used for?

Amitriptyline - Prophylaxis of Tension Type Headaches - Prophylaxis of Migraines

How do you differentiate the types of TACs?

Frequency: CH = 1-8 PH = 1-40 SUNCT = 3-200 Duration: CH = 15-180 mins PH=2-30mins SUNCT = 5-240 seconds I.e. frequency and duration are inversely proportional Pain is sharp and throbbing in CHs & PHs but stabbing/pulsing or burning in SUNCT All have a very severe pain CH most likely to show circadian rythmicity

Summary of Treatments for Headache Types:

Thunderclap - Probably SAH - Coiling/clipping Tension Type Headache - Aspirin/NSAID/Paracetamol + Amitryptiline Migraine - Aspirin/NSAID/Triptan + Propanalol/Anti-epileptic/Amitryptiline Medication Overuse Headache - Use less meds Trigeminal Neuralgia - Carbamazepine Cluster Headache - 100% O2/SC Sumatriptan + Verapamil Paroxysmal Hemicrania - Prophylactic Indometacin NSAID SUNA/SUNCT - Anti-epileptic Lamotrigine