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
Presentation of medication overuse headache
- presents of at least 15 days/month
- no improvement after OTC meds
- variable character
- often co-exists with depression + sleep disturbance
Management of medication overuse headache
Discontinue medication
Epidemiology of cluster headaches
- male > female
- smoking history
- 30-40 year olds
- 1 in 1000
Pathophysiology of cluster headaches
- unkown
- possible due to hypothalamic activation with secondary trigeminal + autonomic involvement
Presentation of cluster headache
- unilateral, around or behind eye
- sharp, stabbing + penetrating
- severe (often disabling)
- occurs in clusters with periods of remission
- usually at night
- associated symptoms: red, watery eye, nasal congestion + ptosis
Aggregating factors of cluster headaches
- alcohol + smoking
- volatile smells
- warm temp
- lack of sleep
Management of cluster headaches
Oxygen
Triptans
Associated autonomic symptoms of cluster headaches
Red, watery eye
Nasal congestion
Ptosis
Presentation of headache due to space occupying lesion
- gradual, progressive
- dull
- mild severity
- worse in mornings
- worsens on leaning forwards, coughing + valsalva manoeuvre
- associated neurological signs + symptoms
Aggregating factors of headache due to space occupying lesion
- leaning forwards
- cough
- valsalva manoeuvre
Epidemiology in trigeminal neuralgia
- female > male
- 50-60 /increasing age
Pathophysiology of trigeminal neuralgia
- compression of trigeminal nerve due to loop of blood vessel (most common)
- tumours, MS or skull base abnormalities
Presentation of trigeminal neuralgia
- unilateral
- pain felt in 1+ division of trigeminal nerve
- sharp, stabbing, ‘electric shock’ feeling
- severe
- lasting seconds - 2 mins
- sudden onset
- associated symptoms: tingling, numbness, radiating pain to areas of CN V distribution
Aggravating factors of trigeminal neuralgia
- light touch to face
- eating
- cold wind
- combing hair
- vibrations
Investigations of headaches
- dependent on cause
- headache diary for chronic
- imaging if red flags
Treatment of headaches
- depends on cause
- simple analgesia
- triptans for migraines
- high low oxygen for cluster headaches
What is temporal arteritis?
Vasculitis involving small + medium sized arteries of head
Epidemiology of temporal arteritis
- female > male
- > 50 years (most commonly >75 years)
When should temporal arteritis is considered?
Any patient > 50 year old with abrupt onset of headache + visual disturbance or jaw claudication
What artery is commonly involved in temporal arteritis?
Superficial temporal artery
What is an important risk of temporal arteritis?
Irreversible loss of vision de to ischaemia of optic nerve
