Headaches Flashcards
What is a primary headache?
Migraine
Tension-type headache
Trigeminal autonomic cephalalgias
———-Cluster headache
What is a secondary headache?
Headache is spercipitated by another condition / disorder - local os systemic. Serious causes of secondary headache are uncommon.
What are long lasting primary headache disorders?
Migraine
Tension type headache
What are short lasting headaches?
Trigeminal autonomic cephalalgias
———-Cluster headache
What is medication overuse headache?
When they have long lasting headaches, and take codeine based medications, and can then get a headache from medication overuse
What are 4 key red flags that suggest 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, swollen optic discs
What are characteristics of episodic headaches?
Unilateral location
Pulsating quality
Moderate or severe pain intensity
Aggravation by routine physical activity
Last hours and sometimes days!
What other symptoms are there for episodic migraines?
Nausea and/ vomiting
Photophobia (lights) and/ phonophobia (sounds)
+/- Auras
What are auras?
Complex array of symptoms reflecting focal cortical or brainstem dysfunction
Gradual evolution: 5-30minutes (<60minutes)
Usually before headache
What is the migraine phase before headache?
Premonitory symptoms - yawning, polyuria, mood change, irritable, light sensitive, neck pain, concentration difficulty
What does the migraine phase aura involve?
Visual, sensory (numbness/paraesthesia), weakness, speech arrest
What does the headache phase involve?
Head and body pain, nausea, photophobia
What are the phases after the headache?
Resolution: rest and sleep
Recovery: mood disturbed, food intolerance, feeling hungover
Can take up to 48 hours
What is the first way to manage migraines?
Lifestyle: avoid triggers
Diet
Sleep
Exercise
Mindfulness
What is the second step to manage migraines?
Pharmacological therapy
What are the 2 types of pharmacological therapies?
Acute/abortive
Long term preventative
What is acute/abortive management?
Hard and fast!
Paracetamol
NSAIDs (high dose & soluble)
Prokinetics
Triptans (5-HT1B/1D/1F receptor agonists)
What is long term preventative management?
> 5 days/month
“low and slow” with doses until at optimal dose
What are the new medications on the block for preventing migraine?
CGRP Anitbodies
What is a tension type headache described as?
Patients usually say its feels like:
Tight muscles around head and neck, as though head is in a vice.
What are features of tension type headaches?
Lasts 30mins (but can be hours long):
—-Bilateral
—–Mild or moderate
—–Not aggravated by movement
No added features typically
—–No nausea or vomiting
—–No photophobia or phonophobia
What is the treatment for tension type headaches?
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 the features of a cluster headache?
Severe unilateral pain
Last 15-180 minutes if untreated.
At least one of the following, ipsilaterally:
——-Conjunctival redness and/or lacrimation
———Nasal congestion and/or rhinorrhoea
——–Eyelid oedema
Forehead and facial sweating
Miosis and/or ptosis
A sense of restlessness or agitation
Not associated with a brain lesion on MRI
What is the acute treatment for cluster headaches?
Triptan: Nasal or subcutaneous route
High flow oxygen: Oxygen inhibits neuronal activation in the trigeminocervical complex
What prevention treatment can be offered for a cluster headache?
Verapamil (Calcium channel inhibitor)
—-Get an ECG first in case they have a heart condition/ heart block as this can make it worse
Greater occipital nerve block
Compare migraines, tension type headaches and cluster headaches?
Unilateral/bilateral
Pulsating or not
Severity
Aggravated by?
Other symptoms
Length
Frequency
