Headaches Flashcards
Why can assessment of headaches be difficult?
Difficulties in quantifying symptoms as well as co-existence of several types in some cases
What are some specific symptoms to consider with headaches?
Aura Autonomic features Systemic/neurological features Contacts with similar symptoms Effect on daily activities Drug History
What is an Aura?
Visual, auditory or gustatory disturbances that preceed/accompany a headache
Why is the effect on daily activities important with headaches?
Some are debilitating, others are not
What are some features suggestive of a new-onset severe headache?
Fever Papilloedema New-onset neurological deficit Change in behaviour Atypical aura Dizziness Visual disturbances Vomiting Recent severe head trauma Current or recent pregnancy
Why is a current/recent pregnancy concerning with a new-onset headache?
Possibly Pre-eclampsia
What features suggest a headache being a Migraine without Aura?
5 attacks of: Headache lasting 4-72h Unilateral, pulsing, moderate/severe pain Aggrevated by exercise N+V Photophobia Phonophobia
What features suggest a headache being a Migraine with Aura?
2 attacks of: Aura 2/more in succession Aura lasts 5-60 mins Aura accompanied by headache
What are some examples of Auras?
Visual symptoms
Sensory symptoms
Speech and language symptoms
Motor weakness
What features suggest a headache being a Tension-Type?
Recurrent episodes lasting from 30mins-7 days not associated with N+V with at least two of:
Bilateral
Pressing/Tightening quality
Mild/moderate intensity
Not aggrevated by routine physical activity
What features suggest a Cluster headache?
At least 5 attacks of unilateral orbital, supraorbital or temporal pain lasting 15-180 minutes
What associated symptoms can there be with Cluster headaches?
Nasal congestion
Facial Sweating
Miosis
How often do Cluster headaches occur while active?
At least every other day
What features suggest a Medication overuse headache?
Headache at least 15 days of the month after regularly overusing medication for more than 3 months to treat a primary headache
Which medications can lead to a medication overuse headache?
Ergotamines
Analgesics
Triptans
Opioids
What is a secondary headache?
A headache due to another pathology/cause
What are some causes of secondary headache?
Trauma/injury to the head/neck Cranial or cervical vascular disorders Non-vascular intracranial disorders Exposure to/withdrawal from a substance Infection Disorders of Homeostasis Disorders of Facial/Cranial structures Psychiatric disorders
What is the recommended management for Cluster headaches?
Sumatriptan Sub-Cut
6mg initially, another 6mg after 1 hour if needed
Maximum of 12mg per day
What is Sumatriptan?
Serotonin (5HT) Agonist
How does Sumatriptan work?
Serotonin agonist leads to blood vessel constriction and inhibition of pro-inflammatory neuropeptide release, reducing pain
What is the recommended management for Medication overuse headaches?
Advise the patient on the cause of the headaches, then withdraw causative medication
Psychological symptoms
What should the patient be told when withdrawing medication to treat a medication overuse headache?
Symptoms will get worse before they get better
What information is useful for patients to collect when suffering from headaches?
Headache diary
What is the recommended management for Tension-Type headaches?
Simple analgesia - Paracetamol + NSAIDs
Which medication should Tension-type headaches not be offered?
Opioids
What should be identified with diagnosed Tension-Type headaches?
Co-morbidities/Casuative factor
What is the recommended management for Migraines?
Simple Analgesia
Sumatriptan - 50-100mg/day
Metacloperamide for N+V
What preventative treatment for Migraines is recommended?
Propanolol
Topiramate
Amitryptylline
