Headache Flashcards
What are the most common headaches?
- Tension/muscular
- Migraine
- Analgesia overuse
- Systemic illness
- Cervicogenic - arising from the neck
What are the most serious headaches?
- Subarachnoid haemorrhage
- Meningitis
- Tumours
- Other space occupying lesion
- Temporal arteritis
- Strokes including CV sinus thrombosis
Describe a typical history of a patient with a tension headache
- Weeks, months or years
- Tightness or pressure, like an elastic band around the head
- Constant, worse towards the evening
- rarely with nausea
What are the treatments for tension headaches?
- Reassurance, explain the muscles of the head
- Reduce analgesia - won’t take away the tightness
- Use relaxation exercise
- Low dose amitriptyline (tricyclic antidepressant)
- Wont go away overnight)
Describe common presenting complaint of patient with migraine
- With or without aura, spreads over minutes
- Unilateral or bilateral
- Pulsating, sharp
- Photophobia, phonophobia, gut symptoms e.g. diarrhoea
- may be exacerbated by physical activity
- Often a family history
Acute migraine treatment
- Triptans
- Aspirin, paracetamol
- Anti-nausea
Prophylactic migraine treatment
- Beta blockers
- Low dose amitriptyline
- Pizotifen
- Topiramate
- Sodium valproate
- Candesartan
- Flunarazine
- Lisinopril
- Methysergide
Other migraine treatments
- Botulinum toxin injections
- Anti CGRP monoclonal antibodies, erenumab
- Acupuncture
why should women with migraine not use a combined oral contraceptive pill?
Increased risk of stroke
What is trigeminal neuralgia?
- Shooting pain in one or more divisions of the trigeminal nerve
- Extremely painful, may be triggered by cold or eating
- In young people consider demyelination, in older people often abberant blood vessel touching CNV
What is the treatment of trigeminal neuralgia?
- Carbamazepine
- Gaba pentin
- Injection
- surgery
What is trigeminal autonomically cephalagia?
- Recurrent pain in the trigeminal distribution with autonomic features (eye watering, nasal congestion, eye redness)
- Cluster headaches
- Paroxysmal hemicranias
what do paroxysmal hemicranias respond to?
Indomethacin
Describe medication overuse headache
- Present for >15 days a month
- Worsened while analgesia has been used
- If using simple analgesia >15 days a month or >10 days for other acute
Describe thunderclap headahces
• Instant or rapidly appearing headache
What should be considered in a patient presenting with thunderclap headaches?
Sub arachnoid haemorrhage
If a patient presents with thunderclap headaches, what investigations should be carried out?
- CT head
* Lumbar puncture after 12 hours look for bilirubin and oxyhemoglobin
What are the symptoms of raised intracranial pressure?
- Headache (usually mild)
- Diurnal variation (worse in the morning - red flag if waking from pain)
- Maybe worse with coughing or straining
- Often mild nausea
- Neurological features
- Look for papilloedema (swelling of optic disc)
What could be causing raised intracranial pressure?
- Tumour
- Abscess
- CSF blockage
What are the symptoms of meningitis?
- Fever
- Photophobia
- Neck stiffness
- Altered consciousness
- Petechial rash
What should you treat meningitis with?
- Ceftriaxone/cefotaxime
* Benzl penicillin
What are the symptoms of temporal arteritis?
- Features of polymyalgia - weak proximal muscles
- Jaw claudication
- Tender temporal arteries and may be thickened
- Raised ESR (erythrocyte sedimentation rate)
Investigations for temporal arteritis
- Ultrasound
* Temporal artery biopsy
What is the danger of temporal arteritis?
Blindness
Features of cerebral venous sinus thrombosis
- Headache, often severe
- Often seizures
- maybe bilateral
What is transient global amnesia
- thought to be a variant of migraine
- Often during stress/exposure to the cold
- Period of amnesia, unable to lay down any new memory
- Lasts a few minutes to a few hours
