Lecture 6: Headache Flashcards
What is a headache?
Pain or discomfort in the hear or face area. They vary greatly in terms of pain location, pain intensity, and how frequently they occur. The brain itself does not feel pain becuause there are no noiceptors located in the brain tisue
What are primary headaches? And what are the types?
Headaches are the primary symptoms.
- Migraine - with or without aura
- Cluster headache: alot of headaches close together, more pain than standard headaches
- Trigeminal autonomic cephalagie: have to be detected by a scan
What are secondary headaches? What are the main types?
Something has caused the heachache
- Tension heachaches
- Trauma/ injury to head or neck
- Cerebral vascular disorders
- Infections of ear/ eyes/ nose/ tooth
- Secondary to facial pain
- Psychiatric disorders - panic attacks/ disorders
- Adverse reactions - rebound headache, nitrates, sildenafil etc
- Dehydration
- Referred pain
What data is needed to diagnose and treat/ refer heaches?
- Who: common condition, rare under 12, migraine more common in woman
-What are the symptoms - Where in head is it affecting you? One side/ both sides?
- When does it happen/ how often?
- Look out for danger symptoms eg thunderclap, recurring, non responsiveness, vomiting, arms/ legs feel weak, pins and needles
- How long? I more than 3 days, recuurimg, become more sevre then refer
- Actions: Have they been taking pain killers? How long? Whats worked in the past? Avoid trigger factors; stress, light
- Medicines: Posibble adverse reaction
What is a migraine without aura?
Headache attacks lasting 4-72 hours. Headache has >2 of the following; unilateral location, pulsating quality, moderate or severe pain intensity, aggravation by or causing avoidance of routine physical activity eg walking, climbing stairs. You also get one or more of the following; nausea or vomitiing or photophobia and phonophobia
What are the triggers for migrains without auras?
- Stress and other emotions
- Biological and environmental conditions, such as hormonal shifts or exposure to light or smells
- Fatique and changes in ones sleep pattern
- Glaring or flickering lights
- Weather changes
- Certain foods and drinks
What are migraines with aura?
Headache >1 of the following fully reversible aura symptom; visual, sensory, speech and or langauge, motor, brainstem, retinal.
Headache >3 of the following 6 characteristics: aura symptom spreads gradually over >5 min, >2 symptoms occur in succession, each individual aura symptom lasts 5-60 mins, >1 aura symptom is unilateral, >1 aura symptom is positive, aura accompanied, or followed in <60 min by headache
If suspected, should be referred
What are cluster headaches?
A series of headaches that may last weeks or months, and the headache sreies may return every year or two. It is severe pain on one side of the head, usually behind one eye. The eye that is affected may be red and watery with a droopy lid and small pupil. Swelling of the eyelid, runny nose or congestion, swelliung of the forehead.
If suspected - refer
What are the treatment options for headaches?
Paracetamol: acts in inhibition of prostaglandin production in pain pathway. Also in activation of descending serotonergic pathways
Ibuprofen: acts on COX1 and COX2 receptors to inhibit production of prostaglandinds in pain pathway
Codeine: acts centrally but has limited effectiveness on its own and works better in combination products
Buclizine: antihistamine with anti-emetic properties, also sedating.
Triptans: selective 5HT ser receptor agonist causes cranial vasocontriction. Rizatriptan has a moderatley/ severe interaction with propanolol, which is used prophylactic for treating patients who get a lot of migraines
Pizitofen: acts on seratonin, histamine and tryptamine, reducing blood flow and alters pain threshold in migraine - POM
Propanolol: Beta blocker reduces blood flow POM
Other: ergotamine POM , Menthol, Oral contraceptives
What aches when you have a secondary headache?
A network of nerves that extends over the scalp.
Certain nerves in the face, mouth and throat.
Muscles of the head, neck and shoulders.
Blood vessels found along the surface and at the base of the brain - these contain delicate nerve fibres
What are tension headaches?
The most common type of headaches. Stress and muscel tension are often factors in tension type heacahes. Common features are: slow onset of the headache, bilateral - head usually hurts on both sides, pain is dull or feels like a band or vice around the head. Pain may involve the back part of the head or neck. Pain is mild to moderate but not severe.
What are the other common secondary headaches?
Trauma to neck or face - whiplash, head knock, watch out for concussion
Infection - infected sinusitis, otitis media, dental abcess, eye infection
Adverse reaction - most medicines list headaches as common side effects - nitrates, sildenafil, oral contraceptives, pain killers
Secondary to facial pain - acute sinusitis, light/ sun, noise, jaw, ear wax
Dehydration - extreme hear, hangover
Psychiatrric causes - panic attacks, extreme anxiety - refer
Neuralgias - refer
What are dangerous causes of headaches?
Blood clots - venous thrombosis eg ischaemic stroke
Thunderclap - rapid onset, severe eg haemorrhagoc stroke or other underlying vascular problem
Brain tumour
What are the treatment options for seconary headaches?
Painkillers - paracteamol, ibuprofen, codeine
Muscle relaxants - diazepam
Antibacterial - treatment dependant on causative organism
Decongestants - pseudoephedrine, xylometazoline
Anxiolytics - POM, watch out for herbals eg St Johns Wort
Amytriptaline (Neuralgesias)
Gabapentin/ pregabalin/ Carbamazapine
What are the non-pharmacological interventios for headaches?
- Drink plenty of water
- Get plenty of rest if you have a cold or flu
- Try to relax - stress makes headaches worse
- Exercise when you can
- For primary headaches avoid trigger factors: alcohol, particularly red wine, certain foods, processed meats that contain nitrates, changes in sleep or lack of sleep, poor posture, skipped meals, light/ noise stimulus
