L19 - headaches Flashcards
acute pain in headaches (seconds to minutes)
SAH/Intra-cerebral haemorrhage/coital/thunderclap
evolving pain in headaches (hours to days)
infection/inflammatory/ increased ICP
chronic pain in headaches (weeks to months)
increased ICP
episodic headaches (at least a few days between each attack)
migraine / cluster headache ‘ trigeminal neuralgia
chronic headaches (most days)
medication overuse / chronic migrine
associated features of headaches
- Nausea and vomiting
- Photophobia/ phonophobia
- Autonomic features (lacrimation/Horner’s/red eye)
red flags for headaches
- Cognitive effects
- seizures
- fever
- visual disturbance
- vomiting
- weight loss
how to check for red flags
SNOOP4
SNOOP4
- Systemic symptoms/signs
- Neurologic symptoms/signs
- Onset sudden
- Older onset
- Pattern change
S in SNOOP4
Systemic symptoms/signs
- fever
- rash
- chills / sweats
- weight loss
- myalgia
myalgia
muscle pain
N in SNOOP4
Neurologic symptoms/signs - weakness - change in level of consciousness - diplopia tinnitus - ataxia - seizure / collapse
O1 in SNOOP4
Onset sudden
- thunderclap headache
thunderclap headache
pain reaches maximal intensity instantly after onset
O2 in SNOOP4
Older onset
- after 50 years of age
P in SNOOP4
Pattern change
- progressive heacache
questions to ask
- pattern of pain (onset and periodicity)
- associated features
- SNOOP4
- behaviour of the headache
- family history
- medication
analgesia
medication which acts to relieve pain
what type of headache is it when the patient wants to lie down in a dark room
migraine
what type of headache is it when the person is agitated / pacing
cluster
cluster headache
- occurs in cluster patterns
- commonly awakens you in the middle of the night
- intense pain in or around one eye on one side of your head.
causes of raised ICP
- Mass Effect (brain tumour, abscess)
- Brain swelling (Hypertensive encephalopathy)
- Increased venous pressure
- CSF outflow obstruction (hydrocephalus)
- Increased CSF production (meningitis/SAH)
causes of papilloedema
raised ICP
symptoms of raised ICP
headache (worse on lying or awakening)
vomiting
seizures
acute management for patients with raised ICP
- Resuscitation
- Broad spectrum IV antibiotics
- neurological consultation
- steroids in patients with strep. pneumoniae meningitis
- neurosurgical consultation
temporal arteritis
large vessel vasculitis affecting external and internal carotid artery
signs and symptoms of temporal arteritis
- weight loos
- myalgia
- transient loss of vision
- jaw claudication
- tender non-pulsatile temporal artery
ESR - erythrocyte sedimentation rate
measures how quickly cells in the blood sink
increased ESR
related to inflammatory conditions
management of temporal arteritis
- high dose steroids (prednisolone 60mg for 1 week)
- temporal biopsy
aura
often occurs before a migraine or seizure
- may consist of flashing lights, a gleam of light, blurred vision, an odour, the feeling of a breeze, numbness, weakness, or difficulty in speaking
occurrence of migraines
10% population
F>M
why are females more likely to get migraines than males
oestrogen
symptoms of migraines
- unilateral headache
- nausea
- photophobia
- dizziness
triggers for migraines
- sleep deprivation
- hunger
- stress
- oestrogens
subtypes of migraines
basilar
hemiplegic
Acephalgic
basilar migraines
Cranial neuropathies/cerebellar signs (with aura or without aura)
hemiplegic migraines
<0.15
weakness on one side of body
Acephalgic migraines
aura but no headache
CGRP
calcitonin gene related peptide
- released during migraine attack
management of migraines
brain imagine
conservative measures to manage migraines
- Avoid caffeine/ increase water intake
- Avoid tyramine foods (cheese/chocolate/red wine)
- Sleep hygiene and regular meals
analgesia for migraines
triptans / naproxen / NSAIDS
preventative treatment for migraines
antihypertensives antidepressants anti-epileptic medications nerve blocks botox
who is more likely to get cluster headaches
men
types of cluster headache
- Cluster (attacks last 30-180 minutes; 1-8 per 24hrs)
- Paroxysmal hemicrania (2-30)
- SUNCT/SUNHA – short unilateral Neuralgiform Headache with Conjunctival injection and tears
pain releief for cluster headache
sumatriptan
high flow oxygen
vagal nerve stimulation
prevention for cluster headache
- prednisolone
- GON bocks
- verapamil
- indomethacin
tension headche
- bilateral
- described as a tight band around head
- unrelieved by paracetamol
