Headaches Flashcards
Headache is a common symptom, and it is associated with many conditions.
Name the two types of headaches
Primary headaches
Secondary headaches
What is the difference between primary and secondary headaches
Primary headaches – those that are not associated with an underlying condition e.g., migraine, tension headache, cluster headache
Secondary headaches – those that are associated with an underlying pathology e.g., trauma, intracerebral infection, vascular disorders, medication overuse, neoplasm
Name some of the red flag symptoms that may be associated with headaches if the patient had meningitis
Fever, photophobia or neck stiffness
Name the red flag symptom that may be associated with headaches if the patient had temporal arteritis or glaucoma
Visual disturbance
Why is fundoscopy examination important in patients presenting with a headache
- Checking for papilloedema (oedema of the optic disc)
- Papilloedema indicates raised intracranial pressure, which may be due to a brain tumour, benign intracranial hypertension or an intracranial bleed
Papilloedema, seen of fundoscopy, indicates?
Indicates raised intracranial pressure
What are the characteristic features of a migraine
Recurrent, severe headache which is usually unilateral and throbbing in nature
Name some of the associated symptoms for a migraine
Aura, nausea and photosensitivity
The aura may be visual e.g., zigzags, sensory e.g., paraesthesia spreading from fingers to face
Name some of the triggers that can bring about a migraine
Aggravated by, or causes avoidance of, routine activities of daily living
In women may be associated with menstruation
How long can a migraine last?
4-72 hours
How do you diagnose a migraine
Clinical diagnosis i.e. history
Presence of aura confirms diagnosis
How do you manage an acute migraine attack
Oral triptan e.g., Sumatriptan
AND
Paracetamol and/or NSAID
Triptan e.g., Sumatriptan is contraindicated in what patient group
Those with ischaemic heart disease
What are the characteristic features of a tension headache
Chronic recurring, bilateral headache, often described as a “tight-band” around the head
Non-pulsatile
In what gender is tension headaches most common in?
Females
Name some of the associated symptoms that may accompany a tension headache
Tenderness of the scalp muscles
Name some of the triggers that can bring about a tension headache
Stress
Not aggravated by routine activities of daily living
How long can a tension headache last?
30mins to 7 days
How do you diagnosis a tension headache
Clinical diagnosis i.e. history
What is the long term mangement of migraines
Avoid triggers
Prophylaxis with Propranolol (beta blocker) or Topiramate
What is the management of tension headaches
Symptomatic relief
Analgesia e.g, paracetamol or NSAIDS
Lifestyle e.g, sources of stress
What are the characteristic features of a cluster headache
Recurrent attacks of sudden-onset unilateral periorbital pain i.e. pain around one eye, which is affect the same.
In what gender is cluster headaches most common in?
Males
What is the typical age of onset of a cluster headache
Age of onset is usually between 20 and 40 years
Name some of the associated symptoms that can accompany a cluster headache
Redness, lacrimation, lid swelling
Name some of the triggers that can bring about a cluster headache
Alcohol
Smoking
Describe the duration pattern of a cluster headache
Each episode lasting 15 minutes to 3 hours, occurring once or twice a day, over a period of 4-12 weeks
Followed by a pain-free period of months before the next cluster begins
How is cluster headaches diagnosed
Clinical diagnosis i.e. history
How do you manage an acute attack of a cluster headache
Triptan e.g. Sumatriptan
AND
100% oxygen via non-rebreathable mask
What drug can be used as a prophylaxis for cluster headaches
Verapamil (Calcium channel blocker)
What are the characteristic features of a Trigeminal neuralgia
Recurrent short episodes of severe stabbing pain, affecting one side of the face, in the trigeminal nerve distribution.
Name some of the triggers that can cause Trigeminal neuralgia
Triggered by touching the face, eating, or talking.
What is the typical age of onset of a Trigeminal neuralgia
typically over the age of 50
How is Trigeminal neuralgia diagnosed
Clinical diagnosis
What imaging modality is used to exclude secondary causes of the Trigeminal neuralgia
MRI
Secondary causes e.g., tumours and aneurysms
What is the 1st line therapy to manage Trigeminal neuralgia
Carbamazepine
Name a surgical option to manage Trigeminal neuralgia
Microvascular decompression
What are the features of the headaches associated with a raised intracranial pressure
Headaches are worse in the morning and upon bending over. Improves after vomiting and lying down
Name some of the associated symptoms of a raised intracranial pressure
Neurological deficits due to compression of cranial structures by a space-occupying lesion.
Reduced level of consciousness.
Papilledema - oedema of the optic disc
How is raised intracranial pressure diagnosed
CT scan
How do we manage a raised intracranial pressure
ABCDE assessment
Treat the underlying cause
What are the features of the headaches associated with a temporal arteritis
Rapid onset unilateral headache
Name some of the associated symptoms that may accompany a headache in a patient with temporal arteritis
Jaw claudication i.e. fatigue of jaw muscles during chewing
Visual disturbance
On examination, how would the temporal artery feel in a patient with temporal arteritis
Tender, palpable temporal artery
What blood test will be raised in temporal arteritis
ESR
What is the management options for temporal arteritis
High dose glucocorticoid and urgent ophthalmology referral
