Headaches Flashcards
Red flags for headaches
Fever, photophobia or neck stiffness - meningitis or encephalitis
New neurological symptoms - malignancy, stroke
Dizziness
Visual disturbances
Sudden onset occipital headache - subarachnoid haemorrhage
Worse on coughing or bending - raised intracranial pressure
Severe in the morning
Vomiting
History of trauma
Pregnancy
Investigations for headaches
Fundoscopy - Papilloedema indicating raised ICP
Causes of secondary headaches
Alcohol
Head injury
Carbon monoxide poisoning
Underlying medical conditions - infection, obstructive sleep apnoea or pre - eclampsia
Hormonal headache features
Related to low oestrogen - causing tension like headache
- 2 days before and first 3 days of menstrual period
- around menopause
- pregnancy - worse during the first week
Cervical spondylosis pathophysiology and presentation
Degeneration of the cervical spine causing neck pain which is worse on movement
Trigeminal neuralgia pathophysiology
Cause unknown but thought to be due to trigeminal nerve compression
Presentation of trigeminal neuralgia
Unilateral, sudden onset, severe facial pain
Often electric shock like shooting pain
Triggers of trigeminal neuralgia
Talking Chewing Combing hair Head movements In the car
Treatment of trigeminal neuralgia
Carbamazepine first line
Consider decompression surgery
Features of tension headaches
Site - band like pattern around the head, symmetrical
Onset - gradual
Character - ache
Relieving factors - analgesia, hydration
Aggravating factors - dehydration, stress, skipping meals and infection
Timing - approx 30 mins
Associated features - pale, tired
Features of migraines
Site - unilateral, often forehead or eyes
Onset - can be gradual or sudden
Character - sharp, throbbing
Relieving factors - dark room, rest, analgesia (triptans)
Aggravating factors - stress, solvents, dehydration
Timing - takes longer to resolve
Associated features - photophobia, aura, nausea, abdo pain
Prophylaxis for migraines and when to use it
Propranolol
Pizotifen
Topiramate
Amitriptyline
Significantly impacting life
Frequent - > 1 per week
Types of migraine
Migraine without aura
Migraine with aura
Silent migraine (migraine with aura but without a headache)
Hemiplegic migraine
Hemiplegic migraines
Mimics stroke
Symptoms vary :
- Typical migraine symptoms
- Sudden or gradual onset
- Hemiplegia (unilateral weakness of the limbs)
- Ataxia
- Changes in consciousness
Treatment of hemiplegic migraines
Essential to act fast and exclude a stroke - CT head
Migraine triggers
Stress Bright lights Strong smells Certain foods (e.g. chocolate, cheese and caffeine) Dehydration Menstruation Abnormal sleep patterns Trauma
Management of migraines
Paracetamol
Triptans - sumatriptan
NSAIDs
Antiemetics if vomiting occurs (e.g. metoclopramide)
Topiramate side effects
Teratogenic and can cause a cleft lip/palate so patients should not get pregnant
Cluster headaches
Site - unilateral, around eye
Onset - sudden
Character - sharp, throbbing, severe
Relieving factors - dark room, rest, analgesia (triptans)
Aggravating factors - alcohol, strong smells, alcohol
Timing - comes in clusters
Associated features - Red, swollen and watering eye Pupil constriction (miosis) Eyelid drooping (ptosis) Nasal discharge Facial sweating
Treatment options for cluster headaches
Triptans - sumatriptan 6mg injected subcutaneously
High flow 100% oxygen for 15-20 minutes (can be given at home)
Prophylaxis of cluster headaches
Verapamil
Lithium
Prednisolone (2-3 weeks to break the cycle during clusters)
