Headaches - Clinical Case Flashcards
What are the most common primary headaches?
- Migraine
- Tension-type headache
- Cluster headache
What important questions / information should you ask / obtain to help you diagnose the type of headaches a patient has?
SOCRATES:
* Site of pain
* Unilateral / Bilateral
* Onset
* When / What are you doing / Sudden
* Character
* Blunt / Sharp
* Radiation
* Associated symptoms
* Photophobia
* Phonophobia
* Anosmia
* Sweating
* Fever
* Time (how long it lasts)
* Exacerbating / Relieving symptoms
* Scale of pain
A 15-year-old boy attends clinic accompanied by his mum. He has a 2-month history of headaches that he describes as “banging” and that make his head “very very sore”. He says that in the past 2 months he has had 6 of these headaches and they last 2-4 hours. He also says that light hurts his eyes, but he does not feel nauseous or vomit when he has the headache.
His Mum says that when he has one of the headache he is unable to go to school. She gives him paracetamol and if that doesn’t work she also gives him ibuprofen. He says that these seem to work but that it still hurts a lot until the headache eventually goes completely.
What type of headaches do you think are in each case?
Migraine without aura
A 15-year-old boy attends clinic accompanied by his mum. He has a 2-month history of headaches that he describes as “banging” and that make his head “very very sore”. He says that in the past 2 months he has had 6 of these headaches and they last 2-4 hours. He also says that light hurts his eyes, but he does not feel nauseous or vomit when he has the headache.
His Mum says that when he has one of the headache he is unable to go to school. She gives him paracetamol and if that doesn’t work she also gives him ibuprofen. He says that these seem to work but that it still hurts a lot until the headache eventually goes completely.
What treatments might you suggest?
- Nasal sumatriptan (serotonin receptor / 5HT1 agonsist)
A 32-year-old man has a history of severe headaches, the most pain he has ever felt, he says. When he gets one of these headaches, the pain is around his eye and along the side of his face, on one side. He also says that he has drooping or swelling of the eyelid, watery eye and nasal congestion, on the same side as the headache.
His first one of these headaches was 2 weeks ago, he went to A&E and had a CT scan; the results were normal.
He has suffered 6 more of these headaches since the first one two weeks ago and mentions that each one last around 15 to 90 minutes.
What type of headaches do you think are in each case?
Cluster headache
A 32-year-old man has a history of severe headaches, the most pain he has ever felt, he says. When he gets one of these headaches, the pain is around his eye and along the side of his face, on one side. He also says that he has drooping or swelling of the eyelid, watery eye and nasal congestion, on the same side as the headache.
His first one of these headaches was 2 weeks ago, he went to A&E and had a CT scan; the results were normal.
He has suffered 6 more of these headaches since the first one two weeks ago and mentions that each one last around 15 to 90 minutes.
What treatments might you suggest?
- Nasal sumatriptan (serotonin receptor / 5HT1 agonsist) and ampulatory oxygen
- Verapamil (calcium-channel blocker) for prophylaxis
NICE says to NOT not offer paracetamol, NSAIDS, oral triptans, ergots or opioids as there is no evidence to suggest that they would have any clinical benefit in the treatment of cluster headache
