Headaches Flashcards
What are the Red Flag Symptoms for a Headache?
- Fever, photophobia, neck stiffness
- Neurological symptoms (haemorrhage, malignancy and stroke)
- Dizziness
- Visual Disturbance
- Sudden onset headache
- Worse on coughing/ straining
- Worse on standing/lying/bending over
- Wakes up from sleep
- Vomiting associated
- History of Trauma
- Pregnancy (pre-eclampsia)
What are the key red flag diagnoses you want to exclude in Headache?
- Raised Intracranial Pressure
- Intracranial Haemorrhage
What would you be looking for on Fundoscopy?
- Papilloedema
What does Papilloedema suggest?
- Raised Intracranial pressure
- Brain tumour
- Benign Intracranial Hypertension
- Intracranial Bleed
How would you describe a tension headache?
- A mild ache across the forehead
- Band-like pattern around the head
- Muscle Ache in the Frontalis, Temporalis and Occipitalis
- Tension Headaches come on and resolve gradually they do not produce visual changes
What are the Risk Factors for tension headaches?
- Stress
- Depression
- Alcohol
- Skipping Meals
- Dehydration
What is the treatment for tension headaches?
- Reassurance
- Basic Analgesia
- Relaxation techniques
- Hot towels to local area
What is a Secondary Headache?
- A similar presentation to a Tension Headache but with a clear cause
What are some of the causes of a Secondary Headache?
- Medical conditions: infection, apnoea, pre-eclampsia
- Alcohol
- Head Injury
- Carbon Monoxide poisoning
What is Sinusitis?
- Sinusitis is a headache associated with inflammation in the ethmoidal, maxillary, frontal or sphenoidal sinuses
- Organisms: Streptococcus Pneumonia, Haemophilus Influenzae, Rhinoviruses
How does Sinusitis present?
- Facial Pain behind the nose, forehead and eyes
- Tenderness over the affected sinus
- Frontal Pressure Pain worse on bending forward
- Nasal Discharge: thick and purulent
- Nasal Obstruction
What are the predisposing factors for Sinusitis?
- Nasal Obstruction (septal deviation or nasal polyps)
- Recent local infection
- Swimming/ diving
- Smoking
What is the managment for Sinusitis?
- Analgesia
- Nasal irrigation with Saline
- Intranasal corticosteroids if the symptoms have been present for more than 10 days
- Oral Abx are not normally required BUT consider:
1. Phenoxymethylpenicillin
2. Co-amoxiclav - systemically unwell, signs and symptoms of a more serious illness - Double Sickening = initial viral sinusitis worsens due to secondary bacterial infection
What is an Analgesic Headache?
- A headache caused by long term analgesia use
- non-specific features of a tension type headache
- Treated by removing the analgesia
What is a Hormonal Headache?
- Hormonal Headaches are related to oestrogen
- Typically low oestrogen
How do Hormonal Headaches present?
- Two days before and three days of the menstrual period
- Around the menopause
- Pregnancy - worse in the first few weeks and improves in the last 6 months (headaches in the second half of pregnancy should prompt investigation for pre-eclampsia
- The oral contraceptive pill can improve hormonal headaches
What is Cervical Spondylosis?
- Common condition caused by degenerative changes in the cervical spine
- Caused by neck pain and worse on movement
- Presents with headaches
- important to exclude other causes of neck pain such as inflammation, malignancy and infection
- important to exclude spinal cord/ nerve root lesions
What is Trigeminal Neuralgia?
- The compression of the Trigeminal nerve
- The trigeminal nerve has 3 branches: Ophthalmic, Maxillary and Mandibular
How does Trigeminal Neuralgia present?
- Facial Pain described as electricity-like shooting pain
- Attacks often worsen over time
What are the triggers of trigeminal neuralgia?
- cold weather, spicy food, caffeine, citrus fruits
What is the treatment for Trigeminal Neuralgia?
- Carbamazepine
- Surgery - to decompress/ intentionally damage the trigeminal nerve
What are Cluster Headaches?
- Severe unbearable unilateral headaches around one eye
- They come in clusters of attacks and then disappear for a while
- A patient may suffer 3/4 attacks a day for weeks/ months with them lasting 15/ 30 mins
- Followed by a pain-free period lasting 1/2 years
What are the symptoms of Cluster Headaches?
- Red, swollen, watery eye
- Pupil constriction
- Eyelid dropping
- Nasal Discharge
- Facial sweating
- Known as suicide headaches as they can be so severe
What are the treatment options for Cluster Headaches?
Acute:
- Triptans (sumatriptan 6mg injected subcutaneously)
- High flow 100% oxygen 15-20 minutes
Prophylaxis:
- Verapamil
- Lithium
- Prednisolone ( short course for 2/3 weeks to break the cycle during clusters
