Headaches Flashcards
What is the most common primary headache syndrome?
Tension-Type headache
What percent of the population get migraine per year?
15% females, 6% males
What is a migraine?
Benign, recurring headache with other symptoms of neurologic dysfunction
What are the clinical features of migraine?
Unilateral, throbbing headache that is aggrevated by movement and is severe in intensity
Associated nausea, vomitting, photophobia, phonophobia, visual disturbance, scalp tenderness, lightheadedness, parasthesias, hemiplegia, diarrhoea, vertigo
What is the pathogenesis of migraine?
Increased nociceptor sensitivity to sensory stimuli
Thought to involve increase calcitonin gene-related peptide and dopamine
Serotonin (5HT agonists) are helpful
What are some treatments for an acute attack of migraine?
NSAIDs
5HT1 receptor agonists
- ergotamine is a non selective agonists
- trptans are specific for 5HT 1B/1D receptors
Dopamine antagonists (metoclopramide, chlorperazine, prochlorperazine)
What are some drugs used to prevent miagraine?
Propanolol
Tricyclics
Anticonvulsants (Topiramate, Valproate, Gabapentin)
What is a typical description of a tension-type headache?
Bilateral, band like headache which slowly builds up and has no accompanying features
What treatment is proven for chronic tension-type headache?
Amitryptyline
What are the 4 types of trigeminal autonomic cephalalgias?
Cluster headache
Paroxysmal hemicrania
Hemicrania continua
SUNCT syndrome
What is the common feature of all trigeminal autonomic cephalgias?
Presence of autonomic symptoms (parasympathetic)
What is the typical presentation of cluster headache?
Cluster attacks = headaches are unilateral, deep, retro-orbital, excruiciating, explosive headaches that last 45-90 minutes
Cluster periods - 1-2 headaches per day for at lease more then a week (typically 6-8 weeks) with at least a 2 week remission between episodes
Are cluster headaches more common in males or females?
Males 3:1
Acute treatment of cluster headache?
High flow oxygen 100% for 15-20 minutes
S/C sumitrptan
Prevention options for cluster headache?
Short bouts
- can use short course steroids or Methysergide 1 hour before expected timing of attack
Long term
- high dose verapamil
Lithium
Surgery as last resort (and only if exclusively unilateral symptoms)
What is paroxysmal hemicrania?
Unilateral brief (10-30 mins), excrutiating headaches that occur frequently in a day (up to 40 x per day)
What is the treatment for paroxysmal hemicrania?
Indomethacin
What is hemicrania continua?
moderate, continuous, unilateral pain with overlying fluctuations of severe pain +/- autonomic features
What is the treatment for hemicrania continua?
indomethacin
What is SUNCT syndrome?
Short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing
Symptoms of SUNCT?
Short, 5-240 second unilateral stabbing pains that are orbital or temporal with significant conjunctival injection and tearing
What can be used to treat SUNCT?
Acutely IV lidocaine if in hospital
Prevention = lamotrigine
What needs to be excluded in the diagnosis of a trigeminal autonomic cephalgia?
MRI brain to exclude pituitary pathology which can mimic the symptoms
What are the red flags for a secondary cause of headache?
Worst headache ever First severe headache Subacute worsening of headache over days to weeks Abnormal neurology Fever or unexplained systemic signs Vomitting preceeding headache Pain induced by bending/lifting/coughing Disturbs sleep or present immediately on waking Known systemic illness Age greater than 55 Temporal artery tenderness
What is the characteristic feature of headache due to low CSF pressure?
Worse on standing or sitting, resolves on lying flat
What is a feature of a headache due to a posterior fossa mass?
vomitting preceding onset of headache by a few weeks
