Introduction to headaches disorders and facial pain Flashcards
What is a sinister headache?
A headache that may indicate serious underlying conditions, affecting 0.18% of stable migraine patients and 13-18% of A+E headache patients
Sinister headaches may suggest conditions like tumors or meningitis.
What characterizes tension-type headache?
Most frequent primary headache; mild, bilateral, pressing or tightening quality; not aggravated by routine physical activity
mild headache
Lifetime prevalence is 42% in men and 49% in women.
What is the treatment for tension-type headache?
NSAIDs or paracetamol; tricyclic antidepressants for prevention
Tension-type headaches rarely present to doctors.
What percentage of people in the UK suffer from migraine?
10% in men and 22% in women
Migraine is the most frequent disabling primary headache.
What are common premonitory symptoms of migraine?
Mood changes, fatigue, cognitive changes, muscle pain, food cravings
These symptoms occur before the headache phase.
What is cortical spreading depression in migraine?
A pathophysiological process associated with transient neurological symptoms
a type of aura
Symptoms may involve visual, sensory, motor, or speech systems. - gadual
What triggers migraine attacks?
Dehydration, diet, stress, sleep disturbances, hormonal changes
Lifestyle factors can precipitate migraine in predisposed individuals.
What is chronic migraine defined as?
Headache on ≥ 15 days per month, with ≥ 8 days being migraine for more than 3 months
conbination of tension headache an dmigraine
Transformation of episodic migraine into chronic can occur.
What is medication overuse headache?
Headache present on ≥ 15 days/month that worsens while taking regular symptomatic medication
Migraines can lead to chronic headaches if pain medications are overused.
What are the symptoms of new daily persistent headache (NDPH)?
Daily headache from the onset, patients often recall the exact day of onset
Must last for >3 months and exclude secondary causes for diagnosis.
What is hemicrania continua?
Strictly unilateral continuous headache that responds to indometacin
Characterized by waxing and waning intensity.
What defines trigeminal autonomic cephalalgias?
Unilateral head pain with severe cranial autonomic symptoms
Includes conditions like cluster headache and paroxysmal hemicrania.
What is the typical presentation of cluster headache?
Rapid onset, excruciatingly severe unilateral pain, lasting 15 mins to 3 hours
mainly orbital and temporal
pt often pacing due to pain
migraine symptoms often present: tireness, yawning, nausea, vomiting, phonophobia, photophoba
Patients are often restless and agitated during an attack.
What is the treatment for cluster headache?
Abortive: subcutaneous sumatriptan, 100% oxygen; Preventative: verapamil, lithium
Treatment varies based on attack frequency and severity.
What characterizes atypical facial pain?
Poorly localized continuous pain, typically involving the eye, nose, cheek, or jaw
It is often associated with depression and has no identifiable triggers.
What is burning mouth syndrome?
An intraoral burning sensation recurring daily for more than 2 hours over >3 months
Commonly affects the tongue and can be associated with deficiencies or conditions like Sjögren’s syndrome.
True or False: All sinus headaches are caused by rhinosinusitis.
False
Most patients diagnosed with sinus headaches actually have migraines.
What features predict a sinister headache?
Associated head trauma, sudden onset, new daily persistent headache, change in headache pattern
These features warrant further investigation.
What is the definition of thunderclap headache?
A high-intensity headache reaching maximum intensity in less than 1 minute
It can be primary or secondary and may indicate serious conditions.
What is a thunderclap headache?
A high intensity headache reaching maximum intensity in less than 1 minute
Majority peak instantaneously and may be primary or secondary. No reliable differentiating features exist.
What are the serious features that predict a sinister headache?
- Associated head trauma
- First or worst headache
- Sudden (thunderclap) onset
- New daily persistent headache
- Change in headache pattern or type
- Returning patient
What is the mortality rate associated with aneurysmal subarachnoid hemorrhage (SAH)?
50%
20% of survivors remain dependent.
