Headaches Flashcards
What are important red flag signs associated with headaches and what could they indicate?
Fever, photophobia + neck stiffness= meningitis
Sudden severe onset= haemorrhage/stroke
Dizziness= stroke
Visual disturbances= glaucoma
Sudden occipital headache= subarachnoid
Exacerbated by coughing, straining, standing, lying or bending over = RICP
Vomiting= carbon monoxide poisoning or RICP
History of trauma= intracranial haemorrhage
Pregnancy= pre-clampsia
What examination is important to carry out when raised ICP suspected?
Fundoscopy
-can identify papilloedema= optic disk swelling which occurs secondary to raised ICP
What are the main different types of headache?
Tension Secondary Sinusitis Analgesic Hormonal Association with trigeminal neuralgia
What are the key features of a tension headache?
What causes tension headaches?
How can they be treated?
- Ache in band-like pattern due to association with frontalis, temporalis and occipitalis muscles
- can be present all the time but doesn’t stop ADL
Causes: Stress Depression Alcohol Skipping meals Dehydration Medication overuse or withdrawl Cervicogenic i.e. cervical osteoporosis spondylsis Straining eyes i.e. especially if might need glasses but doesn’t currently use
TX:
- analgesia
- relaxation
- hot towels
- physio if cervical osteoporosis
- TCA= nortriptyline
- SSRI
How are secondary headaches different to tension headaches?
Associate with clear cause:
- infection
- obstructive sleep apnoea
- head injury
- carbon monoxide poisoning
Why are headaches associated with sinusitis? What feature can help to diagnose these form of headaches?
Inflammation in ethmoidal, maxillary, frontal and sphenoidal cause headache and facial pain
Type of headache indicated if there is tenderness over the affected sinuses
Why do hormonal headaches occur? When are they most likely to happen?
Low oestrogen produces generic, non-specific tension-like headache
Timing:
- 2 days before and 3 days of menstrual period
- menopause
- pregnancy= worst in first few weeks
What causes trigeminal neuralgia?
How might someone with trigeminal neuralgia present?
What is the recommended treatment?
Demyelination of one branch of trigeminal leads to upregulation of sodium channels meaning there is increased amount of Na+ crossing membrane meaning the Em is at point of depolarising all time
THEREFORE= increased sensitivity of the nerve
PX
- Severe stabbing facial pain which can present as headache
- triggered by something aggrevating trigeminal distribution i.e. cold wind, eating or touch
TX:
- carbamazepine
- oxycarbamazepine
- another AED
- MRI= might be presentation but there might be demyelination further up the pathway
What is a cluster headache? How might someone present?
Severe unilateral headache around the eye which comes in clusters of attacks for few days and then disappears for 1-2 years
Termed suicidal headache due to severity of the pain Unilateral presentation: -red, swollen, watering eye -pupil constriction (miosis ) -eyelid drooping (ptosis) -nasal discharge -face sweating
Why do cluster headaches occur and who is at risk of developing one?
Exact cause unknown but tend to occur in 30-50 yo males who smoke Triggers: -alcohol -strong smells -exercise
How are cluster headaches management acutely and how are recurrences minimised?
Acute:
- triptans
- high flow 100% oxygen for 15-20 mins
Prophylaxis:
- verapamil
- lithium
- prednisolone to break cycle between clusters
What are the different types of primary headaches rating from most severe pain to least?
Trigeminal neuralgia
Trigemial autonomic cephalalgias (TACs)
Migraine
Tension type headache
What are TACs?
What types of headaches fall under this category?
How can these types of headaches be treated?
Trigeminal autonomic cephalalgias
-unilateral (side-locked) headaches with pain in the trigeminal distribution
-associated with autonomic activation on same side as headache
I.e. rhinorritis/miosis/ptosis
-agititation
SUNCT
Paroxysmal hemicrania
Cluster headaches
Hemicrania continuas
TX:
- high flow O2
- fast acting triptan
- prednisolone
- indometacin
- MRI
- prophylaxis to prevent being on long term steroids
What is an important differential for TAC/trigmenial neuralgia? How would a patient present?
Acute closed-angle glaucoma
Px:
- intense eye pain
- N+V
- red eye
- headahce
- tenderness around the eye
- rings around lights
- blurred vision
What are secondary causes of headaches?
Raised intracranial pressure
Thunderclap headache
Vascular problems
Sinusitis
