Headaches Flashcards
headache differentials
Tension headaches Migraines Cluster headaches Secondary headaches Sinusitis Giant cell arteritis Glaucoma Intracranial haemorrhage Subarachnoid haemorrhage Analgesic headache Hormonal headache Cervical spondylosis Trigeminal neuralgia Raised intracranial pressure (brain tumours) Meningitis Encephalitis
red flag for headaches
raised IOP
Fever, photophobia or neck stiffness (meningitis or encephalitis)
New neurological symptoms (haemorrhage, malignancy or stroke)
Dizziness (stroke)
Visual disturbance (temporal arteritis or glaucoma)
Sudden onset occipital headache (subarachnoid haemorrhage)
Worse on coughing or straining (raised intracranial pressure)
Postural, worse on standing, lying or bending over (raised intracranial pressure)
Severe enough to wake the patient from sleep
Vomiting (raised intracranial pressure or carbon monoxide poisoning)
History of trauma (intracranial haemorrhage)
Pregnancy (pre-eclampsia)
fundoscopy- papilloedema
tension headahe
common, mild ache along the forehad. band like pattern.
muscle ache- frontalis, temporalis, occipitalis muscle
Associations
Stress, Depression, Alcohol, Skipping meals, Dehydration
Treatment Reassurance Basic analgesia Relaxation techniques Hot towels to local area
secondary headaches:
a similar presentation of tension but has a clear cause.
Underlying medical conditions such as trauma vascular infection non vascular intracranial metabolic / toixc infection obstructive sleep apnoea pre-eclampsia Alcohol Head injury Carbon monoxide poisoning
sinusitis
inflammation of the ethmoidal, maxillary, frontal or sphenoid sinuses. facial pain behind the nose, forehead and eyes. tenderness.
resolves 2-3 weeks
most are viral
tx: nasal irrigation
steroid nasal spray
analgesic headache
long term analgesia use
similar to tension headache
withdrawl is important in treating the headache
hormonal headache
related to oestrogen (low)
Two days before and first three days of the menstrual period
Around the menopause
Pregnancy. It is worse in the first few weeks and improves in the last 6 months. Headaches in the second half of pregnancy should prompt investigation for pre-eclampsia.
COCP can improve
cerivcal spondylosis
egenerative changes in the cervical spine. It causes neck pain, usually made worse by movement. However, if often presents with headache.
rule out malignancy, inflammation, infection, spinal cod or nerve root lesions.
trigeminal neuralgia
Ophthalmic (V1)
Maxillary (V2)
Mandibular (V3)
*associated with MS
facial pain, spontaneous (seconds-hours) electricity like shooting pain.
cold weather, spicy food, caffeine, citrus fruits.
tx: carbamezepine (first line for trigeminal neuralgia)
surgically to decompress or intentionally damage the trigeminal nerve.
SAH
“thunder clap headache”
sudden onset severe headache with maximum intensity in less than 5 mins
durationon of at least 1 hour
associated features
- nausea
- vomiting
- neck stiffness
- LOC
- focal features
meningitis
fever/headache/neck stiffnes viral causes enterovirus- faecal oral herpes infleuzna mumps
cerebral venous thrombosis
progressively more bengin
most have headache with focal features
papilloedema with field defect
cough, exertional and sexual headaches
benign cough headache: severe, sudden and short. old men 55 years old
benign exertional headache
<40 years old
non-explosive throbbing, 5 mins to 24 hours
benign sexual headache
bilateral, 30 min
3 types- dull, explosive, postural
RCVS reversible vasoconstriction sydnrome
recurrent thunderclap headaches
vasoconstriction on cerebral angiography
usually improves without specific treatment
chiari malformation
Usually asymptomatic
Occasionally cough or postural headache
No correlation between symptoms and scan appearances
Responds to indomethacin
