Headaches Flashcards
What can cause primary headache?
Migraine
Cluster
Tension
What can cause secondary headache?
Meningitis, SAH, GCA, idiopathic intracranial hypertension, medication overuse.
What are the risk factors for migraines?
Female (20%)
What are the partial triggers for migraines?
Chocolate Hangovers Orgasms Cheese Oral contraceptive pill Lie-ins Alcohol Tumult Exercise
Describe the epidemiology of headaches
Very common. Episodic tension headache most common.
Give the symptoms of migraine without aura.
4-72 hours Nausea/ vomiting Photo- and phonophobia Throbbing pulsatile pain Unilateral and localised pain in the frontotemporal/ ocular area.
What are the types of migraine?
Migraine with aura
Migraine without aura
Migraine variants
(PTS)
What investigations would you do if someone presents with headache?
Bloods - microbiological cultures - meningitis, encephalitis?
Scans - CT scan - haemorrhage/ stroke?
Eye investigation - acute glaucoma?
What are the diagnostic criteria for migraine with aura?
FeatureFULL compared to tension headache.
1. One of 4 fully reversible aura symptoms:
Visual - dots, melting/jumbling of lines
Sensory - tingling, numbness
Speech/ language - aphasia
Motor - rule out stroke and TIA!
2. Two of 4 characteristics:
- 1+ aura symptom spreading gradually over >5min
- each individual aura symptom lasts 5-60 min.
- at least 1 aura symptom is unilateral
- accompanied or followed 60 minutes later with headache
(PTS)
What are the symptoms of tension headache?
‘featureless’ compared to migraine; ‘normal’ and common
Photo OR phonophobia.
Moderate
What are the diagnostic criteria for migraine with aura?
At least 5 attacks:
- lasting 4-72 hours
- 2+ of: Unilateral, pulsating, moderate/severe pain, aggravation by physical activity (lying still)
- 1+ of: Nausea/vomiting, photophonia and phonophobia.
Describe the management of migraine.
Lifestyle: avoid triggers, change or stop OC pill
Medical: Oral triptan eg synatriptan and NSAID/ paracetamol; consider adding anti-emetic
Prophylaxis: propanolol; if ineffective - acupuncture; amitriptyline (antidepressant)
Riboflavin daily may help (NICE, lecture 23.3.18, PTS)
What are the diagnostic criteria for cluster headache?
Severe, unilateral, orbital/supraorbital/temporal pain
15-180 mins
<8 per day
sense of agitation - opposite to people with migraines who don’t want to move.
Ipsilateral cranial autonomic features: eye lacrimation (tears), redness, rinhorrhea (runny nose), miosis, ptosis.
What are the diagnostic criteria for classical trigeminal neuralgia?
- 3+ attacks of unilateral pain ….
- … in the trigeminal region only….
- …occuring in paroxysmal attacks lasting up to 2 minutes/ severe/ stabbing/sharp/ Triggered by stimulation eg brushing teeth….
4…with no neurological deficit.
(PTS, lecture)
Define infrequent episodic tension headache
<1 day per month, lasting 30m-7 days
Bilateral, pulsating, mild/moderate, photo OR phonophobia, NOT aggravated by physical activity, NO nausea or vomiting.
Define frequent episodic tension headache
1-14 days per month on average for >3 months
Define chronic tension headache
> 14 days per month on average for > 3 months
Define probable tension headache
Doesn’t fit any other criteria, one feature short of fulfilling tension headache criteria.
Describe the management of tension headache.
Analgesics eg aspirin, NSAIDs (ibuprofen, diclofenac)
TCAs eg amitriptyline.
(PTS)
Define episodic cluster headache.
2+ cluster periods lasting 7 days to 1 year, separated by pain-free periods lasting at least a month.
Define chronic cluster headache
Occurs for >1 year without remission, or remission lasting <1 month.
Describe the management of an acute attack of cluster headache.
- Sumatriptan sc/ zolmitriptan nasal spray
- 100% oxygen therapy
- Prevention: verapamil, lithium, corticosteroids.
(PTS)
Describe the management of trigeminal neuralgia.
- Anti-convulsant eg carbamazepine
- Phenytoin, gabapentin
- Surgery: microvascular decompression; sterotactic radiotherapy.
Give a risk factor for cluster headaches
Being male
