Headaches Flashcards
How do tension headaches present?
Bilateral pain/ tightness/ pressure in halo distribution/ forehead. Can be mild mod or severe lasting a few hrs to days. Do not usually disturb sleep, mildest in the morning and may have tenderness around muscles of head.
What could exacerbate/ cause tension headaches?
tightness in neck and head muscles, exacerbated by tiredness, anxiety, eye strain, working/ reading in low light, dehydration, sunlight, cold, noise etc
How are tension headaches treated (4)
- paracetamol and NSAIDs
- reducing stress
- exercise
- amytriptyline (start low dose and increase, stop when no headaches for 4-6 months)
- if chronic: keep diary to find triggers
How do migranes typically present?
Usually unilateral, throbbing/ pulsating pain at front or side, may start in one place and spread. Often preceeded by aura. lasts 2-12 hrs. Associated N+V, photophobia, noise intolerance, blurred vision, sweating
List 6 triggers of a migraine
- diet: caffeine, cheese, choco, alcohol
- smoking
- bright light
- depression/ anxiety/ stress
- loud noises
- strong smells
- medications (HRT, COCP)
- mensturation
- shift work
- lack of sleep
- strenuous exercise
How are migraines managed?
- Try and identify triggers
- 1st: aspirin or ibuprofen w/ prochlorperazine to stop N+V
- 2nd: diclofenac suppository w/ domperidone (for n+v)
- 3rd: 5-HT receptor agonists (triptans: sumatriptan, almotriptan)
- beta blockers, amitriptyline, sodium valproate, pizotifen and botulinum toxin type A as prophylaxis for chronic migraines
How frequent should migraines be for the pt to be offered prophylaxis?
> 2 per month
How does a retinal/ ocular migraine present?
Partial or total loss of vision in one eye lasts 10 to 20 mins before vision returns. Headache before during or after after vision attack. caused by vasospasm of blood vessels in eye
How are retinal migraines treated?
aspirin, b blocker or ccb, TCA
What is a hemiplegic headache?
Temporary paralysis of one half of body with severe headache. lasts hrs- days often confused with stroke.
How does a cluster headache present?
one sided burning/ throbbing headache, mainly around on eye or temple which can spread to other parts of the head. They come on quickly with no warning, last 15mins- 3hrs and happen everyday for weeks- months before improving. may be triggered by alcohol, heat or strong smells. may have redness and watering of eye, runn or buged nose, facial sweating, eyelid dropping. often occur at night and can wake from sleep
What is thought to be happening during a cluster headache?
hypothalamic overdrive causing neurotransmitters to be released that stimulates pain and other symptoms. Nerve overactivity thought to cause vasodilation of blood vessels of one side of brain causing pain and pressure on nearby tissue.
How are cluster headaches treated? (3)
- SC sumatriptan injection releives them within 15 mins
- zolmitriptan nasal spray doesnt work as fast
- high flow oxygen works within 15 mins (3rd line)
How can cluster headaches be prevented? (3)
- verapamil (action not clear)
- lithium (action not clear)
- corticosteroids can help break the cycle
- others eg methysergide, ergotamine, topiramate
- take them till headache free for 14 weeks but may need them indefinatly
How do medication overuse headaches present
constant or dull headache most days, often worse in morning and after exercise on background of paracetamol, aspirin or nsaid use for 15 days or opaite or triptan use for 10 days or more.