Headaches Flashcards
What are some key differentials for headaches?
- tension headache
- cluster headaches
- migrane
- trigeminal neuralgia
- raised intracranial pressure (due to tumours, haemorrhage, IIH etc).
- infections - e.g. meningitis, encephalitis otitis media, sinusitis
- exposure to substances - e.g. alcohol, medication overuse headaches
- trauma
- giant cell arteritis
- opthalm conditions - e.g. glaucoma
+ many others
Describe a tension headache
- bilateral
- tight band / pressure around the head sensation
- may be related to stress
- not associated with aura, nausea/vomiting, photophobia
How are tension headaches managed?
Analgesia per the WHO pain ladder
- Paracetamol or NSAID
Aim to reduce stress.
What are cluster headaches?
Headaches that occur in clusters lasting several weeks.
Who are most likely to suffer from cluster headaches?
- male
- smokers
- can be triggered by alcohol
Describe the symptoms of cluster headaches?
Recurrent attacks of
- headache that lasts between 15 mins and 3 hrs
- there occur once or twice a day for 4-12 weeks before a pain free period before the next cluster
- sudden onset unilateral stabbing periorbital pain with a watery, bloodshot eye
- rhinnorhea
- miosis, ptosis and lid swelling
How are cluster headaches managed?
- avoid triggers
- prophylaxis with verapamil (CCB)
- manage acute attacks with 100% oO2 or nasal (or subcut) triptan
What are the symptoms of giant cell arteritis?
- Unilateral headache
- Jaw claudication
- tender, palpable temporal artery
- visual changes
What investigations are done to diagnose giant cell arteritis?
- bloods - inflammatory markers - CRP and ESR
- Temporal artery biopsy
What is giant cell arteritis?
A medium and large vessel vasculitis that can lead to permanent visual loss.
What other condition is associated with giant cell arteritis?
Polymyalgia rheumatica
How is giant cell arteritis managed?
- urgent high dose steroids
- urgent opthalm review
What are the features of a medication overuse headache?
- headache is present for >15days per month
- developed or worsened whilst taking regular symptomatic (analgesic) medication
- patients on opioids or triptans are most at risk
Who is affected by migraines?
Female > Male
(1 in every 5 females)
Common (15 in every 100)
Presents early to mid-life
Most have first attack by 30
Describe the presentation of migraines?
- unilateral, throbbing headache
- may be preceded by an aura
- headache lasts 4-72 hours
- associated photophobia / phonophobia
- may have identifiable triggers
What can trigger migraines?
Certain foods - e.g. chocolate
Menstrual cycle
Stress
Lack of sleep
Medications - e.g. COCP
How are migraines managed?
- avoid triggers
- prophylaxis with propranolol (B blocker) or Topiramate
- manage acute attack with oral triptans alongside Paracetamol / NSAIDs
- ensure not taking COCP
Why should the COCP be avoided in people who have migraine with aura?
As it increased their risk of an ischaemic stroke.
What are the red flags of headache presentation?
Systemic signs
Neurological symptoms
Onset new or changed in patient > 50 years old
Onset thunderclap presentation
Papilloedema, positional provocation, precipitated by exercise
