Headaches Flashcards
What are the two types of headaches?
Primary (common, chronic/ recurrent)
Secondary (acute, from specific underlying cause)
What are the primary headaches? (3)
- Migraine
- Tension-type
- Cluster
What are some secondary headaches? (4)
- SAH
- GCA
- Meningitis
- Medication overuse
What is the most common type of primary headache?
Tension-type headache
What is the least common type of primary headache?
Cluster headache
What are the clinical features of tension-type headaches? (3)
- Bilateral
- Tightening/ pressing, band-like
- Not aggravated by routine physical activity
How long do tension-type headaches usually last?
From 30min - 1 week
What symptoms wouldn’t you see in tension-type headaches? (2)
No nausea + vomiting
Both photophobia + phonophobia
How would you treat tension-type headaches? (3)
- Conservative: reassurance, stress relief, avoid causes
- Acutely: NSAIDs or aspirin
- Chronic pain: amitriptyline (tricyclic antidepressants)
What are the triggers of tension-type headaches? (7)
MC SCOLD Missed meals Conflict Stress Clenched jaw Overexertion Lack of sleep Depression
What are the clinical features of a migraine? (7)
- Unilateral
- Pulsating/ throbbing pain
- Aggravated by movement
- N&V
- Photophobia
- Phonophobia
- Aura
How long do migraines usually last?
From 4 - 72 hours
How would you treat migraines conservatively?
Avoid triggers
How would you treat acute attacks (mild + severe) in a migraine?
Mild - NSAIDs +/- antiemetics
Severe - oral triptan (sumatriptan- SSRI)
What 1st line prophylaxis would you give for migraines?
Propranolol (beta-blocker) or topiramate (anti-convulsant)
What 2nd line prophylaxis would you give for migraines?
Acupuncture
What 3rd line prophylaxis would you give for migraines?
Amitriptyline (tricyclic antidepressant)
What are the triggers for migraines? (9)
CHOCOLATE Chocolate Hangovers Orgasms Cheese OCP Lie-ins Alcohol Tumult (loud noises) Exercise
What are the clinical features of cluster headaches? (4)
- Unilateral
- Excruciating, burning/ hot poker pain behind one eye
- Occurs at same time every day
- Nothing provides comfort (restlessness, agitation)
What autonomic symptoms are cluster headaches associated with? (3)
- Ipsilateral eye lacrimation & redness
- Rhinorrhoea (runny nose)
- Miosis and/ or ptosis
How would you give acute relief to a pt with a cluster headache? (3)
- 100% oxygen therapy
- SC sumatriptan (SSRI)
- IN zolmitriptan
What prophylaxis would you give to a pt with cluster headaches? (4)
- Verapamil (CCB)
- Lithium
- Corticosteroids
- Valproic acid
What are the triggers for cluster headaches?
Have been associated with cigarettes and alcohol
What is trigeminal neuralgia?
Facial pain
What is the cause of trigeminal neuralgia?
Pain disorder due to compression of trigeminal nerve eg by intracranial vessels
What are the clinical features of trigeminal neuralgia?
- Unilateral
- Electric shock/ lightning-like pain in V1/2/3
What clinical feature wouldn’t you expect to see in a pt with trigeminal neuralgia?
Neurological deficit (neuro exam should be NORMAL)
How long does the pain last in trigeminal neuralgia?
Lasts a few seconds
What are the triggers for trigeminal neuralgia? (5)
Any irritating activity
- Chewing
- Brushing teeth
- Smiling
- Talking
- Washing affected area
What is the first-line treatment for trigeminal neuralgia?
Carbamazepine (anti-convulsant)
What is the second-line treatment for trigeminal neuralgia? (2)
Phenytoin
Gabapentin
(analgesics targeted for neuropathic pain)
What are the surgical interventions for trigeminal neuralgia? (2)
- Microvascular decompression
- Stereotactic radiotherapy
What type of headache is giant cell arteritis (GCA)?
Secondary headache
What is the cause of GCA?
Inflammatory disorder of blood vessels
What are the clinical features of GCA? (4)
- Unilateral headache
- Scalp tenderness
- Jaw claudication (cramping pain)
- Amaurosis fugax (loss of vision)
What are the extracranial symptoms od GCA? (4)
- Fever
- Malaise
- Weight loss
- Depression
What are the signs of GCA? (3)
Palpable, tender and reduced pulsation of the temporal arteries
How would you investigate GCA? (2)
- Temporal artery biopsy (gold standard
- Bloods: raised ESR + CRP
How would you treat GCA? (3)
- Prednisolone 60mg/d immediately
- Low dose aspirin 75mg
- PPI eg omeprazole
What are the risk factors for GCA?
Age (almost never occurs before age 50)
Pt < 55y presents with GCA-like symptoms. What diagnosis should you consider?
Takayasu’s arteritis
