Headaches CA Flashcards
Examples of primary headaches
- Migraine
- Tension-type
- Cluster headache
Note: primary headaches constitute 90% of diagnosed headaches
Examples of secondary headaches (caused by an underlying condition)
- Meningitis
- Fasting
- hypoglycemia, cause metabolic changes - Nose/Sinus
- Inflammation or infection, increased pressure in the nasal cavities, pain - Non-vascular intracranial disease including tumours
- abscesses or structural abnormalities increase ICP or compress surrounding structures - Others
- caused by trauma (like a concussion), infections, or drug use
What is the mechanism of a migraine?
Neurally induced dilatation and inflammation of intracranial and extracranial vessels
What is the mechanism of a tension-type headache?
Unknown
May be increased sensitivity of pain-mediating systems in brain
What is the mechanism of cluster headaches?
Neurally induced inflammation and edema of internal carotid artery
What is the mechanism of a headache caused by an Intracranial Mass Lesion? (e.g. brain tumor, hydrocephalus)
Displacement (traction) of pain-sensitive vessels
“Mass causes pressure → Stretches vessels → Pain signals fire” = Headache from mass lesion.
What is the mechanism of a headache caused by Low Intracranial Pressure state?(e.g. post LP)
Traction through brain sagging on dural attachments ;intracranial vasodilatation
“Brain sag → Stretches dura → Causes pain and vessel dilation” = Low ICP headache.
What is the mechanism of a headache caused by Meningitis/Subarachnoid haemorrhage?
Inflammation of vessels in meninges and of perivascular dura
“Inflamed meninges → Irritated vessels and dura → Pain signals” = Headache from meningitis/SAH.
What is the mechanism of a headache caused by temporal arteritis and intracranial vasculitis?
Inflammation of scalp and intracranial vessels
“Vessels inflamed, blood flow restricted → Pain-sensitive → Headache” = Headache from temporal arteritis or vasculitis.
Investigations to be ordered for headaches
- Blood test
- FBC
- ESR
- CRP
- Biochemistry profile
- Hormonal profile - Imaging
- SXR (Skull X-ray)
- C-spine X-ray
- X-ray of sinuses/para-nasal sinuses
- CT head, base of skull or sinuses
- MRI brain - Lumbar puncture
- Exclusion of SAH
- Diagnosis of CNS infection
- Confirmation of raised ICP in BIH (manometer used to measure the opening pressure of CSF) - Biopsy
- Temporal artery (test for temporal arteritis)
- Meningeal (test for meningitis)
Common triggers for migraine
- Hormonal
- menstruation
- oral contraceptives
- anything hormone related - Dietary
- alcohol
- nitrite laden meat
- MSG
- aspartame
- chocolate
- aged cheese
- missing a mea - Psychological
- stress
- post-stress (weekend or vacation)
- anxiety
- worry/depression - Physical environment
- glare
- flashing lights
- visual stimulation
- fluorescent lighting
- odours
- weather changes
- high altitude - Sleep related
- lack of /excessive sleep
- excessive - Drugs
- nitroglycerine
- histamine
- reserpine
- hydralazine
- ranitidine
- estrogen - Others
- head trauma
- physical exertion
- fatigue
Treatment for migraine
Abortive and symptomatic treatment
1. NSAIDS
e.g. naproxen
- Mixed barbiturate analgesic
e.g. aspirin, acetaminophen, codeine-containing compound - Triptans
e.g. sumatriptan, aolmitriptan, eletriptan - Anti-emetics
e.g. promethazine, procholorperazine, metoclopramide
What is migraine prophylaxis?
refers to preventive treatment aimed at reducing the frequency, severity, and duration of migraine attacks
When to start prophylaxis?
- 2 or more attacks each month with significant disability that lasts 3 or more days
- Contraindication to or ineffectiveness of symptomatic medications
- Use of abortive medications more than twice a week
- Migraine variants such as hemiplegic migraine or rare attacks that suggest risk of permanent neuro injury
Nursing care for headaches
- comfort measures
- patient education
- type of headache
- headache diary
- identify triggers of migraine headache
- lifestyle modification
- stress reduction and relaxation
- medication
