Headaches

Question 1

what are tension headaches?

Answer 1

very common and classically produce a mild ache across the forehead and in a band-like pattern around the head, come and go gradually and don’t produce visual changes

Question 2

what causes tension headaches?

Answer 2

muscle ache in the frontalis, temporalis or occipitalis muscles

Question 3

what are tension headaches associated with?

Answer 3

stress, depression, alcohol, skipping meals and dehydration

Question 4

how are tension headaches treated?

Answer 4

reassurance, basic analgesia, relaxation techniques

Question 5

what are secondary headaches?

Answer 5

similar presentation to tension headaches but have a clear cause

Question 6

what are the causes of a secondary headache?

Answer 6

underlying medical conditions like infection, obstructive sleep apnoea or pre-eclampsia, alcohol, head injury and carbon monoxide poisoning

Question 7

describe the headache from sinusitis.

Answer 7

usually facial pain and tenderness over the effected sinus

Question 8

what is an analgesic headache?

Answer 8

a headache caused by long term analgesic use (can be excessive or continuous), similar non-specific features to a tension headache

Question 9

how are analgesic headaches treated?

Answer 9

withdrawal of the analgesic which may be difficult if patient has long term pain and believes the analgesia is necessary to treat the pain

Question 10

what is a hormonal headache?

Answer 10

related to oestrogen (tends to be when low) and produce a generic, non-specific, tension-like headache

Question 11

when do hormonal headaches occur?

Answer 11

2 days before and the 1st 3 days of menstrual period, around menopause, pregnancy (1st half normal, 2nd half think pre-eclampsia)

Question 12

how are hormonal headaches treated?

Answer 12

OCP

Question 13

what is trigeminal neuralgia?

Answer 13

intense facial pain that comes on spontaneously and can last between a few seconds to hours due to compression of the nerve and is usually unilateral

Question 14

what are some of the causes of trigeminal neuralgia?

Answer 14

vascular compression of the nerve at the nerve root, MS, intracranial tumour touching the trigeminal nerve, brainstem lesions

Question 15

how is trigeminal neuralgia treated?

Answer 15

carbamazepine (anti-epileptic)= 1st line but if not effective then surgery to decompress or damage the nerve

Question 16

what is a migraine?

Answer 16

a complex neurological condition that cause headache and other associated symptoms, occur in attacks that often follow a typical pattern, pathophysiology is unknown

Question 17

what are the 4 different types of migraine?

Answer 17

migraine without aura, migraine with aura, silent migraine and hemiplegic migraine

Question 18

what are the typical headache symptoms of a migraine?

Answer 18

headache usually lasting between 4 and 72 hours, pounding and throbbing, usually unilateral, photophobia, photophobia, nausea and vomiting, with or without aura

Question 19

what is aura?

Answer 19

visual changes associated with migraines, can be multiple different types= sparks in vision, blurred vision, lines across vision, loss of different visual fields

Question 20

what is a silent migraine?

Answer 20

migraine with aura but without a headache

Question 21

what is a hemiplegic migraine?

Answer 21

can mimic strokes so need to act fast to exclude a stroke

Question 22

what are the symptoms of a hemiplegic migraine?

Answer 22

typical migraine symptoms, sudden or gradual onset, hemiplegia (unilateral weakness of the limbs), ataxia, changes in consciousness

Question 23

what are some of the potential triggers of migraines?

Answer 23

stress, bright lights, strong smells, certain foods, dehydration, menstruation, abnormal sleeping patterns, trauma

Question 24

what are the 5 stages of a migraine?

Answer 24

1) premonitory or prodromal stage (can begin 3 days before headache)
2) aura (up to an hour)
3) headache (4-72 hours)
4) resolution (headache fades with vomiting or sleep)
5) postdromal or recovery phase

Question 25

how are migraines treated acutely?

Answer 25

often patients go into dark, quiet rooms and sleep - medication options are paracetamol, triptans, NSAIDs, antiemetics for vomiting

Question 26

how are triptans used for migraine treatment?

Answer 26

used to abort migraines when they start to develop, 5HT receptor agonists

Question 27

what is migraine prophylaxis?

Answer 27

keeping headache diary to identify the triggers and avoiding them can help reduce the frequency of the migraine and demonstrate response to treatment

Question 28

what are some other medications to reduce frequency and severity of attacks?

Answer 28

propanolol, topiramate (teratogenic), amitriptyline, acupuncture, vitamin B2 supplements

Question 29

what are cluster headaches?

Answer 29

severe and unbearable unilateral headaches usually around the eyes and come in clusters of attacks and then disappear for a while

Question 30

who is a typical patient with cluster headaches?

Answer 30

30-50 year old male smoker

Question 31

what are some triggers of cluster headaches?

Answer 31

alcohol, strong smells and exercise

Question 32

what are the symptoms of cluster headaches?

Answer 32

most severe and intolerable pains in the world, usually unilateral, red, swollen and watering eye, mitosis, ptosis, nasal discharge and facial swelling

Question 33

what are the treatment options for cluster headaches?

Answer 33

acute management= triptans and high flow oxygen for 15-20 minutes

Question 34

what are the options of prophylaxis?

Answer 34

verapamil, lithium and prednisolone