Headaches Flashcards
What are some acute causes of headache
VICIOUS Vascular - SAH, intracranial, intracerebral - infarction esp posterior circulation - Venous: sinus thrombosis
Infection/inflammation
- meningitis, encephalitis, abscess
How does a tension headache present
Associated with stress and anxiety Bilateral pressing, tightening pain (non-pulsatile) Fronto-occipital Mild/moderate intensity Not associated with vomiting Not aggravated by exercise Mild - moderate intensity Present at or soon after getting up in the morning G
Who are tension headaches more common in
More common in younger population
prevalence decreases with age
How are tension headaches managed
Non-pharmcological: Alleviate stress - meditation and mindfullness
Pharmcological: Simple analgesia
prophylaxis: accupuncture
How can tension headaches be classified
Episodic - 30mins to 7 days
less than 15 days per month
Chronic - more than 15 days per month for more than 3 months
What are the causes of the headaches
Anxiety Depression Poor posture poor sleep Stress Muscular tightness
What examination would you do in tension headaches
head and neck examination
BP
Fundoscopy
What would you examine in a patient presenting with headaches
BP Fundoscopy Neurological examination Visual acuity Gait Palpation of temporal regions Examination of neck
What are the red flags for headaches
Headache with fever +/- purpuric rash
Thunderclap headache
progressive headache worsening over weeks
Headaches associated with postural change, sneezing, coughing
Recent head injury
Papilloedema
Change in personality, cognitive or neurological deficit
New onset headache in pt with HIV/cancer
Headache with atypical aura (>1hr +/- motor weakness)
Aura for first time and using COCP
What are cluster headaches
Extremely painful headaches focused around one eye with associated autonomic symptoms
- red watery eye
- forehead sweating
- eye drooping
- runny/blocked nose
Pain lasts 15-180 mins
1x every 2 days - 8x per day
What are the risk factors for cluster headaches
Smoking
Over 20 - rare in <20 years
male
What would you do with a patient presenting for the first time with cluster headaches
Referral to neurology or neuroimaging
What is given in an acute attack of cluster headaches
100% Oxygen 12L for 10-20 mins
5HT agonists - sumitriptan
What is the prophylaxis used for cluster headaches
Verapamil 80mg
no response to this =referral
What is trigeminal neuralgia
Intense, burning, stabbing, electric shock like pain in the trigeminal nerve distribution on face
Pain may be provoked by facial movements or by touching face
More common in >50 years old
No symptoms between attacks
Normally unilateral pain
Which disease is associated with trigeminal neuralgia
Multiple Sclerosis
How is trigeminal neuralgia managed
Spontaneous remission may occur
carbamazepine
Pregabilin
Amitriptylline
How does Giant Cell Arteritis present
Scalp tenderness may have jaw claudication Unilateral throbbing headache Facial pain transient visual symptoms Temporal artery abnormality - tenderness, thickness, decreased pulsation
Which investigations are done in GCA - temporal arteritis
Bloods: FBC, U+Es, ESR (>50)
Temporal artery biopsy
Why might the temporal artery biopsy be negative
Skip lesions
Which visual symptoms are associated with temporal arteritis
Diplopia
Sudden loss of vision
fleeting loss of vision (amaurosis fugax)
What is the management of temporal arteritis
Prednisolone 40-60mg OD Osteoporosis prophylaxis - bisphosphonates (if hx of fragility #s, >65), Vitamin D and Calcium Steroid card Consider aspirin 75mg OD Referral to ophthalmology - same day if visual symptoms Rheumatology (for biopsy)
What should be asked in a headache history
Timing
- how recent
- when do they occur during the day
- how sudden when they start
- how frequent
- duration
Character
- intensity of pain
- nature and quality of pain
- site and spread
- associated symptoms
Cause questions
- predisposing or triggering factors
- lifestyle factors - poor sleep, stress, lack of exercise
- aggrvating or relieving factors
- Family hx of similar headaches
Response
- what do you do when you have a heaache
- how much are your activities limited
- What medication has been used
- how has the medication been used
State between attacks
- well between attacks?
- any residual or perssitent symptoms between attacks
- any concerns about recurrent headaches
- any concerns about cause
