Headaches Flashcards
Types of headaches
Tension headache
Medication overuse headache
Migraine
Tension headache
normal everyday headache
Causes of tension headache
stress
not enough sleep
too much alcohol
depression
skipping meals
dehydration.
Chronic vs episodic tension headaches
Chronic tension headaches occur on 15+ days per month for 3 months
whilst episodic occur on less than 15 days per month.
Usual symptoms of tension headache and how long they last
dull ache
pressure around head
tightening of neck muscles and/or feeling of pressure behind eyes
pain located bilaterally
symptoms usually last 30 mins to several hours. Can last for a few days.
Management of tension headache
Usual doses of aspirin, paracetamol or NSAIDS.
Medication overuse headache
pt takes opioids or triptan drugs for 10 days or NSAIDs for migraine/headache for around half the days in a month for 3 months causing them to develop a headache due to their use of analgesics
How to diagnose medication overuse headache
how often pt takes this medication. If frequent, patient may be advised to stop taking the medication to see if the
headache is relieved (likely to worsen initially)
Migraine causes
exact cause unknown
brain scans suggest they are the result of temporary changes in the chemicals (serotonin, prostaglandins, calcitonin gene related peptide) and their effect on blood vessels (vasodilation) and nerves (potential hyperactivity in the brain).
Migraine triggers
Period
Stress
Tiredness
Certain food/drink
Migraine with aura
Recurring after sensory disturbances/ ‘warning signs’ (flashing lights)
Chronic vs episodic migraine
Chronic migraine (w/or w/out aura) occur on 15+ days per month for >3 months
whilst episodic occur <15 days per month.
Symptoms of migraine
pulsating pain on one side of the head
worse when moving around
sensitive to light/sound
nausea/vomiting
How long do migraine symptoms usually last?
2hrs-3 days
Cluster headache symptoms
Severe, sharp, stabbing pain around one eye, often described as “excruciating”.
Red or watery eye, nasal congestion, or a drooping eyelid on the affected side.
Duration of pain cluster headache
Attacks last 15 minutes to 3 hours and often occur in clusters (several attacks per day).
Triggers of cluster headache
Alcohol or histamine release.
Sinus headache symptoms
Pressure and pain around the forehead, cheeks, and eyes. Often accompanied by sinus congestion.
Associated symptoms: Nasal discharge, facial tenderness, and sometimes fever.
Sinus headache duration
Persistent, often correlating with sinus infection.
Sinus headache triggers
Sinusitis, infections.
When is referral to GP necessary for migraines
The headache is severe or has a sudden onset.
There are neurological symptoms (e.g., confusion, vision changes, weakness).
The headache has changed pattern (e.g., previously infrequent headaches that are now daily or more severe).
There is a history of head trauma or a previous serious condition.
Pulsating pain on one side
Recommended to keep a diary to record pain etc.
What to look out for in pt with tension headache
Look out for people w/ tension-type headaches going on to developing medication-overuse headache- if they take pain killers 15+ days in a month and when stopped this headache gets worse
Secondary headache
Symptomatic of an underlying cause
What can a progressive headache over weeks/months suggest?
Intracranial lesion
What could a new headache in someone over 50 be?
Temporal arthiritis
What could a headache in a pregnant woman in her 3rd trimester be?
Enclampsia (headache with visual disturbance)
What could a new, increasing headache present on waking, increased by stooping and straining result in?
Result in raised incranial pressure
What could a sudden explosive headache within seconds suggest?
Subarachnoid haemorrhage- medical emergency
What could a headache with fever, photophobia and neck stiffness suggest?
Meningitis
What could headache with nausea/vomiting, unilateral painful red eye and impaired vision be?
primary angle-closure gluacoma
Some other red flag symptoms for secondary headaches?
Headache w/ atypicalaura (duration > 1hr
motor weakness)
Aura occuring first time in patient using combined oral contraceptives
New onset headache in pt < 10yrs.
Migraine 1st lines
Paracetamol
NSAIDs
Triptans in moderate-sever headache
Migraine 2nd lines
Triptan and NSAID/paracetamol combination
Anti-emetics
Effective treatment for migraine prophylaxis
Antidepressants
Anticonvulsants
CRGP-inhibiting Monoclonal Antibodies
