Headaches Flashcards
What are the 2 types of primary headache?
Tension type headache
Cluster headache
How does a tension headache present?
- Tight band/pressure sensation around forehead
- Bilateral (migraine is unilateral)
- Comes on and resolves gradually
- No visual changes
What is the difference between a migraine and a tension headache?
A tension headache is bilateral
A migraine tends to be unilateral
Are there visual changes with a tension type headache?
No
What is a tension headache associated with?
- Stress
- Depression
- Dehydration
- Alcohol
What is the management of a tension headache?
- Reassurance
* Analgesia
What can you give as prophylaxis for a tension headache?
Amitriptyline
What analgesia can be given for a tension headache?
Aspirin
Paracetamol
NSAID
What is now the recommended prophylaxis for a tension headahce?
10 sessions of acupunture
What is a chronic headache?
A headache for 15 days or more per month
How do cluster headaches appear?
They typically occur in clusters lasting several weeks, with the clusters themselves typically once a year
How long do cluster headaches last?
15 mins to 2/3 hours
What are the main triggers for a cluster headache?
Alcohol
Who are cluster headaches more common in?
Older men
Smokers
How do cluster headaches present?
- intense sharp, stabbing pain around one eye (recurrent attacks ‘always’ affect same side)
- accompanied by redness, lacrimation, lid swelling
- nasal stuffiness-nsasl discharge
- ptosis and meiosis
How does a patient with a cluster headache attack appear?
Restless and agitated during attack
What is the first line management of a cluster headache?
High flow oxygen
What is the medical management of cluster headaches?
Sumatriptan
Subcutaneous triptan
Who is sumatriptan contraindicated in?
People with CAD
What is the prophylaxis for cluster headaches?
Verapamil
What are forms of secondary headaches?
Giant cell arteritis
Trigeminal Neuralgia
What does giant cell arteritis affect?
Temporal arteries
What is giant cell arteritis a form of?
Systemic vasculitis
How is giant cell arteritis diagnosed?
- Clinical
- ESR raised 50mm/hour
- Temporal artery biopsy
What would you find with a temporal artery biopsy in someone with giant cell arteritis?
Multinucleated giant cells
What is the management of giant cell arteritis?
40-60mg prednisolone per day
Review in 48 hours
What are the 2 main causes of trigeminal neuralgia?
- Idiopathic
* Compression of trigeminal roots by tumours or vascular problems
How does trigeminal neuralgia present?
- Unilateral severe pain
- Sudden onset of brief electric shock-like pains
- Occur in clusters
- nasolabial fold or chin may be particularly susceptible to the precipitation of pain
- usually last 2 seconds - 3 minutes
Where is particularly sensitive to pain with trigeminal neuralgia?
• nasolabial fold or chin may be particularly susceptible to the precipitation of pain
How long does the pain last with trigeminal neuralgia?
Usually last 2 seconds - 3 minutes
What are triggers for trigeminal neuralgia?
- light touch, including washing, shaving, smoking, talking, and brushing the teeth
- cold weather
- spicy food
- caffeine
What is the management for trigeminal neuralgia?
• Carbamazepine
What would you do if a patient with trigeminal neuralgia didn’t respond to treatment?
Refer to neurology
What are red flag symptoms of trigeminal neuralgia?
- Sensory changes
- Deafness or other ear problems
- Pain only in the ophthalmic division of the trigeminal nerve (eye socket, forehead, and nose), or bilaterally
- Optic neuritis
- A family history of multiple sclerosis
What is the main neuroimaging used in someone presenting with a cluster headache?
MRI with gadolinium contrast
What is the main complication of giant cell arteritis?
Permanent vision loss
What is the main presentation of giant cell arteritis?
Patient over 60
Rapid onset
Headache
jaw claudication
anterior ischemic optic neuropathy
Tender, palpable temporal artery
What is the main occular complication of temporal arteritis?
Anterior ischaemic optic neuropathy
What might you see on a temporal artery biopsy in someone with temporal arteritis?
Skip lesions
What is the management of giant cell arteritis if there is evolving vision loss?
IV methylprednisolone
What are the main presenting symptoms of giant cell arteritis?
- headache over tender inflamed superficial temporal and/or occipital arteries
- jaw claudication, scalp tenderness (e.g. when combing hair)
- systemic features ⇒ fever, myalgia, malaise, weight loss
- visual disturbance/loss
