Headaches Flashcards
What are the types of primary headache?
- Migraine
- Cluster
- Tension
- Drug overdose
- (Trigeminal neuralgia)
Define migraines
Unilateral, throbbing usually with a specific trigger, with or without aura
What is an aura?
neurological changes that accompany or precede the headache; FULLY REVERSIBLE visual, sensory or other CNS symptoms
What are some symptoms of migraines?
2 of
- unilateral pain
- throbbing
- motion sickness
- mod-severely intense
1 of
- nausea and vomiting
- photophobia/ phonophobia
WITH NORMAL NEURO EXAM
Describe the pathophysiology of migraines
- Prodrome (days before the attack) mood change
- Aura (part of attack, minutes before headache) visual changes, zig zag lines
- Throbbing headache lasting 4-72 hrs
What are some triggers of migraines?
CHOCOLATE
Chocolate
Hangover
Orgasms
Cheese
Oral contraceptives
Lie ins
Alcohol
Tumult (noise)/ travel
Exercise
How do you diagnose migraines?
Clinical unless other pathology suspected
How do you treat migraines?
- At onset of headache - Triptans, 1st line is oral sumatriptan (or aspirin 900mg)
- Simple analgesia first and foremost; paracetamol or NSAIDs
- Prophylaxis - BB: Propranolol or Amitriptyline
- Antiemetic treatment includes buccal prochlorperazine
What medication should you avoid in migraines?
- Opiates: risk of dependence + worsens nausea
Define cluster headaches
Recurrent, unilateral headaches
centred around eye or temporal
region.
What are risk factors of cluster headaches?
- Male
- Smoking
- Genetics
How long are cluster headaches?
Short attacks (15-180 mins)
What are the signs of a cluster headache?
ipsilateral autonomic signs:
- lacrimation + conjunctival infection (watery bloodshot eyes)
- rhinorrhoea (runny nose)
- miosis (dilated unilateral pupil)
- ptosis (droopy eyelid)
- sweating
What are symptoms of cluster headaches?
- crescendo (rising in severity) unilateral periorbital moderate/excruciating pain and
restlessness or agitation - most disabling primary headache
How do you diagnose cluster headaches?
Clinically
5 or more similar attacks confirms
What investigations do you do for cluster headaches?
Investigations are often to exclude more severe pathologies
- CT head and MRI.
How do you treat cluster headaches?
- First line management is sumatriptan and short burst oxygen therapy
- verapamil (CCB) prophylactically
- Avoiding potential triggers
identified by the patient works too
Define tension headaches
Bilateral generalised headache, radiates to neck
Describe the pathophysiology of tension headaches
- Most common primary headache
- Bilateral, mild/moderate
intensity, not worsened by
routine physical activity
What are the symptoms of tension headaches
- Rubber band tight around the head presentation
- Bilateral
- NO nausea, NO photophobia or
phonophobia
What is a trigger of tension headaches?
Stress
What are red flags that may accompany tension headaches?
- Fever (Meningitis)
-Neoplasm history (Metastatic disease)
-Neurological deficit (Tumour) - Pregnancy (Pre-eclampsia)
-Sudden onset (Haemorrhage/injury) - Older onset (GCA)
- Reduced or loss in consciousness (Haemorrhage)
- Papilloedema (Idiopathic Intracranial Hypertension)
-Painful eye; autonomic features (Cluster headache) - Worsened by sitting or standing (CSF leak)
How do you treat tension headaches?
Simple analgesia
- Aspirin or paracetamol
Avoid opiates (dependence)
Define trigeminal neuralgia
Episodes of acute, severe facial
pain; electric shock in nature
Describe the pathophysiology of trigeminal neuralgia
- Unilateral pain in 1 or more trigeminal branch
- Can be either due to vascular
compression (primary),
compression due to lesion
(secondary) or idiopathic
What are risk factors of trigeminal neuralgia?
- MS (20x more likely)
- Increasing age
- Female
- Family history
What are triggers of trigeminal neuralgia?
- Eating
- Shaving
- Talking
- Brushing teeth
How do you diagnose trigeminal neuralgia?
- Pain should be from a fraction of
a second to 3 minutes.
-Severe intensity - 3 or more attacks with symptoms
What are the symptoms of trigeminal neuralgia?
Electric shock pain, shooting, stabbing
How do you treat trigeminal neuralgia?
Carbamazepine (anticonvulsant)
If that doesn’t work, lamotrigine or gabapentin.
What are concerning features of a headache that need further investigation?
● Constant
● Nocturnal
● Worse on waking
● Worse on coughing, straining or bending forward
● Vomiting
