Headaches Flashcards
What is a primary headache ?
A headache that has no underlying medical cause
What are the 3 primary headaches ?
- Tension type headache
- Migraine
- Cluster headache
What is a secondary headache ?
A headache that has an underlying medical cause
What would the patient complain about if they had a TTH ?
- Bilateral headache
- Tightening feeling
- No other features
- Can last 30 minutes - days
What is classed as infrequent episodic TTH ?
< 1 day per month
What is classed as frequent episodic TTH ?
1 - 14 days per month
What is classed as a chronic TTH ?
> 15 days per month
How do you treat a TTH ?
What is the preventative treatment ?
- NSAID’s
- Aspirin
- Preventative treatment - Tricyclic Anti-depressants
How many phases does a migraine have ?
5
What are the phases of a migraine ?
Premonitory Aura Early headache Advanced headache Postdrome
What occurs in premonitory ?
- Behavioural changes/irritable
- Mood changes
- Food cravings
- Muscle pain
What happens in the Aura phase ?
- Hearing or vision changes
- Funny smells
- Tingling
What occurs in the Early headache ?
- Dull pain
- Nasal congestion
- Muscle pain.
What happens during the Advanced headache ?
- Unilateral throbbing
- Photophobia
- Phonophobia
- Nausea
- Vomiting
What occurs during the Postdrome ?
- Fatigue
- Muscle pain
What is the definition of a Chronic Migraine ?
Headaches > 15 days per month with > 8 of these being Migraines. Must have occurred for 3 consecutive months.
What is the treatment for migraines ?
What are the preventative treatments ?
- NSAID’s
- Aspirin
- Triptans
Preventative measures include Tricyclic-Antidepressants, Anti-epileptics and Propranolol.
What treatments can be given in pregnancy ?
Propanolol and Paracetamol
What are the features of a cluster headache ?
- Orbital/temporal
- Unilateral
- Patients are agitated and restless
- Comes on quickly and stops quickly
- Usually lasts 1-2 hours
Do cluster headaches show any patterns ?
They occur at the same time everyday
What can be used to treat cluster headaches ?
- 100% oxygen
- Sumatriptan
What is a medication overuse headache ?
Headache that has started and occurs > 15 days per month since talking regular symtomatic medication.
What causes a medication overuse headache ?
- Simple analgesics > 15 days per month
- Combination analgesics/opioids > 10 days per month
What is paroxysmal hemicrania ?
- Orbital and temporal
- Unilateral
- Rapid onset and rapid cessation
- Less than 30 minutes
- No circadian rhythm
What can be used to treat paroxysmal hemicrania ?
- Indometacin
What are the features of a SUNCT headache ?
- Unilateral
- Supraorbital/temporal
- Stabbing/pulsatile
- Usually only lasts minutes
- Cutaneous triggers
- No refractory period
How do you treat SUNCT ?
Gabapentin or Topiramate
List the features of Trigeminal Neuralgia
- Maxillary or mandibular pain
- Last seconds
- Stabbing pain
- Has a refractory period
- Cutaneous triggers
What is used to treat Trigeminal Neuralgia ?
- Carbemezapine
- Decompressive surgery
What are some of the red flag symptoms with headaches ?
- First and worst headache
- New symptoms
- Changing symptoms
- Visual changes
- Comes on with changes to posture
- Stiff neck/fever
What is a thunderclap headache ?
- Peaks in less than one minute
- No differentiating features
What is a thunderclap headache usually mistaken for ?
SAH, meningitis or a stroke
What surgical treatment is needed in a SAH if due to a berry aneurysm ?
Coiling or clipping
How do you investigate a SAH ?
CT scan, CT angiography if SAH found and LP if nothing found on CT scan (within 12 hours).
How do you maintain a patient who has had a SAH ?
Three HHH rule :
- Control Hypertension (BP)
- Hydrate
- Give plasma if needed to maintain volume
What complications can arise from an SAH ?
- Hydrocephalus
- Vasospasm
- Seizures
What medication is given for up to 3 weeks after to prevent Vasospasm ?
Nimodipine
If headache comes on due to position changes or patient is having seizures, what would you suspect ?
Space occupying lesion
What causes intracranial hypotension ?
CSF leak due to Iatrogenic/ spontaneous hole formation
What makes hypotension worse ?
Standing up
How would you investigate/treat intracranial hypotension ?
MRI of brain and spine
- Epidural blood patch
- Bed rest
- Caffeine
- Analgesia
What is Giant Cell Arteritis ?
inflammation of the large arteries. Should consider this in any patient over 50.
What do patients with Giant Cell Arteritis present with ?
- Scalp tenderness
- Jaw claudication
- Visual disturbances
- Prominent temporal veins
What tests are done and what do they show ?
Giant Cell Arteritis
Blood tests and should do a biopsy
High ESR and CRP
What is used to treat Giant Cell Arteritis ?
Prednisolone
