Headaches Flashcards
what are tension headaches?
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
what causes tension headaches?
muscle ache in the frontalis, temporalis or occipitalis muscles
what are tension headaches associated with?
stress, depression, alcohol, skipping meals and dehydration
how are tension headaches treated?
reassurance, basic analgesia, relaxation techniques
what are secondary headaches?
similar presentation to tension headaches but have a clear cause
what are the causes of a secondary headache?
underlying medical conditions like infection, obstructive sleep apnoea or pre-eclampsia, alcohol, head injury and carbon monoxide poisoning
describe the headache from sinusitis.
usually facial pain and tenderness over the effected sinus
what is an analgesic headache?
a headache caused by long term analgesic use (can be excessive or continuous), similar non-specific features to a tension headache
how are analgesic headaches treated?
withdrawal of the analgesic which may be difficult if patient has long term pain and believes the analgesia is necessary to treat the pain
what is a hormonal headache?
related to oestrogen (tends to be when low) and produce a generic, non-specific, tension-like headache
when do hormonal headaches occur?
2 days before and the 1st 3 days of menstrual period, around menopause, pregnancy (1st half normal, 2nd half think pre-eclampsia)
how are hormonal headaches treated?
OCP
what is trigeminal neuralgia?
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
what are some of the causes of trigeminal neuralgia?
vascular compression of the nerve at the nerve root, MS, intracranial tumour touching the trigeminal nerve, brainstem lesions
how is trigeminal neuralgia treated?
carbamazepine (anti-epileptic)= 1st line but if not effective then surgery to decompress or damage the nerve
what is a migraine?
a complex neurological condition that cause headache and other associated symptoms, occur in attacks that often follow a typical pattern, pathophysiology is unknown
what are the 4 different types of migraine?
migraine without aura, migraine with aura, silent migraine and hemiplegic migraine
what are the typical headache symptoms of a migraine?
headache usually lasting between 4 and 72 hours, pounding and throbbing, usually unilateral, photophobia, photophobia, nausea and vomiting, with or without aura
what is aura?
visual changes associated with migraines, can be multiple different types= sparks in vision, blurred vision, lines across vision, loss of different visual fields
what is a silent migraine?
migraine with aura but without a headache
what is a hemiplegic migraine?
can mimic strokes so need to act fast to exclude a stroke
what are the symptoms of a hemiplegic migraine?
typical migraine symptoms, sudden or gradual onset, hemiplegia (unilateral weakness of the limbs), ataxia, changes in consciousness
what are some of the potential triggers of migraines?
stress, bright lights, strong smells, certain foods, dehydration, menstruation, abnormal sleeping patterns, trauma
what are the 5 stages of a migraine?
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
how are migraines treated acutely?
often patients go into dark, quiet rooms and sleep - medication options are paracetamol, triptans, NSAIDs, antiemetics for vomiting
how are triptans used for migraine treatment?
used to abort migraines when they start to develop, 5HT receptor agonists
what is migraine prophylaxis?
keeping headache diary to identify the triggers and avoiding them can help reduce the frequency of the migraine and demonstrate response to treatment
what are some other medications to reduce frequency and severity of attacks?
propanolol, topiramate (teratogenic), amitriptyline, acupuncture, vitamin B2 supplements
what are cluster headaches?
severe and unbearable unilateral headaches usually around the eyes and come in clusters of attacks and then disappear for a while
who is a typical patient with cluster headaches?
30-50 year old male smoker
what are some triggers of cluster headaches?
alcohol, strong smells and exercise
what are the symptoms of cluster headaches?
most severe and intolerable pains in the world, usually unilateral, red, swollen and watering eye, mitosis, ptosis, nasal discharge and facial swelling
what are the treatment options for cluster headaches?
acute management= triptans and high flow oxygen for 15-20 minutes
what are the options of prophylaxis?
verapamil, lithium and prednisolone
