Headaches Flashcards
What are the different types of headaches?
Primary headaches:
Migraine
Tension headache
Cluster headache
Secondary head
Giant cell arteritis
Subarachnoid haemorrhage
Meningitis
Increased intercranial pressure
Medication overuse headache
Other: Trigeminal Neuralgia
Is it primary or is it secondary headache?
Immediate referral if you suspect SAH, seizures, meningitis and encephalitis
Whats included when taking headache history?
How would primary headaches present?
Features of a migraine
Episode of recurrent throbbing headache +/- aura and with vision change
Prodrome (days before) - yawning/craving/mood change
Aura (mins before) - visual disturqance - zigzag lines, dots, or somatosensory disturbance - parathesia
Migraine criteria:
Features of a tension type headache
Bilateral - starts at the back of the head and make its way forward
Pressing tight and non pulsatile - Like a rubber band +/- scalp tenderness
NO AURA / NO N/V
Mild to moderate pain -
Not aggravated by routine physical activity (e.g. walking or climbing stairs)
Features of a cluster type headache
can be episodic or chronic
At least 5 headaches:
Severe unilateral orbital-supraorbital and/or temporal pain
Presents with autonomic cranial features:
facial flushing.
watery blood shoot eyes
Horner syndrome (Miosis : pupillary constriction and Pitosis - Droopy eye lid)
Blocked nose
and/or sense of restless agitiation
Features of trigeminal neuralgia and TX
Usually caused by compression or trauma to trigeminal cranial nerve 5
causing electric shock facial pain and spasms
Heavily affected by triggers: kissing, vibration, washing face, touch, swallowing, shaving, talking
Tx with carbamazepine
Criteria:
Headache Table
Treating primary headaches?
1st line: Mono/Dual
Triptan +/-
Aspirin
NSAIDs
Paracetamol
Preventing of migraines
- Offer topiramate or propranolol
Features of meningitic headache?
Headache with
– photophobia
– neck stiffness +
– pyrexia
– rash
+
Kernig’s Signs
Brudzinski’s Sign
Features of SAH headache?
Thunderclap headache
– maximum severity within seconds
– “worse ever”
– SAH until proven otherwise
+ Late/absent - Meningeal irritation
+ Focal sx
Features of Raised intercranial pressure headache?
Worse on waking
* Worse coughing, sneezing, straining
* Postural, worse lying down
* Nausea, vomiting
- Papilloedema - may be absent if acute
- +/- focal signs
Features of GCA headache?
Large vessel vasculitis predominatly presenting in WHITE FEMALE >50 YEARS
Unilateral tender scalp+ intermittent jaw claudication
if severe w/ amaurosis fugax
Dx
ESR Elevated
Temporal artery biopsy: Skip lesion
granulomatous inflammation
TX Prednisolone
If fugax - iv methylprednisolone
