Headaches Flashcards
What are some of the possible causes of headaches?
Tumour Meningitis Vascular disorders Systemic infection Head injury Drug induced
What are the different types of primary headaches?
Tension type headache
Migraine
Cluster headaches
What are the clinical features of a tension type headache?
Mild pain Bilateral Pressing or tightening No significant associated features Not aggravated by routine physical activity
What abortive treatment is used for tension type headaches?
Aspirin
Paracetamol
NSAIDs
What preventative treatments are used for tension type headaches?
Tricyclic antidepressants
What is a migraine?
Chronic disorder with episodic attacks due to complex changes in the brain
What are the clinical features of a migraine?
Headache Nausea Photophobia Phonophobia Functional disability
What are some of the triggers of a migraine?
Stress Diet Dehydration Environmental stimuli Changes in oestrogen level in women Sleep disturbance Hunger
What are the different stages of a migraine?
Premonitory Aura Early headache Advanced headache Postdrome
What is an aura?
Neurological symptoms resulting from cortical brainstem dysfunction, may involve visual, sensory, motor or speech systems
What can make headaches worse?
Medication overuse
Caffeine overuse
What is the abortive treatment for migraines?
Aspirin or NSAIDs
Triptans
What is the prophylactic treatment for migraines?
Propanolol or candesartan
Anti- epileptics
Tricyclic antidepressants
Venlafaxine
What effect can pregnancy have on migraines?
Migraines with aura get better
Migraines without aura usually don’t change
What is the effect of OCP on migraines?
Contraindicated in migraine with aura
What are the different types of trigeminal autonomic cephalagias?
Cluster headaches
Paroxsymal hemicrania
SUNCT
SUNA
What are the clinical features of a cluster headache?
Mainly orbital and temporal Strictly unilateral Rapid onset Excruciatingly severe Restless and agitated
What are the clinical features of paroxysmal hemicrania?
Mainly orbital and temporal Strictly unilateral Rapid onset Restless and agitated Absolute response to indometacin CHRONIC
What are the clinical features of SUNCT?
Unilateral orbital, supraorbital or temporal pain Stabbing or pulsating pain Short lived No refractory period Conjunctival injection and tearing
What are the clinical features of trigeminal neuralgia?
Unilateral maxillary, mandibular or ophthalmic pain
Stabbing
Short lived
Has a refractory period
What are the triggers of trigeminal autonomic cephalagias?
Wind, cold
Touch
Chewing
What is the abortive treatment for cluster headaches?
Subcutaneous sumatriptan
Nasal zolmatripan
Occipital depomedrone injection
What is the preventative treatment for cluster headaches?
Verapamil
Lithium
What is the treatment for paroxysmal hemicrania?
No abortive treatment
Indometacin
Topiramate
What is the treatment for SUNCT/SUNA?
No abortive treatment
Topiramide
Lamotrigine
What is the treatment for trigeminal neuralgia?
No abortive treatment Carbamazepine Oxcarbazepine Glycerol ganglion injection Steriotactic radiosurgery
What presentations of headache are more likely to have a sinister cause?
Associated head trauma First or worst Sudden (thunderclap) headache New daily persistent headache Change in headache pattern or type
What are the red flag symptoms associated with headache?
Neck stiffness Fever High or low pressure New onset or change in headache Abnormal neurological examination
What is a thunderclap headache?
High intensity headache reaching maximum intensity in less than 1 minute
What is the differential diagnosis of a thunderclap headache?
Subarachnoid haemorrhage Intracerebral haemorrhage TIA/stroke Carotid/vertebral dissection Meningitis/encephalitis Cerebral venous sinus thrombosis
What investigations are used for a subarachnoid haemorrhage?
CT scan
Lumbar puncture 12 hours after onset
What are the signs of meningitis?
Nausea, vomiting
Photo/phonophobia
Neck stiffness
What are the signs of encephalitis?
Altered mental state/ consciousness
Focal symptoms or signs
Seizures
What are the features suggestive of a space occupying lesion or raised intracranial pressure?
Progressive headache with associated symptoms and signs Visual obscurations Pulsatile tinnitis Seizures Personality change
What investigations are used for intracranial hypotension?
MRI brain and spine
What is the treatment for intracranial hypotension?
Bed rest, fluids, analgesia, caffeine
Epidural blood patch
IV caffeine
What are the symptoms of giant cell arteritis?
Diffuse, persistant headache Systemically unwell Scalp tenderness Jaw claudication Visual disturbance Prominent, beaded or enlarged temporal arteries
What is the treatment for giant cell arteritis?
High dose prednisolone
Temporal artery biopsy
