Headaches Flashcards
what is a primary headache ?
headache with no underlying medical cause
- disturbance in brain function
give three examples of primary headaches ?
- migraines
- tension type headaches
- cluster head aches
what is a secondary headache?
a headache with an identifiable structural or biochemical cause
give 6 examples of secondary head aches ?
- tumours
- meningitis
- vascular disorders
- systemic infection
- head injury
- drug-induced
are all secondary headaches sinister ?
no
what percentage of headaches presenting at GPs are primary ?
90%
are tension head aches disabling ?
no
are migraine head aches disabling ?
yes
are tensions head aches unilateral or bilateral ?
bilateral
describe the pain of tension head aches
Mild, bilateral headache which is often pressing quality
what is the treatment for tension headaches
- abortive treatment
- preventative treatment
abortive treatment
- NSAIDs
- aspirin
preventative treatment (rare) - tricyclic antidepressants
how many people are affected by migraines ?
6 million
what gender are most effected by migraines ?
females
what age range is most effected by migraines ?
20-50yrs
what causes migraines ?
complex circuit changes in the brain
what symptoms are felt during a migraine ?
headache nausea photophobia phonophobia functional disability
is a migraine bilateral or unilateral ?
unilateral
can physical activity trigger a migraine ?
yes
can physical activity trigger a tension headache ?
no
state some triggers for migraines ?
- dehydration
- diet
- change in oestrogen
- stress
- after stress
- hunger
- sleep disturbance
what are the 5 stages of a migraine ?
- premonitory
- aura
- early head ache
- advanced head ache
- postdrome
what occurs in the premonitory stage of a migraine ?
mood change
fatigue
muscle pain
food craving
what occurs in the aura stage of a migraine ?
visual somatosensory changes
what occurs in the early headache stage of a migraine ?
dull head ache
nasal congestion
muscle pain
what occurs in the advanced headache stage of a migraine ?
unilateral throbbing nausea photophobia phonophobia osmophobia
what occurs in the postdrome stage of a migraine ?
fatigue
cognitive changes
muscle pain
what percentage of migraineurs have aura?
33%
what can aura be confused with?
TIA
how many days a month does someone have to have a headache to have chronic migraines ?
> 15days for >3months
what substances can trigger a headache?
- caffeine
- over use of analgesias
what is the treatment of migraines ?
- abortive
- preventative
abortive
- aspirin
- NSAIDs
preventative
- b blocker
- anti-epileptics
- tricyclic antidepressants
- venlafaxine
do migraines get better or worse with pregnancy ?
better
what two drugs are women told to avoid if they have migraines ?
Combined OCP
Anti epileptics
whats the treatment of migraines during pregnancy?
- abortive
- preventative
abortive
- paracetamol
preventative
- propranolol
what are the four types of trigeminal autonomic cephalalgias ?
cluster headache
paroxysmal hemicrania
SUNCT
SUNA
what are the symptoms someone experiences with trigeminal autonomic cephalalgias ?
very severe unilateral head pain
cranial autonomic symptoms
state some cranial autonomic symptoms
- conjunctival infection
- nasal congestion
- eyelid oedema
- forehead sweating
- miosis/ptosis
where do patients with cluster head aches feel the pain?
around the eye and temporal area
are cluster head aches bi lateral or unilateral?
unilateral
do cluster head aches have a gradual on sudden onset?
sudden onset
what is the common duration of cluster head aches ?
15mins - 3 hours
do patients with cluster head aches want to stay still or move about?
they want to move about
- whereas people with migraines want to stay still
do the autonomic symptoms of cluster head aches happen on the same or opposite side of the pain?
same side of the pain
can migraine symptoms be present during a cluster head ache?
yes
state some migraine symptoms ?
- tiredness (yawning)
- nausea
- photophobia
- phonophobia
- aura
can alcohol trigger a cluster head ache ?
yes
what is the typical episodic pattern of cluster head aches ?
1-3 months of attacks followed by 1 month of remission
attacks typically occur at the same time everyday at the same time of year
what would make someone have chronic cluster head aches?
having attacks for over a year without remission
or remissions last less then 1 month
is paroxysmal hemicranial unilateral or bilateral ?
unilateral
what is the pain on the head for paroxysmal hemicrania ?
around the eye and temporal area
are the autonomic symptoms on the same or opposite side of the pain during a paroxysmal hemicrania attack?
same side
how is paroxysmal hemicrania different from cluster head aches ?
paroxysmal hemicrania attacks are short and occur many in one day
what quality of pain is experienced with SUNCT?
stabbing pulsating pain
how long do SUNCT attacks last?
