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Neurology > Headaches > Flashcards

Headaches Flashcards

1
Q

Define Cluster Headaches:

A
  • A neurological disorder characterised by recurrent, severe headaches on one side of the head typically around the eye, tending to recur over a period of several weeks
  • EXCRUCIATING PAIN
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2
Q

Aetiology/risk factors of cluster headaches:

A
  • UNKNOWN aetiology – may be superficial temporal artery smooth muscle hyperreactivity to 5HT
  • Genetic factor implicated – an autosomal dominant gene has a role
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3
Q

Epidemiology of cluster headaches:

A
  • More common in MEN

* Usually occurs between 20-40 yrs

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4
Q

Symptoms/ signs of cluster headaches:

A

o Pain:

  • rapidly over around 10 mins,
  • intense, sharp and penetrating-centred around the eye, temple or forehead
  • unilateral
  • typically lasts around 45-90 mins (range: 15 mins - 3 hours)
  • once or twice daily
Associated autonomic features:
•	Ipsilateral lacrimation 
•	Rhinorrhoea 
•	Nasal congestion 
•	Eye lid swelling 
•	Facial swelling and flushing
•	Flushing 
•	Conjunctival injection 
•	Partial Horner's syndrome 
o	Patients find it difficult to stay still and will pace around, occasionally banging their heads on things
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5
Q

What are the two types of cluster headaches:

A

o Episodic - occurring in periods lasting 7 days - 1 year, separated by pain-free periods lasting a month or longer.

Chronic - occurring for 1 year without remissions or with short-lived remissions of less than a month. Can arise de novo or arise from episodic cluster headaches.

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6
Q

What is the pattern of recurrence in cluster headaches:

A

o Headaches occur in clusters lasting 4-12 weeks
o These occur once every year or once every 2 years, and tends to occur at the same time each year
o Headaches typically occur at night, 1-2 hours after falling asleep

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7
Q

What are triggers to cluster headaches?

A

o ALCOHOL - major precipitant
o Exercise and solvents
o Sleep disruption

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8
Q

Investigations for cluster headaches:

A
  • CLINICAL diagnosis based on history

* Neurological examination may be useful

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9
Q

Define migraines:

A

• Severe episodic headache that may have a prodrome of focal neurological symptoms (aura) and is associated with systemic disturbance

Note classic migraine is with an aura

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10
Q

Aetiology/risk factors of migraines:

A
  • Poorly understood
  • Early aura of cortical spreading depression is associated with intracranial vasoconstriction leading to localised ischaemia
  • This is then followed by meningeal and extracranial vasodilation mediated by serotonin, bradykinin and the trigeminovascular system
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11
Q

Epidemiology of migraines:

A

• Prevalence:
o Males - 6%
o Females - 15-20%
• Usually occurs in adolescence and early adulthood

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12
Q

Symptoms of migraines:

A 
Classically: visual or other aura lasting 15-30min followed within 1 hour by unilateral, throbbing headache
•	Headache
o	Pulsatile 
o	Duration 4-72 hrs 
o	Episodic 
Associated Symptoms
o	Nausea 
o	Vomiting
o	Photophobia/Phonophobia
o	Aura:
•	Flashing lights 
•	Spots 
•	Blurring 
•	Zigzag lines 
•	Blind spots (scotomas)
•	Tingling/numbness in the limbs
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13
Q

Triggers for migraines:

A

o Stress
o Exercise
o Lack of sleep
o Oral contraceptive pill (if patient has history of migraines, the pill cannot be prescribed as it can lead to ischaemic stroke)
o Foods (e.g. caffeine, alcohol, cheese, chocolate)

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14
Q

Signs for migraines:

A
  • NO specific physical findings

* Exclude secondary causes with MMSE, neurological examination, fundoscopy etc.

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15
Q

Investigations for migraines:

A
  • Diagnosis is usually based on HISTORY
  • Investigations may be useful for excluding other diagnoses
  • Bloods, CT/MRI, lumbar puncture
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16
Q

Management of migraines:

A

• NOTE: analgesia overuse can cause headaches

ACUTE
o Sumitriptan + NSAIDs + metoclopramide

Prophylaxis
o Remove triggers
o 1st line: Beta-blockers (propranolol) or Topiramate
o 2nd line: Amitriptyline

Menstrual migraines can be controlled with the oral contraceptive pill

Advice
o Avoid triggers
o Rest in a quiet dark room during episodes

17
Q

Complications of migraines:

A
  • Disruption of daily activities

* Can lead to analgesia-overuse headaches in people who use analgesia regularly

18
Q

Prognosis of migraines:

A
  • Usually CHRONIC

* Most cases can be managed well with preventative/early treatment measures

19
Q

Define tension headaches:

A

• The most common type of headache, which is considered a ‘normal, everyday headache’.
• Can be divided into:
o Episodic - occurs on < 15 days per month
o Chronic - occurs on > 15 days per month

20
Q

Aetiology/risk factors of tension headaches:

A 
•	The exact cause is unclear 
•	There are well-known triggers:
o	Stress/anxiety 
o	Squinting 
o	Poor posture 
o	Fatigue 
o	Dehydration
o	Missing meals 
o	Bright sunlight 
o	Noise 
•	They are primary headaches (i.e. they have no underlying cause)
21
Q

Epidemiology of tension headaches:

A
  • MOST COMMON type of headache
  • More common in WOMEN
  • Most common in YOUNG ADULTS
  • Most people will experience a tension headache at some point in their lives
22
Q

Symptoms and signs of tension headaches:

A
  • Mild-moderate in severity
  • Pressure/tightness around the head like a tight band
  • Pain tends to be bilateral
  • Non-pulsatile
  • +/- scalp muscle tenderness
  • Often a relationship with the neck
  • Can be disabling for a few hours but does not have specific associated symptoms (unlike migraines)
  • Gradual onset
  • Variable duration
  • Usually responsive to over-the-counter medication
23
Q

Investigations of tension headaches:

A

None

24
Q

Management of tension headaches:

A

o Reassurance
o Address triggers (e.g. stress, anxiety)
o Advice on avoiding medications that can cause medication-induced headaches (e.g. opioids)
o Simple analgesia (e.g. ibuprofen, paracetamol, aspirin)
o Tricyclic antidepressants may be considered in frequently recurrent episodic tension headaches or chronic tension headaches

25
Q

Complications of tension headaches:

A

none

26
Q

Prognosis of tension headaches:

A

Good

Not very severe or disabling + recur

Neurology (26 decks)

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