Headaches Flashcards
what are Acute Vascular causes fora headaches ?
Haemorrhage- SAH, IC, SDH, EDH
Thrombosis - Venous sinus
what are acute infective causes of headaches ?
Meningitis
Encephalitis
Abscess
temporal arteritis
what is an acute ophthalmic cause of headaches ?
Glaucoma
What are situational causes of headaches ?
cough, exertion and coitus
What are chronic causes of headaches ?
Migraine , cluster headaches
Drug side effects
tension headaches
Trigeminal Neuralgia
what are chronic causes of headaches that require immediate attention ?
Raised ICP from SoLs
Temporal / Giant cell arteritis
Systemic - HTN, Pre-eclampsia and pharmochromocytoma
what is difference between primary and secondary headaches ?
primary - due to the headache condition itself
secondary - present due to another condition
what do you consider to do next when someone comes in with headaches ?
Investigations
treatment
send to specialist or A and E
What must you consider in HPC of a patient with headaches ?
the cause / trigger PMH DH - Analgesics, side effects FH Stress- eating , water
what must you consider in examinations and why ?
vital sign/obvs - Bradycardia, hypotension from raised ICP
Neuro - peripheral and CN exam
any other exams dependant on history
what are red flag features of headaches ?
SNOOP
Systemic signs - of meningitis, HTN
Neurological symptoms - SoLs, Glaucoma
Onset new or changed and patient >50 years old - malignancy
Onset in thunderclap presentation - vascular (SAH)
Papilloedema - raised ICP
What SoL symptoms from a headache presentation ?
Gradual onset ,Progressive Associated neurological features- vision features of Increased ICP: Early morning headache nausea and vomiting worse on coughing or bending
what is the HPC of migraines ? think SQITARS
S= Unilateral , frontal
Quality - gradual or sudden, throbbing and pulsating
Intensity - moderate
Timing- Lasts 4-72 hours, cyclical
A- photo/Phonophobia, food , stress and lack of sleep
R- sleep , medications (Triptans)
S- aura with N+V
what is a theory for patholgy of margarine’s ?
vasodilation = spreading depression to cortex with FH linked
what is the HPC of tension headches ? think SQITARS
site - bilateral , frontal, radiate to neck Quality - squeezing, non pulsatile Intensity - less sever (mild/mod) timing - worse at end of day Chronic if > 15 times per month Episodic if <15 times per month Aggravating factors - stress, poor posture lack of sleep Relieving factors - analgesics S - Mild nausea
what is the pathology of tension headaches ?
Maybe tension in muscles of head and neck (e.g. occipitofrontalis)
Usually no family history
what is the epidemiology of tension headaches ?
Sex ?
age ?
onset ?
Most common type of headache
Females > males
Young > old
First onset in over 50s unusual (thing possibility of malignancy)
what is the epidemiology of migraines ?
2% of general population
Twice as many females as males
Most have had first attack when young (<30)
Severity decreases as age increases
what is the epidemiology of meds over use headache?
3rd most common type of headache 1-2% of UK population 20% of headaches are due to medication overuse 30-40 yrs Females > males OTC responsive
what is the definition of meds over use headache?
Present on at least 15 days per month
No improvement after OTC medication
may get worse before better
What is the DH of these patients ?
patients who get this headache are using
analgesics on at least 10 days per month
triptan or opioids at least 10/month
Paracetamol , NSAIDs at least 15/month
what are some features of patients with Over use headaches ?
seems to come about in people who are taking analgesia for headache mixed symptoms difficult to manage Co-exist with depression and sleep disturbances
What is the management of over use headaches ?
discontinuation of meds
may get withdrawal
what is the pathology of over use headaches ?
upregulation of pain receptors in meninges
what is the epidemiology of cluster headaches ?
1/1000 people
Males > females
Usual onset 20-40 years old
what is the HPC of cluster headaches ?
S- Around / behind one eye ,No radiation
q- Sharp and penetrating
I-Very severe and constant intensity
T- Rapid onset , 15-3hrs 1-2x/day, nocturnal , lasts 2-12 wks, remission can be 3mo-3yrs
A- head injury, Alcohol, Smoking
R- Simple analgesics
S- Decreased sympathetics = red /watery eye , nasal congestion and ptosis
what are some triggers for cluster headaches ?
Alcohol Histamine (hayfever) GTN Heat Exercise Solvent inhalation Lack of sleep
what is the epidemiology of trigeminal nerve ?
Peak incidence 50-60, increasing with age
25/100 000 UK population
Females > males
What is the HPC of Trigeminal neuralgia ?
S- Unilateral , over one eye, radiates to eyes, lips , nose
Q- Sharp and stabbing
I - Severe
T- sudden onset , few secs - 2mins
A- Light touch to face Eating Cold wind, Vibrations
R- difficult to alleviate
S- numbness and tingling preceding an attack
history of chronic pain
what is the pathophysiology of TN headaches ?
caused by compression of trigeminal nerve by a
vascular malformation few cases can be found to be caused by tumours, MS or skull
base anomalies
how can you treat migraines
triptans
how can you treat cluster headaches?
high flow oxygen
when do you refer to specialists ?
Suspicion of a tumour Suspicion of raised ICP Recent onset seizures Previous cancer Unexplained focal deficit Unexplained cognitive/personality changes
