Headaches Flashcards
What are some differentials for headaches?
Sinusitis Migraines Overuse of Analgesia Tension Headache Temporal Arteritis Cluster Headaches Raised ICP
What are some emergency presentations of headaches?
Raised ICP - Meningitis or Thunderclap - Subarachnoid Headache
Throbbing Temporal Artery with Visual Loss
What is the headache like in Sinusitis?
Other features?
How do you treat it?
Frontal
Worse leaning forwards
Tender if press on the sinuses
Constant, dull
Feeling “Blocked Up” and other signs of URTI (discharge, fever)
Leave it
Decongestants, inhale steam
What is the headache like in a migraine?
Pathophysiology?
Other features?
Throbbing, unilateral, orbital headache
Aura
Comes on over a minutes-hours
Can last up to 48 hours
Due to 5HT disturbing cerebral blood flow
Photophobia
Unpredictable timing
Nausea and Vomiting
Linked to menstruation
What is the headache like in a Tension Headache?
Other features?
How do you treat it?
Feels like a tight band around the head
Bilateral
Younger people get them
Associated with stress, anxiety
Treat with stress relief
What is the headache like in Temporal Arteritis?
Pathology?
Risk Factors?
Unilateral headache Over the temporal artery Scalp tenderness Jaw claudication Shoulders feel stiff Visual disturbances or loss
Large Vessel Vasculitis, granulomatous inflammation with skip lesions
Risk factors: middle aged, female, temporal artery abnormality, PMR
What is the headache like in a Cluster Headache?
Other features?
Multiple headaches in a day Predictable onset - related to time or thing Unilateral Around one eye Last under 3 hours each time
Autonomic symptoms
Investigating Temporal Arteritis?
How do you treat Temporal Arteritis?
Raised ESR
TA Biopsy - take multiple/large sample
High dose steroids (40-60) decreasing over 2 years
Give bone protection and a PPI
Can give steroid sparing DMARDs
Emergency if Visual signs! Methyprednisilone IV needed inpatient
What is a headache due to medication overuse like?
How do you treat it?
Dull, throbbing, constant
Due to using for 10+ days
Stop analgesia
What is a raised ICP headache like?
Other features?
How do you treat it?
Worse leaning forward Photophobia Vomiting Confusion Worse after sleeping
Meningitis Symptoms…
Emergency!
CT Scan
Empirical Antibiotics (Ceftrioxone)
What is a subarachnoid headache like?
Can have sentinel bleed and headache Severe headache like hit on back of head Vomiting LoC Stiff Neck Raised ICP signs (diplopia, ptosis)
What is the headache in Trigeminal Neuralgia like?
Sharp, constant pain in area of trigeminal nerve branches
What are other things which can cause Head Pain (like a headache)?
Paget’s Disease - bone remodelling can cause pain, nerve pain
Trigeminal Neuralgia
Dental Caries
How do you treat cluster headaches?
Acutely:
Long Term:
O2 and a 5HT agonist
Verapamil (Ca2+ blocker)
How do you investigate headaches?
Opthalmoscope (papilloedema)
Bloods - CRP, ESR, WCC