What is the risk of re-bleed in the first month after subarachnoid hemorrhage?
40%
Risk of re-bleed is 4-6% in the first 24-48 hours.
Who should be assessed for SAH?
All patients presenting with a sudden severe headache that peaks within a few minutes and lasts for at least 1 hour
Examination is often normal.
When should a CT brain scan be performed for suspected SAH?
Same day hospital assessment
CT brain is 3% negative at 12 hours and 7% negative at 24 hours.
What are the symptoms of meningo-encephalitis?
- Headache (thunderclap or gradual onset)
- Fever
- Nausea +/- vomiting
- Photo/phono phobia
- Stiff neck
- Altered mental state/consciousness
- Focal symptoms/signs
- Seizures
What are warning features of a space-occupying lesion and/or raised intracranial pressure?
- Headache worse in the morning or wakes patient from sleep
- Headache worse lying flat or brought on by Valsalva
- Focal symptoms or signs
- Personality change
- Drowsiness
- Seizures
- Visual obscurations and pulsatile tinnitus
What is giant cell arteritis?
Arteritis of large arteries, on a spectrum with polymyalgia rheumatica
Should be considered in any patient over the age of 50 years presenting with new headache.
What are specific features of giant cell arteritis?
- Scalp tenderness
- Jaw claudication
- Visual disturbance
- Prominent, beaded or enlarged temporal arteries
What should be started if giant cell arteritis is considered likely?
High dose prednisolone
A temporal artery biopsy should also be arranged.
What percentage of patients with thunderclap headache will have a subarachnoid hemorrhage?
1 in 10
This indicates a significant risk factor for serious intracranial pathology.
True or False: Serious intracranial pathology is very likely in longstanding episodic headache.
False
Serious intracranial pathology is very unlikely in longstanding episodic headache.
What are the differential diagnoses for thunderclap headache?
- Primary (migraine, primary thunderclap headache, etc)
- Subarachnoid hemorrhage
- Intracerebral hemorrhage
- TIA / stroke
- Carotid / vertebral dissection
- Cerebral venous sinus thrombosis
- Meningitis / encephalitis
- Pituitary apoplexy
- Spontaneous intracranial hypotension
Fill in the blank: CNS infection should be considered in any patient presenting with headache and _______.
[fever]
What are the features suggestive of raised intracranial pressure?
- Progressive headache with associated symptoms and signs
- Headache is a common first presenting feature, but other symptoms and signs are usually present
Primary headache?
No underlying medical cuasue
secondary headache?
Has an identifiable structural or biochemical cause
causes of secondary headaches?
Tumour
Meningitis
SAH
Systemic infection
Head injury
Sinusitis
Drug-induced
Types of primary earache?
Tension type headache
Migraine
Cluster headache
how long does an aura last?
15-60 minutes
tx for migraine?
lifestyle
- diet, sleep, regular exercise, trigger avoidance
acute tx
- aspirin or NSAIDs, triptans, limit to 10 days
prophylactic tx
- propanolol, anti-epilectics
primary and secondary causes of new daily persistent headache?
SUNCT/SUNA?
unilateral orbital, eupraorbital or temporal pian
stabbing or pulsating paid
can be triggered by: wind, cold, chewing, touch
thought of as a primary headahe disorder or could be a trigeminal issue in the opthamic division.
Causes of trigeinal neuralgia?
iodopathic (most common) or vascular compression of the trigemminal nerve
uncommon: MS
2nd and third division
get a refractory period
tx for trigeminal neuralgia?
prophylactic: carbamazepine
surgicla intervention: glycerol ganglion injection, steriotactic radiosurgery, decompressive surgery
no abortive tx
SUNCT/SUNA tx?
no abortive tx
prophylaxis: gabapentin, carbamazepine
what is a subarachnoid haemorrhage?
1 in 10 people with a thunderclap haedache will have sah
need to go to a&e
present with fast onset maximumintensity haedache
