Headache Flashcards
What is the most common form of headache?
Tension
Describe the presentation of a subarachnoid haemorrhage
Sudden onset - thunderclap Worst ever pain Occipital stiff neck Focal signs Decreasing consciousness
Describe the presentation of meningitis
Rapid onset headache Fever Photophobia Stiff neck Purpuric rash Coma Neck stiffness - meningeal irritation
Describe the initial management of meningitis
LP and start antibiotics
Describe the presentation of encephalitis
Rapid onset headache Fever Odd behaviour Fits Reduced consciousness
Describe the initial management of encephalitis
Urgent CT head
LP - look for infection
Describe the presentation of venous sinus thrombosis
Subacute headache
Papilloedema
Describe the presentation of sinusitis
Dull constant ache over frontal or maxillary
sinuses with tenderness +/- post nasal drip
Pain is worse on bending down
Ethmoid or sphenoid sinus pain is felt deep in the midline at the front of the root of the nose
Common with coryza
Pain lasts 1-2 weeks
Describe the presentation of intracranial hypotension
Subacute/gradual onset
CSF leakage
Headache worse on standing
Describe tension headache
Tight band
Bilateral
Non pulsatile headache
Scalp muscle tenderness
What can chronic progressive headaches indicate?
Raised ICP
Describe raised ICP presentation
Chronic progressive headache Worse on waking, coughing, lying and bending forward Vomiting Papilloedema Seizures False localising signs Odd behaviour
What may cause raised ICP
Space occupying lesion
Idiopathic intracranial hypertension
Describe the symptoms of a cluster headache
Rapid onset Excruciating pain around one eye that may become watery and bloodshot with lid swelling, lacrimation, facial flushing, rhinorrhoea, miosis, ptosis Unilateral pain Affects the same side Lasts 15-180 mins Occurs once or twice a day Nocturnal Clusters last 4-12weeks and are followed by pain free periods of months or years between next cluster Sometimes chronic and not episodic
How do you treat an acute cluster headache attack
Give O2 100% for 15mins via non-rebreathable mask
Sumatriptan SC 6mg at onset
How can cluster headaches be prevented
Avoid triggers
Corticosteroids short term only
Verapamil 360mg
Lithium 900mg
Describe the presentation of trigeminal neuralgia
Paroxysms of intense stabbing pain lasting seconds in the trigeminal nerve distribution
Unilateral
Affects mandibular or maxillary divisions
Face screws up with pain
What can trigger trigeminal neuralgia
Shaving
Eating
Talking
Dental prostheses
What is a typical trigeminal neuralgia patient
Asian
>50yo
Male
List the secondary causes of trigeminal neuralgia
Compression of the trigeminal root by anomalous or aneurysmal intracranial vessels or a tumour, chronic meningeal inflammation, MS, zoster, skull base malformation
How do you treat trigeminal neuralgia
Carbamazepine (start at 100mg/12h PO) Lamotrigine Phenytoin 200-400mg/24h PO Gabapentin Microvascular decompression
Describe medication overuse headache
Mixed analgesics - paracetamol plus codeine/opiates, ergotamine and triptans
Common reason for episodic headache becoming chronic daily headache
How is medication overuse headache treated
Withdraw analgesia - aspirin and naproxen may modify the rebound headache
Describe the presentation of acute glaucoma
Eye pain
Reduced vision
Elderly, long sighted people
Constant pain develops round one eye radiating to the forehead with markedly reduced vision, visual haloes and a red, congested eye
Describe giant cell arteritis
Subacute onset headache
ESR >40mm/h
Exclude in >50yos with a headache that lasted a few weeks: prompt diagnosis and steroids avoid
