Lecture 6 - headaches Flashcards
what is a headache?
headache is pain or discomfort in the head or face area. headaches vary in the location, pain, intensity and frequency. brain itself does not have nociceptors, so pain is located around brain tissue or face.
what are primary headaches?
migraine - with or without aura
cluster headache
trigeminal autonomic cephalalgia - detected by scan
other primary disorders
what are the wwham QUESTIOSN WE SHOIDL LOOK OUT FOR?
Who - common condition, but rare in u12
what - danger symptoms eg thunderclap, recurring, non-responsive, vomiting, arms/ legs feel weak, pins and needles
how long - >3 days then refer, recurring, more severe
actions - been taking pain killers, what’s worked in the past, non-pharmacological actions
medicines - possible adverse drug reactions
describe primary headaches without aura
headache attacks that last 4-72 hours untreated or unsuccessfully treated.
headache has more than 2 of the following characteristics
1. unilateral location
2. pulsating quality
3. moderate or severe pain intensity
4. aggravation by or causing avoidance of routine physical activity eg waking, climbing stairs
headache has 1 or more of the following:
1. nausea and/or vomiting
2. photophobia and phonophobia
what can triggers of primary headache without aura? x6
stress and other emotions
biological and environmental conditions, such as hormonal shifts, exposure to light or smells
fatigue and changes in ones sleep pattern
glaring or flickering lights
weather changes
certain foods and drinks
describe primary headaches migraine with aura
headache with > 1 of the following fully reversible aura symptoms:
1. visual
2. sensory
3. speech and/or language;
4. motor
5. briasntem
6. retinal
headache with > 3 of the following 6 characteristics
1. aura symptoms reads gradually over >5min
2.>2 symptoms occur in succession
3. each individual aura symptom lasts 5 to 60min
4.>1 aura symptom is unilateral
5.>1 aura symptom is positive
6. aura accompanied, or followed in <60 min by headache
if suspected should be referred
describe cluster headaches
cluster headaches usually occur in a series that may last weeks or months, and the headache series may return every year or two.
severe pain on one side of the head, usually behind Fien eye
the eye that is affected may eb red and watery with a droopy lid and small pupil
runny nose or congestion
swelling of the forehead
if suspected 0 should be referred
what are the treatment options for primary headaches ?
paracetamol - acts in inhibition of prostaglandin production in pain pathway. also in inactivation of descending serotonergic pathways
ibuprofen - act on the COX-1 and COX-2 receptors to inhibit production of prostaglandins 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 serotonin receptor agonists causes cranial vasoconstriction. sumatriptan is P med with restrictions
pizitofen - acts on serotonin, histamine and tryptamine reducing blood flow and alters pain threshold in migraine POM
propanolol - beta blockers, reduces blood flow POM
other - ergotamine POM, menthol, oral contraceptive POM
what aches when you have a headache?
a network f nerves that extends over the scalp.
certain nerves in the face, mouth and throat
muscles of th head, neck, and shoulder s
blood vessels found along the surface and at the base of the brain
what are tension headaches?
type of secondary headache. stress sand muscle tension are common factors in tension headaches. common features are
slow onset of the headcahe
bilateral - head usually hurts on both sides
pain is dull or fells like a band or vice around the head
pain may involve the back (posterior) part of the head or neck
pain is mild moderate
but not severe
what are causes secondary headaches? x8
tension headache.
due to trauma/ injury to neck r head
cerebral calcular disorders
infection in the ete, ear, nose, tooth
secondary to facial pain (sinus/ mouth, eyes - light or sun/ ears - noise)
psychiatric disorders - panic attacks/ disorders
dehydration - hangover
referred pain
what are dangerous causes of secondary headaches?
blood clots - venous thrombosis eg ischaemic stroke
thunderclap - rapid onset, sever eg haemorrhage stroke or underlying vascular problem
Brian tumour
if in doubt, refer
what are treatment options for secondary headaches?
painkillers - paracetamol, ibupofen, codein e
muscle relaxants - non pharm, diazepam
antibacterial - rx dependant causative organism
decongestants - pseudoephedrine, xylometazoline
anxiolytics - POM an watch out for herbals eg St johns wort
amitriptyline - POM neuralgias
gabapentin/ prcegablin/ carbamazepien - POM beuralgisia
hat are non pharmacological advice for headaches?
drink pity of water
get rest
relax
keep exercise to keep body less tense
for primary headaches:a void trigger
alcohol
processed meats including nitrates
changes in sleep pattern
poor posture
skipped melas
light /noise stimulus
