Headaches Flashcards
Define Cluster Headaches:
- 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
Aetiology/risk factors of cluster headaches:
- UNKNOWN aetiology – may be superficial temporal artery smooth muscle hyperreactivity to 5HT
- Genetic factor implicated – an autosomal dominant gene has a role
Epidemiology of cluster headaches:
- More common in MEN
* Usually occurs between 20-40 yrs
Symptoms/ signs of cluster headaches:
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
What are the two types of cluster headaches:
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.
What is the pattern of recurrence in cluster headaches:
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
What are triggers to cluster headaches?
o ALCOHOL - major precipitant
o Exercise and solvents
o Sleep disruption
Investigations for cluster headaches:
- CLINICAL diagnosis based on history
* Neurological examination may be useful
Define migraines:
• 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
Aetiology/risk factors of migraines:
- 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
Epidemiology of migraines:
• Prevalence:
o Males - 6%
o Females - 15-20%
• Usually occurs in adolescence and early adulthood
Symptoms of migraines:
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
Triggers for migraines:
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)
Signs for migraines:
- NO specific physical findings
* Exclude secondary causes with MMSE, neurological examination, fundoscopy etc.
Investigations for migraines:
- Diagnosis is usually based on HISTORY
- Investigations may be useful for excluding other diagnoses
- Bloods, CT/MRI, lumbar puncture
Management of migraines:
• 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
Complications of migraines:
- Disruption of daily activities
* Can lead to analgesia-overuse headaches in people who use analgesia regularly
Prognosis of migraines:
- Usually CHRONIC
* Most cases can be managed well with preventative/early treatment measures
Define tension headaches:
• 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
Aetiology/risk factors of tension headaches:
• 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)
Epidemiology of tension headaches:
- 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
Symptoms and signs of tension headaches:
- 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
Investigations of tension headaches:
None
Management of tension headaches:
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
