headaches pbl Flashcards
how are headaches classified
primary vs secondary
what are primary headaches
headaches without anatomical or physiological explanation
involved neurovascular system of the brain
give examples of primaryh headaches
migraine (with or without aura)
cluster headache
tension headache
what are secondary headaches and give examples
headaches caused by another disease
vascular disorders - TIA, stroke, chronic subdural hematoma, gas, primary CNS angiitis, cerebral venous thrombosis
infectious headache - meningitis, sphenoid sinusitis , brain abscess, chronic meningitis (hiv, lyme disease, neurosyphilis),
post-traumatic headache
metabolic disorders - sleep apnea, hypothyroidism
deranged ICP or volume - idiopathic intracranial HTN, spontaneous low csf pressure,
intra cranial neoplasm
what are causes of acute single episodes of headache
meningitis
encephalitis
subarachnoid haemorrhage
head injury
sinusitis
glaucoma (acute closed-angle)
tropical illness e.g. Malaria
what are the causes of chronic headache
chronically raised ICP
Paget’s disease
psychological
what does the term trigeminal autonomic cephalgia refer to
number of conditions including cluster headache, paroxysmal hemicrania and short-lived unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT)
It is recommended such patients are referred for specialist assessment as specific treatment may be required
what are the features of migraine
Recurrent, severe headache which is usually unilateral and throbbing in nature
May be associated with aura, nausea and photosensitivity
Aggravated by, or causes avoidance of, routine activities of daily living. Patients often describe ‘going to bed’.
In women may be associated with menstruation
what are the features of tension headache
Recurrent, non-disabling, bilateral headache, often described as a ‘tight-band’
Not aggravated by routine activities of daily living
what are the features of cluster headache
Pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours with clusters typically lasting 4-12 weeks
Intense pain around one eye (recurrent attacks ‘always’ affect same side)
Patient is restless during an attack
Accompanied by redness, lacrimation, lid swelling
More common in men and smokers
what are the features of temporal arteritis
Typically patients> 60 years old
Usually rapid onset (e.g. < 1 month) of unilateral headache
Jaw claudication (65%)
Tender, palpable temporal artery
Raised ESR
what are the features of medication overuse headache
Present for 15 days or more per month
Developed or worsened whilst taking regular symptomatic medication
Patients using opioids and triptans are at most risk
May be psychiatric co-morbidity
what are the red flags for headache
compromised immunity, caused, for example, by HIV or immunosuppressive drugs
age under 20 years and a history of malignancy
a history of malignancy known to metastasis to the brain
vomiting without other obvious cause
worsening headache with fever
sudden-onset headache reaching maximum intensity within 5 minutes - ‘thunderclap’
new-onset neurological deficit
new-onset cognitive dysfunction
change in personality
impaired level of consciousness
recent (typically within the past 3 months) head trauma
headache triggered by cough, valsalva (trying to breathe out with nose and mouth blocked), sneeze or exercise
orthostatic headache (headache that changes with posture)
symptoms suggestive of giant cell arteritis or acute narrow-angle glaucoma
a substantial change in the characteristics of their headache
what are the common triggers of migraines
tiredness, stress
alcohol
combined oral contraceptive pill
lack of food or dehydration
cheese, chocolate, red wines, citrus fruits
menstruation
bright lights
what is the migraine diagnostic criteria
A At least 5 attacks fulfilling criteria B-D
B Headache attacks lasting 4-72 hours* (untreated or unsuccessfully treated)
C Headache has at least two of the following characteristics:
1. unilateral location*
2. pulsating quality (i.e., varying with the heartbeat)
3. moderate or severe pain intensity
4. aggravation by or causing avoidance of routine physical activity (e.g., walking or climbing stairs)
D During headache at least one of the following:
1. nausea and/or vomiting*
2. photophobia and phonophobia
E Not attributed to another disorder (history and examination do not suggest a secondary headache disorder or, if they do, it is ruled out by appropriate investigations or headache attacks do not occur for the first time in close temporal relation to the other disorder)
