Headaches Flashcards
What are points of particular significance on examination of someone with a headaceh?
fever, rash and neck stiffness in patient’s with recent onset headache
Scalp tenderness in older people
Fundoscopy in all patients
What are dangerous headaches?
Meningitis SAH Temporal arthritis Raised intracranial pressure Encephalitis Sinusitis Arterial dissection
What are safe but unpleasant headaches?
Tension-type headache Migraine Trigeminal neuralgia Medication overuse headache Cluster headache
What are the symptoms of a subarachnoid haemorrhage?
Sudden headache (like being hit on the back of a head with a baseball bat) Neck stiffness (due to subarachnoid blood) There may be associated loss of consciousness and focal neurological signs.
What are the symptoms of a headache due to meningitis?
Progressive headache developing over hours to days. Associated fever and neck stiffness. Rash May be impaired consciousness Photophobia
What are the symptoms of temporal arteritis?
Headache is insidious in onset, usually produced bitemporal pain.
Tender scalp
Jaw claudication on chewing
1/4 have generalised joint and muscle aching typical of polymyalgia rheumatica.
What causes temporal arteritis? Why is it dangerous?
Inflammation of the middle sized blood vessels - vasculitis.
It is dangerous because it can affect the retinal vessels, resulting in blindness.
What tests are done for temporal arteritis?
ESR is very raised (60-100), as are other markers such as CRP and plasma viscosity.
Diagnosis is confirmed with a temporal artery biopsy, however this may be negative as the arthritic lesions are patchy.
What is the treatment is temporal arteritis is suspected?
Treatment with steroids should be started immediately, where there is usually a brisk response. Treatment can be monitored using the ESR and can usually be stopped after 2 years.
What are the symptoms of a raised intracranial pressure headache?
Made worse/brought on by manoeuvres that increase intracranial pressure such as coughing, bending or lying down.
They are worse on waking up in the morning and tend to clear a short time after getting up.
May be associated with vomiting.
Papilloedema.
Cranial nerves 3 and 6 palsies.
May be associated focal signs/altered consciousness depending on the cause of raised ICP.
What is an idiopathic intracranial hypertension headache?
Diagnosed after demonstrating no structural cause for the raised ICP after investigations and measured increased ICP on lumbar puncture, with normal CSF constituents.
Who is idiopathic intracranial hypertension most associated with and what could cause it?
Young obese women.
Could be cause by tetracycline.
Why is idiopathic idiopathic intracranial hypertension treated? What is the treatment?
Because raised ICP puts the optic nerve at risk and can result in significant visual field defects.
It is treated by lumbar puncture, acetazolamide (decreases CSF pressure) and weight loss.
What documents the progress of treatment in idiopathic intracranial hypertension?
Visual field measurements.
What other disease presents similarly to idiopathic intracranial hypertension? What causes it?
Venous sinus thrombosis.
Associated with the COCP, dehydration, clotting abnormalities and ear infections.
What are the symptoms of sinusitis?
Tender, painful sinuses (esp frontal and maxillary).
Fever
Nasal discharge
What are the symptoms of arterial dissection?
Sudden onset neck or head pain
Ipsilateral Horner’s syndrome
Associated stroke or transient ischaemic attacks
What are the symptoms of a migraine?
Photophobia
Phonophobia
Nausea
Aura (1/3)
Throbbing headache - usually unilateral, bilateral in 1/3
Headache worsened by activity and improved by sleep
What sort of things have been found to trigger migraine headaches?
Red wine, cheese, chocolate or coffee. Lie ins Relaxation Oral contraceptives Menstruation (more common during)
What is the most common type of aura? What others are known?
The aura is most commonly visual with flashes of light or more complicated zigzag fortification spectra which shimmer and enlarge over 5-30 minutes.
5% have sensory symptoms, usually paraesthesiae.
Aphasia
How long do auras tend to last?
10-30 mintues
What premonitory symptoms occur before a migraine?
A day or 2 before the attack, 1/2 of patients will have mood swings, hunger and drowsiness
What are the treatment options and levels for migraines?
- Identification and removal of triggers (dietary, sleep, contraceptive)
- Treatment for acute attacks
Pain relief (paracetamol and aspirin)
Anti-emetics (domperidone, metoclopramide, prochloperazide)
Sumatriptan
3. Prophylaxis Beta blockers (propanolol, atenolol) Amitriptyline Sodium valprote Topiramate Pizotifen
What are tension-type headaches often caused by?
Stress and lack of sleep