10-240 seconds
what can trigger SUNCT attacks ?
Wind
Cold
Touch
Chewing
where is the pain of trigeminal neuralgia?
unilateral maxillary or mandibular division pain
what is the main difference between trigeminal neuralgia and trigeminal autonomic cephalalgias ?
trigeminal neuralgia occurs at the lower parts of the face
what os the quality of pain with trigeminal neuralgia?
stabbing pain
what is the duration of trigeminal neuralgia?
5-10 seconds
what are some triggers of trigeminal neuralgia?
wind
cold
touch
chewing
are autonomic symptoms present with trigeminal neuralgia?
not present
what 3 treatments can be used for cluster head aches?
100%oxygen
subcutaneous sumatriptan
nasal zolmatriptan
what drug type own work for cluster head aches?
tablets
what four drugs can be used to prevent cluster head aches from occurring ?
verapamil
lithium
methysergide
topiramate
is there any abortive treatment for paroxysmal hemicrania ?
no
- no drugs available
which trigeminal autonomic cephalalgias and trigeminal neuralgia conditions don’t have any abortive treatment?
SUNCT
Trigeminal Neuralgia
Paroxysmal hemicrania
what treatment can be used as prevention for paroxysmal hemicrania ?
indomethacin
what treatment can be used as prevention for SUNCT ?
Lamotrigine
Topiramate
Gabapentin
Carbamazepine / Oxcarbazepine
what treatment can be used as prevention for trigeminal neuralgia ?
Carbamazepine / Oxcarbazepine
what three surgical options are available for trigeminal neuralgia ?
Glycerol ganglion injection
Steriotactic radiosurgery
Decompressive surgery
what presentations may indicate a sinister headache ?
- associated with head trauma
- sudden onset
- new daily persistent headache
- change in headache pattern
- returning patient
is a headache likely to be sinister if the headaches have a longstanding pattern episode ?
no
what are some red flags for head aches ?
new onset
new change in frequency, characteristic, associated symptoms
non-focal/focal neurological symptoms
neck stiffness
in what position would a high pressure head ache be worse ?
worse lying down
what can trigger a high pressure head ache ?
physical exertion
valsalva manoeuvre
what is a risk factor for high pressure head aches ?
cerebral venous sinous thrombosis
in which position would a low pressure head ache be worse ?
sitting or standing up
what is the definition of a thunderclap head ache?
A high intensity headache reaching maximum intensity in less than 1 minute
what are some differential diagnoses which would have to be ruled out for a thunderclap head ache ?
SAH (subarachnoid haemorrhage) Intracerebral haemorrhage TIA/Stroke carotid/ vertebral dissection cerebral venous sinus thrombosis meningitis
what percentage of people die form SAH?
50%
what are the two surgical treatments for a cerebral aneurysm ?
coiling
clipping
is examination usually normal with a SAH patient ?
yes
what investigations should be done for a SAH?
CT scan Lumbar puncture (>12 hours after headache onset) Both tests should be done on the same day
state two types of CSF infections ?
Encephalitis and Meningitis
what are the symptoms of meningitis ?
nausea +/- vomiting, photo/phono phobia, stiff neck
what are the symptoms of encephalitis ?
altered mental state / consciousness, focal symptoms / signs, seizures
what rash is present during a CFS infection ?
rash which doesn’t go away when you press on it
what could be a cause of intracranial hypotension ?
dural CSF leak
what are some warning signs which might indicate that the intracranial pressure is raised ?
head ache is worse
- in the morning
- when lying down
- during valsalva
focal symptoms:
weakness in one arm
non focal symptoms:
personality change, drowsiness
seizures
visual impairment
what investigation should be done for intracranial hypertension ?
MRI of brain and spine
is intracranial hypotension worse when standing or lying down?
standing up
what is the treatment for intracranial hypotension ?
bed rest fluids analgesia caffeine epidural blood patch
what is the main difference between intracranial hypotension and raised incracranial pressure ?
intracranial hypotension
- worse when standing up
raised incracranial pressure
- worse when lying down
what is giant cell arteritis ?
inflammation of large arteries
what are the symptoms of giant cell arteritis?
headache is diffuse, persistent and severe systematically unwell scalp tenderness visual disturbance prominent temporal arteries
what three blood tests should be done for giant cell arteritis?
- elevated ESR (>50)
- raised CRP
- raised platelet count
what treatment should be started if giant cell arteritis is suspected ?
high rise prednisolone
