Headaches Flashcards
What is meant by a secondary headache?
- Headache occurs because of another condition
What are the acute causes of headache?
- Vascular
- Infective/inflammatory
- Ophthalmic
- Situational
What are the vascular causes of headache?
- Haemorrhage (subarachnoid, subdural, extradural)
- Thrombosis (venous sinus thrombosis)
What are the infective/inflammatory causes of headache?
- Meningitis, encephalitis, abscess, temporal arteritis
What are the ophthalmic causes of headache?
- Glaucoma
What are the situational causes of headache?
- Cough
- Exertion
- Colitis
What are the causes of chronic headaches?
- Migraine
- Cluster headaches
- Drug side effects
- Tension headaches
- Trigeminal neuralgia
- Raised ICP
- Temporal/giant cell arteritis
- Systemic
Which drugs can lead to headaches as a side effect?
- Analgesics
- Caffeine
- Vasodilators
What are the systemic causes of headaches?
- Hypertension
- Pre-eclampsia
- Phaeochromocytoma
What history do we need to take from a patient with a headache?
- Full history of presenting complaint using SQITARS
- What might be causing/triggering the headache?
- PMH of headache
What drug history do we need to take from a patient with a headache?
-Analgesics
- Side effects causing headache e.g. vasodilators
What family history do we need to take from a patient with a headache?
- E.g. migraine with aura has some heritability
What social history do we need to take from a patient with a headache?
- Stress
- Diet (some foods can trigger migraine)
- Hydration
What should we look for when examining a patient with a headache?
- Vital signs/ obs
- E.g. raised ICP can cause bradycardia/hypotension
- Hypertension itself can cause headache
- Neurological examination - full peripheral and cranial nerve
- Other relevant systems as guided by history
What are the red flag features of headache?
- Systemic signs and disorders e.g. of meningitis or hypertension
- Neurological symptoms
- Onset is new or changed and patient is >50 yo (suggestive of malignancy)
- Onset in thunderclap presentation (suggests vascular cause)
- Papilledema
Outline the characteristics of a headache caused by a space occupying lesion such as a tumour?
- Gradual onset
- Progressive
- Associated neurological features e.g. visual disturbance or focal signs
- Early morning headache
- Nausea and vomiting
- Worse on coughing and bending
What is the epidemiology of migraine?
- 2% of general population
- Twice as many females as males
- Most have had first attack when young
- Severity decreases as age increases
What is the site of a migraine?
- Unilateral, often frontal
What is the quality of migraine?
- Onset can be sudden or gradual
- Throbbing/pulsating
What is the intensity of migraine like?
- Moderate
What is the timing of migraine like?
- Lasts between 4 and 72 hours, possibly with cyclical character
What are the aggravating factors of migraine?
- Photophobia/phonophobia (dislike of loud noise)
What are the relieving factors of migraine?
- Sleep helps
- A number of medications are available (e.g. triptans)
What are the secondary symptoms of migraine?
- May have aura
- Nausea and vomiting