Headaches Flashcards
Red flags associated with headaches
Fever, photophobia or neck stiffness
New neurological symptoms
Dizziness
Visual disturbance
Sudden onset occipital headache
Worse on coughing or straining (raised intracranial pressure)
Postural, worse on standing, lying or bending over
Severe enough to wake the patient from sleep
Vomiting
History of trauma
Important assessment in headaches
Fundoscopy examination to look for papilloedema is an important part of an assessment of a headache. Papilloedema indicates raised intracranial pressure, which may be due to a brain tumour, benign intracranial hypertension or an intracranial bleed.
Presentation of tension headaches
Classically they produce a mild ache across the forehead and in a band-like pattern around the head.
This may be due to muscle ache in the frontalis, temporalis and occipitalis muscles.
Tension headaches comes on and resolve gradually and don’t produce visual changes.
What are tension headaches associated with
Stress Depression Alcohol Skipping meals Dehydration
Treatment of tension headaches
Reassurance
Basic analgesia
Relaxation techniques
Hot towels to local area
What can secondary headaches be secondary to
Underlying medical conditions such as infection, obstructive sleep apnoea or pre-eclampsia
Alcohol
Head injury
Carbon monoxide poisoning
How does sinusitis usually present
Causes a headache associated with inflammation in the ethmoidal, maxillary, frontal or sphenoidal sinuses.
This usually produces facial pain behind the nose, forehead and eyes. There is often tenderness over the affected sinus, which helps to establish the diagnosis.
Sinusitis disease course
usually resolves within 2-3 weeks. Most sinusitis is viral.
Management of sinusitis
Nasal irrigation with saline can be helpful.
Prolonged symptoms can be treated with steroid nasal spray.
Antibiotics are occasionally required.
What is an analgesic headache
Caused by long term analgesia use. It gives similar non-specific features to a tension headache.
They are secondary to continuous or excessive use of analgesia.
Withdrawal of analgesia important in treating the headache, although this can be challenging in patients with long term pain and those that believe the analgesia is necessary to treat the headache.
What are hormonal headaches related to
They produce a generic, non-specific, tension-like headache.
They tend to be related to low oestrogen
Presentation of hormonal headache
Two days before and first three days of the menstrual period
Around the menopause
Pregnancy. It is worse in the first few weeks and improves in the last 6 months.
Headaches in the second half of pregnancy should prompt investigation for pre-eclampsia.
What can help improve hormonal headaches
Oral contraceptive pill
What is cervical spondylosis caused by
Degenerative changes in the cervical spine. It causes neck pain, usually made worse by movement. However, if often presents with headache.
Which condition is associated with trigeminal neuralgia
MS
How does trigeminal neuralgia present
Presents with intense facial pain that comes on spontaneously and last anywhere between a few seconds to hours. It is often described as an electricity-like shooting pain. Attacks often worsen over time.
Possible triggers for pain in patients with trigeminal neuralgia
Cold weather
Spicy food
Caffeine
Citrus fruits
First line treatment for trigeminal neuralgia
Carbamazepine
Surgery to decompress or intentionally damage the trigeminal nerve is an option
Typical migraine symptoms
Headaches last between 4 and 72 hours. Typical features are:
Moderate to severe intensity Pounding or throbbing in nature Usually unilateral but can be bilateral Discomfort with lights (photophobia) Discomfort with loud noises (phonophobia) With or without aura Nausea and vomiting
What does aura refer to
Aura is the term used to describe the visual changes associated with migraines. There can be multiple different types of aura:
Sparks in vision
Blurring vision
Lines across vision
Loss of different visual fields
