Headaches Flashcards
Primary vs secondary headaches
- primary: due to a headache condition - non life or sight threatening
- secondary: due to another condition - can be life or sight threatening
Examples of primary headache disorders
Tension headache
Migraine
Cluster headache
What are red flags for life threatening headaches?
SNOOP
- Systemic signs + disorders
- Neurological symptoms
- Onset new or changed
- Onset in thunderclap presentation
- Papilloedema, Pulsatile tinnitus, Positional provocation, Precipitated by exercise
Pathophysiology of tension headache
Tension in muscles of head and neck e.g. occipitofrontalis
Epidemiology of tension headache
- female > males
- young > older
- first onset > 50 is unusual
Presentation of tension-type headache
- generalised to occipitofrontalis region
- bilateral
- +/- radiate to neck
- squeezing/band like constriction
- non pulsalitie
- mild-moderate intensity
- worse at end of day
Aggravating factors of tension type headaches
- stress
- poor posture e.g. at a computer
- lack of sleep
What is the commonest headache?
Tension-type headache
Epidemiology of migraines
- female > male
- present early to mid-life
- most likely first attack by 30
Pathophysiology of migraines
- unclear
- possibly due to inflammation of trigeminal sensory neurones > alters way pain is processed by brain > increased sensitivity
Presentation of migraine
- unilateral + often frontal
- throbbing + pulsating
- moderate-severe (can be disabling)
- prolonged (4-72 hours)
- often family history
- associated symptoms - photophobia, photophobia, aura, nausea
Aggregating factors of migraines
- certain foods
- menstrual cycle
- stress
- lack of sleep
- photophobia
Relieving factors of migraines
Sleep
Simple analgesics
triptans
Epidemiology of medication overuse headache
- female > male
- 30-40 years old
- in patients with pre-existing headache disorder
- patient uses analgesics on at least 10 days/month
Pathophysiology of medication overuse headache
Up regulation of pain receptors in meninges