Headaches Flashcards
What are primary headaches? What 3 types?
-No other cause
1. Migraine
2. Tension-type headache
3. Trigeminal autonomic cephalalgias (cluster headache)
What are Secondary headaches?
Headache is caused by another condition /
disorder - local onset systemic. Serious causes of
secondary headache are uncommon.
Are primary headaches short or long lasting?
Long (duration >4Hrs):
- Migraine
- Tension-type
Short (duration <4Hrs)
-TAC (Cluster headache)
Why is further treatment sometimes needed after diagnosis of primary headache
Can develop into a secondary headache
-Look for red flags
What are the 4 key red flags suggesting secondary headaches?
Age:
- New onset or different headaches in a person >50yrs
Onset:
- Sudden, abrupt onset of a severe headache (thunderclap headache)
Systemic symptoms:
- Fever, neck stiffness, rash, weight loss
Neurological signs:
- Confusion, impaired consciousness, focal neurology (weakness concentrated on one side of the body), swollen optic discs
What causes headaches?
- Abnormal cortical hyperexcitability & excitation of brain stem
contribute to… - Activation of the trigemino-vascular system, which leads to…
- Vasodilation, neurogenic inflammation & central sensitisation=
HEADACHE PAIN
What are the characteristics of Migraines?
- Unilateral location (common, but not always)
- Pulsating quality
- Moderate or severe pain intensity
- Aggravation by routine physical activity
- Last hours and sometimes days!
- Frequency 1-2 attacks per month
What are some symptoms of Migraines?
- Nausea and/ or vomiting
- Photophobia (light is aggrevating)
- Phonophobia (Loud sounds are aggrevating)
- Can have Auras- sensory disturbance (not always)
What are auras?
Complex array of symptoms reflecting focal cortical or brainstem dysfunction (can appear as zig zag’s, expanding C’s and elemental visual disturbance)
What are the 5 phases of a Migraine?
- Premonitory (yawning, polyuria, mood change, irritable, light sensitive, neck pain, concentration difficulty)
- Aura (Visual, sensory- numbness/paraesthesia, weakness, speech arrest)
- Headache (head and body pain, nausea, photophobia)
- Resolution (rest and sleep)
- Recovery (mood disturbed, food intolerance, feeling hungover- can take up to 48 hours)
What is the first line of treatment for a headache?
Lifestyle changes:
- Avoid triggers
- Diet
- Sleep
- Exercise
- Mindfulness
What is the 2nd line of treatment if lifestyle changes do not improve to treat the headache?
Pharmacological therapy:
-Acute/ abortive: “HARD AND FAST”
* Paracetamol
* NSAIDs (high dose & soluble)
* Prokinetics
* Triptans (5-HT1B/1D/1F receptor agonists)
Long term preventative: “LOW AND SLOW”
* >5 days/month
* Give low doses until optimal dose is reached
(opiate- based and mixed analgestics should be avoided)
What are characteristics of tension headaches?
- Feels like “tight muscles around head and neck, as though head is in a vice
- Lasts 30 mins (or even hours)- episodic
- Bilateral
- Mild or moderate pain
- Pain not aggravated by movement
What is the treatment for tension headaches?
Treatment:
* Reassurance may suffice in the majority of patients.
* Individual attacks can be treated with simple analgesics such as Aspirin or Paracetamol.
* Preventative medications rarely required
What are characteristics of cluster headaches?
- Severe unilateral pain (never switches sides)
- Last 15-180 minutes if untreated
- At least one of the following, ipsilaterally (happens on the same side as the headache:
- Conjunctival redness and/or lacrimation
- Nasal congestion and/or rhinorrhoea
- Eyelid oedema
- Forehead and facial sweating
- Miosis and/or ptosis (small/ constricted pupils)
- A sense of restlessness or agitation
- Not associated with a brain lesion on MRI
