Lecture 5.2: Headaches Flashcards
Examples of Primary Headaches
- Migraine
- Tension Headaches
- Cluster Headaches
Reasons for Secondary Headaches
- Head Trauma
- Medication Overuse
- Cancer
- Infection
- Vascular
Mechanisms of Headaches (6)
- Skeletal Muscle Tension
- Arterial Dilatation
- Traction on Arteries
- Traction or Dilatation on Venous Sinuses
- Inflammation
- Referred Pain
Stages of Migraines (4)
- Prodromal Fatigue (vague change in mood/appetite)
- Aura Phase
- Headache Phase
- Resolution
Acute Management of Migraines (3)
- Analgesia
- Triptans
- Antiemetic
Chronic Management of Migraines (3)
- Precipitant Avoidance
- Beta Blockers/Topiramate
- Acupuncture
Precipitating Factors of Migraines (6)
- Foods
- Alcohol
- Emotion
- Menses
- Bright Light
- COCP
How common are Tension Headache?
Most common type of headache in primary care
Characteristics of Tension Headaches (6)
- Bilateral Pressure
- Rarely Systemic Upset
- No Aura
- Gets worse during the day
- Lasts 30mins to 7days
- Ranges from infrequent attacks to daily pain
Management of Tension Headaches: Lifestyle (6)
- Stress
- Alcohol
- Exercise
- Mood
- Medication Abuse
- Reassurance
Management of Tension Headaches: Medications (3)
- OTC medicine – paracetamol, ibuprofen
- NB – avoid codeine based products
- Low dose amitriptyline >2days/week
Characteristics of Migraine Headaches (4)
- Unilateral
- Pulsatile
- Aura
- Triggers
Characteristics of Cluster Headaches (6)
- Bouts of severe orbital pain lasting from 15mins to
3hrs - a/w conjunctival injection, lacrimation and nasal
blockage - Occasionally ptosis and Horner’s syndrome
- Makes patient restless (unlike migraine)
- Occur frequently (daily for several weeks)
Acute Management of Cluster Headaches (2)
- Oxygen
- Triptan
Prophylaxis of Cluster Headaches (3)
- Specialist Advice
- Verapamil / Li
- Avoidance of Triggers (alcohol, nicotine)
Causes of Secondary Headaches (10)
- Temporal Arteritis
- Trigeminal Neuralgia
- Subarachnoid Haemorrhage
- Medication Overuse Headache
- Raised Intracranial Pressure
- Tumour
- Idiopathic Intracranial Hypertension (benign
intracranial hypertension) - Sinusitis
- Toothache
- Meningitis
Red Flags for Headaches (12)
- Worsening headache with fever
- Sudden-onset headache reaching maximum intensity
within 5 minutes - 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) or sneeze - Headache triggered by exercise
- Orthostatic headache (headache that changes with
posture) - Symptoms suggestive of giant cell arteritis
- Symptoms and signs of acute narrow-angle glaucoma
What is Chronic Pain? (2)
- Pain which persists beyond the natural healing time * Usually >3months
Chronic Pain a Vicious Cycle (6)
- Acute Pain
- Immobility
- Increasing BMI
- Further Pain
- Increased Immobility/BMI
- Further Injury
What does Inflammation Alter? (4)
- Ion channels on Neurones
- Sensitivity of Neurones/Receptors
- Decreases the threshold for firing
- Alters the trigger for firing
Central Effect of Chronic Pain (4)
- Spontaneous Firing from Dorsal Horn
- Altered Descending Inhibition
- Personality/Perception
- Psychology
Complex Region Pain Syndrome (CRPS)
- COMPLEX: Varied and dynamic clinical presentation
- REGIONAL: Non-dermatomal distribution of symptoms
- PAIN: Out of proportion to the precipitating events
- SYNDROME: Constellation of signs and symptoms
What is Complex Region Pain Syndrome (CRPS)?
A broad term describing excess and prolonged pain and inflammation that follows an injury to an arm or leg
Complex Region Pain Syndrome: Type 1
No identifiable lesion (5-10%)
Complex Region Pain Syndrome: Type 2
- After nerve injury (causalgia)
- Linked to the sympathetic nervous system
- Triggered by variety of stimuli
- Minor trauma, bone fracture, surgery, stroke,
myocardial infarcts
Presentation of Complex Region Pain Syndrome (7)
- Triad of Symptoms: Autonomic, Sensory, Motor
- Pain (spontaneous, hyperalgesia, allodynia)
- Distal Oedema
- Skin Temperature Changes
- Skin Colour Changes
- Altered Sweating
- Bone Changes (peri-articular osteoporosis, joint
stiffness)
Motor Symptoms of CRPS (4)
- Weakness
- Tremor
- Dystonia
- Myoclonus
Mechanism of CRPS (3 Hypothesis)
- Neurogenic inflammation
- Autonomic dysfunction
- Neuroplastic changes in CNS
Management of Complex Regional Pain Syndrome (7)
- Steroids
- Analgesia
- Neuropathic Meds
- Physiotherapy
- Occupation Therapy
- Psychotherapy – CBT
- Sympathetic Nerve Blocks
