Headaches Flashcards
What are red flags in headaches?
Fever, photophobia or neck stiffness (meningitis, encephalitis or brain abscess)
New neurological symptoms (haemorrhage or tumours)
Visual disturbance (giant cell arteritis, glaucoma or tumours)
Sudden-onset occipital headache (subarachnoid haemorrhage)
Worse on coughing or straining (raised intracranial pressure)
Postural, worse on standing, lying or bending over (raised intracranial pressure)
Vomiting (raised intracranial pressure or carbon monoxide poisoning)
History of trauma (intracranial haemorrhage)
History of cancer (brain metastasis)
Pregnancy (pre-eclampsia)
What does fever, photophobia and neck stiffness indicate?
Meningitis, encephalitis, brain abscess
What do new neuro symptoms indicate?
Haemorrhage or tumours
What do visual disturbances indicate?
Giant cell arthritis
Glaucoma
Tumours
Sudden onset occipital headache?
Subarachnoid haemorrhage
Rose on coughing and straining?>
Increased intracranial pressure
Postural, worse on standing, lying or bending over>
Raised intracranial pressure
Vomiting?
Raised intracranial pressure
Carbon monoxide poisoning
History of trauma?
Intracranial haemorrhage
History of cancer?
Brain metastasis
Pregnancy?
Pre-eclampsia
What is important in headaches?
Fundoscopy for papilloedema
What does papilloedema suggest?
Raised intracranial pressure
What may cause papilloedema?
Brain tumour, benign intracranial hypertension or a bleed
How does a tension headache present?>
Mild ache or pressure in a band like pattern
Development and resolve gradually
No visual changes
What are tension headaches associated with?
Stress
Depression
Alcohol
Skipping meals
Dehydration
What is the management of tension headaches?
Ibuprofen and paracetamol
Amitriptyline in chronic or frequent pain
What are the causes of secondary headaches?
Infections
Obstructive sleep apnoea
Pre-eclampsia
Head injury
Carbon monoxide poisoning
What is sinusitis?
Inflammation of para nasal sinuses
How do sinusitis present?
Pain and pressure following recent viral upper respiratory tract infection
Can be tender or swelling on palpating
How quickly does sinusitis resolve?
2-3 weeks
How can prolongues sinusitis be treated with?
Nasal spray
Phenoxymethylpenicillin
What causes medication overuse headaches?
Frequent analgesia use
How can med overuse headaches be treated?
Withdraw analgesia
How are hormonal headaches caused?
Low oestrogen
How do hormonal headache present?
Similar to headaches
When may hormonal headaches occur?
2 days before first 3 days of period
Perimenopause’s
Early pregnancy
What is the treatemnt for hormonal headaches?
Triptans or NSAIDS
What is cervicak spondylitis caused by?
Degenerative changes in cervical spine
What does cervical spondylisis cause?
Neck pain, usually worsened by movement
Headaches
What does trigeminal neuralgia cause?
Intense facial pain in distrubution of nerve:
-ophthalmic
-maxillary
-Mandibular
Who is trigeminal neuralgia common in?
In people’s with MS
How does trigeminal neuralgia present?
Suddenly and lasts second to hours
Electricity like
Triggered by touch, talking, eating, shaving or cold
What is the treatemnt for trigeminal neuralgia?
Carbamazepine
