Headache tutorial Flashcards
What is the difference between the cause of primary and secondary headaches?
Primary= no structural or metabolic abnormality
Secondary= caused by a structural or metabolic abnormality
Is there biomarkers for primary headaches?
No
What are the differences in onset of primary and secondary headaches?
Primary= generally chronic and episodic
Secondary= usually present as an abrupt single episode or new onset
What is the most common type of headache?
Migraine
What are the symptoms of a tension type headache?
Often bilateral, an achey pain that gets worse with stress. Little associative features
What constitutes a chronic headache?
More than 15 days a month
What percentage of headaches are secondary?
5%
What are the symptoms of a migraine?
Throbbing headache, associated with ‘aura’, visual problems; flashing lights and zig zag lines
Dizziness, brain fog, nausea and vomiting accompany it
Photophobia and photophobia are common
What is photophobia and phonophobia?
Photophobia= sensitivity to light Phonophobia= sensitive to sound
What can help relieve migraines?
Lying down in a dark room
What drops during migraine?
The ability to absorb oral drugs
What is the hypothesis for the pathophysiology of migraines?
Come from blood vessels that supply the brain
Migraine suffers have ‘sparkier’ reflexes that control the vessels
If they get too small or too large can cause migraine symptoms
What happens to migraine sufferers when brain vessels shrink too much?
Some parts of brain, such as vision processing cannot deal and the result is flashing lights or zig zag lines
Whole brain can be affected- can get brain fog
Migraine ‘aura’
What happens to migraine sufferers when brain vessels stretch too much?
If blood vessels become too big they activate receptors and the stretch causes the pain of a migraine.
When they become too stretched, can feel waves of pain in rhythm with heart beat
What is the treatment for migraines?
Pain killers are first option
Can also give triptans to reduce the size of blood vessels
What are the names of triptans?
Sumatriptan (Imigran®)
Zolmitriptan (Zomig®)
Rizatriptan (Maxalt®)
What are common side effects of triptans?
Common side effects of triptans include:
Warm sensations
Tightness
Tingling
Flushing
Feelings of heaviness in the face, limbs or chest
How should pain killers be given to a patient who suffers from migraines and why?
Treat it like an acute disorder, only give painkillers 3 days a week in large doses, to avoid chronic headaches from overuse
Should you scan patients who present with migraine symptoms?
Only if it will reassure the patient
May pick up something indecently that would have been benign
What is an example of a trigeminal autonomic cephalagia?
Cluster headache
What is trigeminal autonomic cephalagia?
Trigeminal autonomic cephalalgia (TAC) is the name for a type of primary headache that occurs with pain on one side of the head in the trigeminal nerve area
What are the symptoms of trigeminal autonomic cephalagia?
Unilateral pain around temporal lobe
Symptoms in autonomic systems on the same side, such as eye watering and redness or drooping eyelids (ptosis) as well as nasal stuffiness/runny nose
What are examples of mass occupying lesions that will cause headaches?
Haemorrhage (burst blood vessel)
Tumour
Brain abcess
Why do mass-occupying lesions cause headaches?
Monro-Kelly doctrine
Increasing volumes of one of the comments increasing ICP and causes headache
What are different types of haemorrhage?
Epidural (between skull and dural)
Subdural
Subarachnoid
Intraparenchymal (bleeding into the brain parenchyma proper)
Intraventricular
What are the symptoms of headaches caused by meningitis/encephalitis?
Severe headache
Stiff neck
Fever
Confusion
Altered conscious state
What are the symptoms of carotid artery dissection?
Pain that radiates up and around an eye, described as tearing pain.
One eye with a droopy lid and small pupil
What causes Horner syndrome?
In carotid artery dissection, if the blood vessel expands the sympathetic nerves wrapped around the vessel stop working
What are the features of Horner syndrome?
It is characterized by a constricted pupil (miosis), drooping of the upper eyelid (ptosis), absence of sweating of the face (anhidrosis), and sinking of the eyeball into the bony cavity
What types of strokes can cause headaches?
