Headaches Flashcards
Red flags for headaches
Worst ever headache Worse in morning, bending forwards or coughing Neck stiffness Decreased GCS Neurological deficit Scalp tenderness Pregnant - preeclampsia
Causes of thunderclap headache
Subarachnoid haemorrhage Carotid dissection Vertebral dissection Cerebral venous thrombosis Meningoencephalitis Intermittent hydrocephalus - 3rd ventricle cyst
What is coning
Brain herniation through foramen magnum following lumbar puncture with raised ICP
Describe exertional headaches
Feels like being hit over back of head with a brick
Pain subsides in 10-15mins
Brought on by exertion e.g weight lifting and after intercourse
Describe tension headaches
Tightness in scalp, forehead, sudoccipitals and neck
Gets worse towards evening and clears overnight
Treatment for tension headache
Amitriptyline
Describe cluster headaches (5)
Headaches on daily basis, usually waking patient up at night. Then go months with no headaches, then they return on daily basis.
Middle aged men
Associated with autonomic features - nose and eye secretions, ptosis, swelling
Red hot poker sensation in orbit and nostril on one side
Rapid onset and offset
What triggers cluster headaches
Alcohol
GTN spray
Exercise
Treatment for cluster headaches
Subcutaneous Triptan
Verapamil to prevent onset
First line migraine treatments
Paracetamol
NSAIDs including aspirin
Oral triptan
Add on treatment for migraines
Dopamine antagonists e.g metoclopramide and domperidone
Stepwise treatment for migraine prophylaxis
1st line- beta blocker, topiramate
2nd line- amitriptyline, acupuncture
3rd line- duloxetine, gabapentin
Factors causing migraines
Stress Seasonal Menstrual cycle or pregnancy related Exercise Infection Small head injuries
Areas affected by migraines
Frontotemporal Occipitoorbital Orbital Cheiro-orbital - arm, face, mouth in that order can mimic TIA due to dysphasia Facial
Symptoms associated with migraine
Photophobia Aura - visual most common Hemiparesis Nausea Vertigo Dysphasia
Significance of migraine + vertigo
If sudden onset or vomiting with positional change,
NEED FURTHER INVESTIGATION
look for tumour in posterior cranial fossa
Describe trigeminal neuralgia
Excruciating deep pain in face lasting a few seconds every few minutes
Rarely at night
Where is the pain felt in trigeminal neuralgia and what is the trigger
Mouth-ear: triggered by motor activity
Nose-orbit: triggered by cutaneous sensory activity
Investigations needed in trigeminal neuralgia
MRI to rule out meningioma or trigeminal schwannoma
Treatment for trigeminal neuralgia
Baclofen
Gabapentin
How to distinguish paroxysmal hemicrania from cluster headaches
Paroxysmal hemicrania F>M, Cluster headache M>F
Episodes are shorter and more frequent in paroxysmal hemicrania
Patient will be agitated in cluster headache
Paroxysmal hemicrania is triggered by head movements
What is SUNCT
Short lasting
Unilateral
Neuralgiform headache
With conjunctival tearing
Treatment for SUNCT
None
Describe atypical facial pain and treatment
Feels like bone is ‘going rotten’
Treat with tranquillisers and antidepressants
