Headaches Flashcards
what are primary headaches?
what are secondary headahces
Primary headaches- 90%- headache is the main issue, episodic and benign
types or primary headahces?
types of less worrying secondary headaches
Immediately more worrying headaches
describe Tension type headache
- Primary
- most commong
- young adults
- stress and depression
- epsiodic (<15 days month) chronic
- Featureless headahce (no other symptoms, normal neuro exam)
- mild- moderate bilateral pain
- tight band squeezing (may also have neck pain)
- duration 30 mins - 7 hours
Describe migraine generally
- affecst 1 in 7
- disabling0 large efect on QoL
- childhood/ young adulthood onset
- more common in females
- not fully understood- though to have triggers
describe the pahses of migraines
- prodrome
- aura (focal neurological symptoms)
- headache
- prodrome
describe clinical presentation of migraine
- Featureful headache
- lasts 4 hours- 3 days
- seevre unilateral- throbbing/pulsating
- patient want to lie ind ark rooma dn go to slee
- for diagnosis need headache +
- nausa/vommiting or Photophobia/phonophobia
what are the 3 main types of migraine
treatment for migraines
simpel analgesia
anti-inflammatories
anti-sickness drugs
triptans
triggers for mirgaine
- lack of sleep/too much
- premenstrual
- chocolate
- cheese
- dehydration
- missed meals
- stress
desrribe cluster headache generall- occurence ?
triggers for cluster headaches
Clinical features of cluster headaches?
- severe, unilateral pain around the eye
- ipsilateral autonomic symptoms (same side as headache,m eye watering, nasal congestion, facial sweating)
- excrutiating sharp pain (not pulsatile)- behind the eye
- alos knowna s suicide headahce
- last 15 mins to 3 hours
- typically occurs at night and wakes the patient
Treatment for cliuster headaches
simple analgesia NOT recommended by nice
oxygen- administered at start of attack can lesses
triptans
preventer therpoay ( verapamil tablkets)
Describe the causes of a Vascular headahce?
subarchnoid haemorrhage- SAH- bleeding increases intracnial pressure- irirtant effect opn brain by the blood
commest cause of non-trauamric SAH- rupture berry aneurysm (tends to grwon in circle or willis (associated with polycystic kidney disease)
- causes
- genetic
- arteriovenous malformation
- trauam
- infections (cuase weakness
- smoking, hypertension, alcohol excess
Clinical presentation of Vascular headache
- Explosive or thundercalp headache
- wrost ever
- peak intensity within 3 seconds
- may have signs of meningism
- jheadache, neck stiffness, photophobia
- nausa vomiting
- high mortality and mobdidiyt
What is Giant cell arteritis (GCA)
symptoms of GCA
- headache- usually oveer the site of arteries affeceted
- scalp tenderness (coimbing hair)
- jaw claudication
- amaurosis fugax ( temporary visual loss)
- generally unwell, stiff joints ( polymylagia rheumatica)- association -n shoudler or pelvic girdle
Treatment of GCA
urgent assessment by rheumatolgoists
visual loss needs same day assessment by opthalmost
once suspected need immeidate high dose oral steriod (prednisolone)
Causes of Raised intracranila pressure
Clinical presentation of Raised intracranial pressure
triad of
headache
vomiting
papilledema (sweleling ot the optic disc on fundoscopy
describe late stage raised intrcranial pressure
Raised BP, wide pulse pressure, bradycardia
cushing triad
caused by compression of the medulla
what is a space occupying lesion
?
what are the mechanism behind which space occupying lesions cause signs and symptoms
what are red flags that indicat a high risk SOL
New headache in a patient with PHO cancer and immunosuppression
Headache and focal neurology
Worsening headache- growing
Headaches associated with seizures
types of intracranial infections? and cause (which is more severe bacterial or viral)
Meningitis
encephaltiis
meningoencephaltiis
bacterial is more severe
what are Meningism a tirad of
headache, stiffness of neck, photphobia.
also
fevr, altered mental state, focal neurology, petechial rash (non blanching)
Causes of Encephaltiis and triad of symtpoms seen
usually viral- HSV
common at extreems of age
presnetation - triad of- hgih fever, headahce, personality chnage (noticed by friend/family)
range from mild to serious
what is Medication overuse headache
obverurse headache medication using medication 10-15 per month for period of 3 months
describe the use of antimigraine therpay
describe acute management of migraine
oral triptan+ NSAID ( most effective)
OR
oral triptan + paracetmol
Or
monotherpay if patient prefers
Consider antiemetic
Descirbe prophylaxis of migraine
if significant impact, treatment resistant or at risk of MOH
topiramate or propranolol
Describe thow Triptains work- give examples
give examples of Anti-emetics used in combination with analgesics for migraine management
contraindictaes for Topiramate (anti-epileptic medication)- used in prophyalxis for migraines?
treatment if the migraine fails to respond to pahramcological prophylaxis?
botulinum toxin Type A (specialist teatment)
