Headaches Flashcards
What are the most common forms of headaches?
- Migraines
- Tension headaches
- Cluster headaches
- Temporal Arteritis
- Medication overuse headaches
What are other less common forms of headaches with acute onset?
- Subarachnoid Haemorrhage
- Meningitis
- Encephalitis
- Head injury
- Tropical illness
What are the causes of chronic onset?
- Chronically raised intracranial pressure
- Venous sinus thrombosis
What are Migraines?
- Severe, unilateral throbbing headaches
- Last up to 72 hours
What are the clinical features of Migraines?
- Associated with nausea, photophobia, and phonophobia
- Sufferers go to a quiet dark room during attack
- May have an aura - lasting up to 1 hour
- Allodynia
What are the common triggers of Migraines?
=> Mnemonic CHOCOLATE
C - Chocolate H - Hangovers O - Orgasms C - Cheese/ caffeine O - Oral contraceptive L - Lie ins A - Alcohol T - Travel E - Exercise
What is the diagnostic criteria for Migraines?
=> ABCDE
=> A - At least 5 attacks must fulfil criteria B-D
=> B - Headache attacks must last 4-72 hours
=> C - Headaches show at least 2 of the following characteristics:
- Unilateral location
- Pulsating quality
- Moderate or severe pain
- Aggregated by routine physical exercise
=> D - During headache at least 1 of the following:
- Nausea or vomiting
- Photophobia or Phonophobia
=> E - Not attributed to another disorder
What is the management of Migraines?
=> Acute treatment:
- First line: PO Triptan + NSAIDs or PO Triptan + Paracetamol
- For 12-17 age, consider Nasal Triptan NOT PO
- If above not tolerated:
Non oral Metaclopramide + Prochloperazine OR Non oral NSAID OR Triptan
=> Prophylactic treatment:
- Propranalol or Topiramate
What are the clinical features of Tension Headaches?
- Tight band around head or pressure sensation
- Symptoms bi-lateral
- Lower intensity compared to Migraine
- Not associated with aura, nausea + vomiting or physical activity
- Related to stress
- May co-exist with migraines
=> Chronic tension headache last longer than 15 days
What is the management of Tension Headaches?
Acute treatment => Aspirin, Paracetamol, or NSAID
What are Cluster Headaches?
- Severe unilateral headaches
- Rapid onset
- Occur in clusters lasting several weeks
What group of people are Cluster Headaches common in?
- Men
- Smokers
What are the clinical features of Cluster Headaches?
- Pain once or twice a day
- Episodes last 15 mins - 2 hours
- Clusters last 4-12 weeks
- Intense, sharp stabbing pain around one eye
- Redness, lacrimation and lid swelling
- Nasal stuffiness
What is the management of Cluster Headaches?
=> Acute treatment:
- Oxygen 100% for 15 mins via non-rebreathe mask
- Sumatriptan at onset
=> Prevention:
- Avoid triggers
- Consider corticosteroids, Verapamil, Lithium short term use only
What is the biggest trigger of Cluster Headaches?
Alcohol
