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MD4001 Clinical > Headaches > Flashcards

Headaches Flashcards

1
Q

Name some examples of common types of headaches

A
  • Migraine,
  • Cervicogenic (bad positioning of the neck),
  • Systemic illness,
  • Analgesia overuse,
  • Muscular tension
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2
Q

What are serious causes of headaches

A
  • Subarachnoid haemorrhage,
  • Low cranial pressure,
  • Cerebral venous sinus thrombosis,
  • Temporal arteritis,
  • Raised intracranial pressure,
  • Infection (meningitis)
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3
Q

What are important questions to ask when taking a headache history?

A
  • Duration,
  • Position on the head,
  • Character (pressure, dislike of light or noise),
  • Frequency?
  • Diurnal variation,
  • Change in character,
  • Nausea/vomiting,
  • Postural (worse lying down?)
  • Other neurological symptoms?
  • Medicines (use of analgesia more than 15 days in the month indicates analgesic abuse headache),
  • PMH, FH.
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4
Q

What is the history of symptoms which present when patient has tension headache

A
  • Headache can last for weeks, months or even years.
  • Feels like tightness or pressure round the head,
  • Pain is constant but worse towards evening,
  • Often frequent use of analgesia,
  • Rarely presents with nausea
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5
Q

What is the treatment for tension headaches

A
  • Reassure! and explain it won’t go away over night.
  • Use relaxation exercises,
  • Reduce analgesia,
  • Give low dose amitriptyline
  • Discuss muscles around head
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6
Q

What are the symptoms of migraines?

A
  • Classically presents on one side and most patients presenting with headaches and nausea are migraines!
  • Can be unilateral or bilateral and usually lasts for hours or days.
  • Present with photophobia, phonophobia and gut symptoms (IBS can be gut migraine),
  • Pulsating and sharp character of pain,
  • More common in women especially at mid cycle or newly at menopause.
  • Can present with aura (visual, weakness (can look like hemiplegia) or sensory, black and white scotoma)
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7
Q

What is coloured scotoma associated with?

A

Danger sign associated with epilepsy

looks like pulsating flashing lights around visual feild

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8
Q

What are some causes of migraines?

A
  • Mechanism is unclear but has vascular/neural theories but often has family history.
  • So look for triggers (food/ alcohol/ timing) maybe keep a diary,
  • May be exacerbated by exercise of head trauma
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9
Q

What is the treatment of acute migraines?

A
  • Aspirin and paracetamol
  • Anti-nausea medication (prochlorperazine or metocloperamide)
  • Triptans (agonists of 5HT -1b/d receptors) such as sumatriptan, rizatriptan. (thought to be best)
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10
Q

Describe the treatment of migraines which occur more than 2 a month?

A

Prophylactic treatment; Beta blockers (propranol), low dose amitriptyline, pizotifen (5HT antagonist), topiramate, sodium valproate, candesartan, flunarazine, lisinopril or methysergide.

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11
Q

What are some other migraine treatments?

A
  • Botulinum toxin injection (every 90 days),

- Anti CGRP monoconal antibodies eg, erenumab,

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12
Q

Women with migraines and auras should not be given??

A

OCP as it increases stroke risk

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13
Q

What are trigeminal autonomic cephalagia?

A

Rare condition s which are cluster headaches or paroxysmal hemicrania

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14
Q

Describe features of cluster headaches

A

Unilateral, usually around the eye.

  • Striking circadian rhythm (same time of day)
  • Presents with recurrent pain in trigeminal distribution with autonomic features (water eyes, nasal congestion or redness) and is more common in males
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15
Q

Describe features of paroxysmal hemicrania

A
  • More common in women with shorter more frequent attacks.

- Respond to indomethacin (differentiator between this and cluster headaches)

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16
Q

What is the treatments of trigeminal autonomic cephalagia

A
  • Triptans,
  • High sode oxygen,
  • High dose verapamil (calcium channel blocker),
  • Indomethacin for P hemicrania
17
Q

How does medication overuse headaches present?

A
  • Medications have been used for over 15 days of the month and the headaches worsened while analgesia has been used.
18
Q

What are features of thunderclap headaches

A
  • Instant/rapidly appearning with very severe pain.
  • Must consider sub-arachnoid haemorrhage which requires urgent investigation of head CT followed by LP after 12 hours to look for blood, billirubin or oxyhaemaglobin in CSF.
  • Could be exertional (coital cephalgia) which is a type of migraine from vasospasm which quickly reverses with rest
19
Q

What are causes of cervicogenic headaches?

A
  • Poor posture in bed,
  • Over exertion,
  • Spinal degeneration (spondylosis),
  • Usually muscular if not presenting with neurological compromise,
  • Use anti-inflammatory or pain treatment
20
Q

What is another cause of early morning headaches?

A

Sleep apnoea with CO2 retention which occurs in obese patients or patients with a history of snoring. It is tested by monitoring chest movements and treated with positive pressure oxygen.

21
Q

What is the presentation of raised intracranial pressure headaches?

A
  • Headaches are usually mild and have diurnal variation (worse in morning and gone by lunch) and have mild nausea
22
Q

What is the neurological features of raised intracranial pressure and the treatmetn

A

look for Bilateral papilloedema. Treatment of raised ICP headaches is urgent scan and referal

23
Q

How does meningitis present and what is the treatment?

A

Presentation - Feverm photophobia, neck stiffness, altered consciousness, petechial rash from meningococcal meningitis.
Treat - Ceftriaxone/cefotaxime or benzyl penicillin. (however most are viral)

24
Q

Describe the presentation of temporal arteritis

A
  • Nevere occurs below age 50,
  • Jaw claudication,
  • Polymyalgia (tired and stiff) in morning followed by temporal headache,
  • Can caused embolism into the eye
25
Q

What are the tests of temporal arteritis

A
  • Palpation of temporal arteries for tenderness,
  • Test for raised erythrocyte sedimentation rate (ESR>50),
  • Use ultrasound or temporal artery biopsy for inflammation
26
Q

What is the treatment for temporal arteritis

A

High dose steroids as early as possible but side effects include - osteoporosis, hypertension, muscle wasting and truncal obesity.

27
Q

Describe the presentation of cerebral venous sinus thrombosis

A
  • Severe headache,
  • Raised ICP often with papilloedema and seziures,
  • Haem seen bilaterally on MRI,
  • Empty delta sign
  • Patients are often female and on OCP.
28
Q

Describe the presentation and treatment of low ICP and how it can occur

A
  • Can occur following LP and thought to be due to leak of CFS through hole left by needle (reduce incident by using atraumatic needles).
  • Presents with headaches on standing which is eased with lying. Can develop into fits and even death if left untreated.
  • Treatment is blood patch for post-LP headache (squirt patients own blood over hole to form clot over hole.)

MD4001 Clinical (20 decks)

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