Both haemorrhage and ischemic strokes
What are other CNS pathology that cause headaches?
Venous sinus thrombosis
Idiopathic intracranial hypertension
Post head trauma
Post lumbar puncture headache
What is a feature of reversible cerebral vasoconstriction syndrome?
Recurrent sudden-onset headaches over a period of around 4 weeks
What is an example of a primary headache with sudden onset?
Primary thunderclap headache
Refers to a severe and explosive headache with peak intensity at onset
What are some red flags with headaches?
Thunderclap (sudden onset)
Associated focal neurological deficit- weak/numb down one side
Associated systemic features (e.g. weight loss) for cancer or meningitis
Abnormal vital signs
Papillodema
Patients > 50
What is papillodema?
Papilledema is a term that is exclusively used when a disc swelling is secondary to increased intracranial pressure
What are features of temporal vasculitis?
Very rare in <60
Classic symptom= acute vision loss (get small emboli to eye)
Pain in temporal area, ‘brushing hair pain’
What is a medicine overuse headache?
If a patient with pain overuses pain killers, can lead to chronic headache called rebound headache (as drug starts to wear off in blood, headache comes back)
What is a abrupt onset headache?
Reaches max intensity within 10 mins
What must be done to patients with abrupt onset headache?
CT scan- worried about haemorrhage
Needs to be done ASAP
Why are CT scans time sensitive?
The sensitivity decreases- by day 3 only 74% sensitive and a week= 50%
What happens if the CT is negative but the history indicates a sub-arachnoid haemorrhage?
Do a lumbar puncture and check for bilirubin > 12 hours after onset.
If negative, exclude SAH
What are the symptoms of a tension headache?
Tension- felt as a band or across the forehead, can last for several days. Uncomfortable and tiring, but do not usually disrupt sleep. They tend to worsen as the day progresses and are not usually made worse by physical activity
What are cluster headaches?
Cluster- severe and occur in clusters, often every day for a number of days or even weeks. They are uncommon and tend to occur particularly in adult male smokers. They are severe, one-sided headaches, which are really very disabling. Patients often have a red watery eye on the affected side, a stuffy runny nose and a droopy eyelid
What are chronic tension headaches?
Chronic tension- usually caused by muscle tension in the back of the neck and affects women more often than men. Can be started by neck injuries or tiredness
What is a exertional/sexual headaches?
Exertional/sexual headaches- associated with physical activity. They can become severe very quickly after a strenuous activity such as running, coughing, having sex (intercourse), and straining with bowel movements.
What are primary stabbing headaches?
Primary stabbing headaches- These are short, stabbing headaches which are very sudden and severe. They usually last between 5 and 30 seconds, at any time of the day or night. They feel as if a sharp object (like an ice pick) is being stuck into your head
What is hemicrania continua?
It typically causes a continuous but fluctuating pain on one side of your head. The pain is usually continuous with episodes of more severe pain, which can last between 20 minutes and several days. During these episodes of severe pain there may be other symptoms such as watering or redness of the eye, runny or blocked nose, and drooping of the eyelid.
What are some causes of headaches due to substances?
Can be due to substances-carbon monoxide, alcohol or lack of fluid.
What is sinusitis?
Sinusitis= infection of sinuses. The headache of sinusitis is often felt at the front of the head and also in the face or teeth. Often the face feels tender to pressure, particularly just below the eyes and beside the nose. You may have a stuffy nose and the pain is often worse when you bend forwards
What are the reg flags of headaches?
- Extreme onset
- History of significant head injury
- Accompanied by fever
- Have problems with speech/balance
- Associated with red/painful eyes or vomiting
- Weight loss
What are headaches with a very sudden onset associated with?
Subarachnoid haemorrhage
What are headaches that are worse in the mornings suggestive of?
Raised ICP
What are the symptoms associated with raised ICP?
Headaches worse in the morning
Headaches worse whilst coughing
Headaches worse when lying flat
