Headaches Flashcards
Name some examples of common types of headaches
- Migraine,
- Cervicogenic (bad positioning of the neck),
- Systemic illness,
- Analgesia overuse,
- Muscular tension
What are serious causes of headaches
- Subarachnoid haemorrhage,
- Low cranial pressure,
- Cerebral venous sinus thrombosis,
- Temporal arteritis,
- Raised intracranial pressure,
- Infection (meningitis)
What are important questions to ask when taking a headache history?
- 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.
What is the history of symptoms which present when patient has tension headache
- 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
What is the treatment for tension headaches
- Reassure! and explain it won’t go away over night.
- Use relaxation exercises,
- Reduce analgesia,
- Give low dose amitriptyline
- Discuss muscles around head
What are the symptoms of migraines?
- 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)
What is coloured scotoma associated with?
Danger sign associated with epilepsy
looks like pulsating flashing lights around visual feild
What are some causes of migraines?
- 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
What is the treatment of acute migraines?
- Aspirin and paracetamol
- Anti-nausea medication (prochlorperazine or metocloperamide)
- Triptans (agonists of 5HT -1b/d receptors) such as sumatriptan, rizatriptan. (thought to be best)
Describe the treatment of migraines which occur more than 2 a month?
Prophylactic treatment; Beta blockers (propranol), low dose amitriptyline, pizotifen (5HT antagonist), topiramate, sodium valproate, candesartan, flunarazine, lisinopril or methysergide.
What are some other migraine treatments?
- Botulinum toxin injection (every 90 days),
- Anti CGRP monoconal antibodies eg, erenumab,
Women with migraines and auras should not be given??
OCP as it increases stroke risk
What are trigeminal autonomic cephalagia?
Rare condition s which are cluster headaches or paroxysmal hemicrania
Describe features of cluster headaches
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
Describe features of paroxysmal hemicrania
- More common in women with shorter more frequent attacks.
- Respond to indomethacin (differentiator between this and cluster headaches)
What is the treatments of trigeminal autonomic cephalagia
- Triptans,
- High sode oxygen,
- High dose verapamil (calcium channel blocker),
- Indomethacin for P hemicrania
How does medication overuse headaches present?
- Medications have been used for over 15 days of the month and the headaches worsened while analgesia has been used.
What are features of thunderclap headaches
- 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
What are causes of cervicogenic headaches?
- Poor posture in bed,
- Over exertion,
- Spinal degeneration (spondylosis),
- Usually muscular if not presenting with neurological compromise,
- Use anti-inflammatory or pain treatment
What is another cause of early morning headaches?
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.
What is the presentation of raised intracranial pressure headaches?
- Headaches are usually mild and have diurnal variation (worse in morning and gone by lunch) and have mild nausea
What is the neurological features of raised intracranial pressure and the treatmetn
look for Bilateral papilloedema. Treatment of raised ICP headaches is urgent scan and referal
How does meningitis present and what is the treatment?
Presentation - Feverm photophobia, neck stiffness, altered consciousness, petechial rash from meningococcal meningitis.
Treat - Ceftriaxone/cefotaxime or benzyl penicillin. (however most are viral)
Describe the presentation of temporal arteritis
- Nevere occurs below age 50,
- Jaw claudication,
- Polymyalgia (tired and stiff) in morning followed by temporal headache,
- Can caused embolism into the eye
