Headaches Flashcards
Types of primary headache (3)
- Migraine
- Cluster
- Tension
Types of secondary headache
- Meningitis
- Subarachnoid haemorrhage
- Giant cell arteritis
- Idiopathic intracranial HTN
- Medication overuse headache
When to consider further investigation or referral
History (4)
Clinical presentation (7)
Examination (4)
History: 1. >50 2. Hx of HIV, cancer 3. Change of personality or cognitive function 4. Vomiting with no obvious cause Clinical presentation 1. Jaw claudication 2. Severe eye pain - closed angle glaucoma 3. Change in frequency, characteristics, associated symptoms 4. Postural 5. Sudden onset/thunderclap 6. Exercise or valsalva 7. Focal neurological symptoms Examination: 1. Fever 2. Altered consciousness 3. Neck stiffness 4. Other abnormal neurological exam
Immediate referral if (5)
- Thunderclap
- Seizure and new headache
- Suspected encephalitis
- Red eye - glaucoma
- Headache + new focal neurology`
Define migraine
Recurrent severe headaches lasting 4-72h associated with visual or GI disturbance. Typically unilateral.
RF for migraine
- Smoking
- > 35 years old
- Obesity/DM
- HTN
- OCP
Triggers for migraines
Chocolate Hangover Orgasm Cheese/caffeine OCP Lie-in Alcohol Tumult (loud noise), travel Exercise
Signs and symptoms migraine with aura
At least 2 attack fitting:
- At least one reversible aura symptom: visual (dots, melting + zig zag lines), speech (aphasia), sensory (tingling, numbness), motor weakness
- At least 2 characteristics : each aura lasts 5-60min, at least 1 unilateral aura, at least 1 spreads over 5 min, aura followed by headache within 1 hour
Signs and symptoms of migraine without aura
At least 5 attacks
- Lasts 4-72h
- At least 2: pulsatile, moderate - severe pain, unilateral, aggravated by routine physical activity
- Associated with nausea + vomiting, photophobia, phonophobia
Investigations of migraines
- Diagnosis clinical
2. Neuroimaging to rule out mass lesions
Management of migraines
- Avoid triggers
- Propranolol/amitriptyline- reduce frequency
- During attack - oral triptan + NSAID/paracetamol + anti-emetic
Characteristics of a tension headache
Most common type of headache
- Bilateral pressure/tightness
- Mild-moderate intensity
- Lasts 30min-7 days
- Not aggravated by exercise
- No nausea and vomiting, not associated with more than 1 of photophobia and phonophobia
Causes of tension headache - MC SCOLD
Missed meals
Conflict
Stress Clenched jaw Overexertion Lack of sleep Depression
Management of tension headaches
- NSAIDs/paracetamol
2. Tricyclic antidepressants - amitriptyline
Characteristics of cluster headaches (5)
- Rapid onset unilateral severe pain
- Watery, bloodshot eye with lid swelling
- Associated with lacrimation, facial flushing, miosis, rhinorrhoea
- Lasts 15mins - 3h
- 1-2 times a day for months, then months without attacks
