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Year 2 C&M symposia > Managing Headaches > Flashcards

Managing Headaches Flashcards

1
Q

How many people are affected by headaches in their lifetime?

A

95%.

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2
Q

What normally causes acute onset headaches (secs-mins)? (4)

A
  • SAH
  • Intra-cerebral haemorrhage
  • Coital
  • Thunderclap
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3
Q

What normally causes evolving onset headaches (hours-days)? (3)

A
  • Infection
  • Inflammation
  • Increased ICP
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4
Q

What normally causes chronic onset headaches (weeks-months)? (2)

A
  • Chronic daily headache

- Increased ICP

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5
Q

What types of headache are episodic? (2)

A
  • Migraine

- Cluster headache

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6
Q

What types of headache are chronic? (3)

A
  • Medication overuse
  • Chronic migraine
  • Hemicrania continua
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7
Q

What are autonomic associated features of headaches? (3)

A
  • Lacrimation
  • Horners
  • Red eye
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8
Q

What are red flag symptoms?

A
  • Cognitive effects
  • Seizures
  • Fever
  • Visual disturbance
  • Weight loss (systemic)
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9
Q

What sort of behaviour does a migraine normally cause?

A

Patient lies down in dark room.

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10
Q

What sort of behaviour does a cluster headache normally cause?

A

Patient in agitated/pacing.

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11
Q

What sort of headache often has a family history (60%)?

A

Migraine.

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12
Q

Give some examples of 1* headache syndromes.

A

Migraine
Tension headache
Cluster headache
Coital headache

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13
Q

What is a secondary headache syndrome?

A

A headache that is caused by another condition.

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14
Q

Give some examples of secondary headache syndromes.

A

SAH
Stroke
Meningoencephalitis

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15
Q

CASE 1:

  • woke with severe sudden onset head pains
  • vomiting & confused
  • hyper-reflexive
  • ocular movements impaired (R eye down & dilated)
A

DIAGNOSIS: occulomotor (III) nerve palsy & migraine
MANAGEMENT: pain relief & refer to neurology

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16
Q

CASE 2:

  • diabetic
  • 72 hours evolving headache & nausea
  • hyper-reflexia in right arm & leg
A 
TEST: S. pneumoniae in blood culture
DIAGNOSIS: infection/abscess
MANAGEMENT: -broad spectrum antibiotics (cefotaxime)
-steroids
-Neurosurgical consultation
17
Q

What causes raised intra-cranial pressure? (4)

A
  • Mass effect (e.g. tumour)
  • Brain swelling
  • Increased venous pressure
  • CSF build up
18
Q

What are the symptoms of raised intra-cranial pressure? (3)

A
  • Headache (worse when lying)
  • Vomiting
  • Seizures
19
Q

What are the signs of raised intra-cranial pressure? (2)

A
  • Papilloedema

- Lateralising signs

20
Q

CASE 3:

  • Left temporal headache for 2 weeks (» jaw)
  • Visual disturbance this morning
  • Fees nauseated
A

DIAGNOSIS: temporal arteritis
MANAGEMENT: -high dose steroids (prednisolone)
-temporal artery biopsy

21
Q

What is temporal arteritis?

A

Condition where medium/large arteries in the head and neck become inflamed.

22
Q

What are the signs & symptoms of temporal arteritis?

A
  • Weight loss
  • Myalgia
  • Transient vision loss
  • Jaw claudication
  • Non-pulsatile temporal artery
23
Q

CASE 4:

  • 3 month episodic headache (R temporal/occipital)
  • Nausea & dizziness
  • Black dots in vision
  • Left hemi-sensory disturbance
A

DIAGNOSIS: migraine
MANAGEMENT: -brain imaging
-analgesics (e.g. triptans)
-Preventative treatment (e.g. propanolol)

24
Q

What are the triggers for migraines?

A
  • Sleep deprivation
  • Hunger
  • Stress
  • Oestrogen
25
Q

What is the pathophysiology of migraines?

A

Cortical spreading depression (brain waves slow down).

26
Q

What are coloured dots in the visual field likely to be due to?

A

Occipital seizures.

27
Q

What are black and white dots in the visual field likely to be due to?

A

Likely to be due to migraines.

28
Q

CASE 5:

  • severe gradual onset unilateral right orbital pain
  • agitated & tachycardia
  • streaming red eye with eyelid droop
  • smoker
A

DIAGNOSIS: trigeminal autonomic cephalgias
CHARACTERISTICS: short-lasting headaches & autonomic features (e.g. eyelid droop)
MANAGEMENT: -pain relief (sumatriptan)
-prevention (prednisolone)

29
Q

What is trigeminal autonomic cephalgias?

A

Pain on one side of head.

-activation of trigeminal systems.

30
Q

What are the 3 types of trigeminal autonomic cephalgias?

A
  • Cluster headache
  • Paroxysmal hemicrania
  • SUNCT
31
Q 
CASE 6:
-intermittent bilateral headache for few months
('tight band around head')
-hypertension
-IBS
A

DIAGNOSIS: tension headache (mild migraine)
MANAGEMENT: -relaxation
-consider amitriptyline

32
Q

What is new daily persistent headache?

A
  • Similar to tension headache
  • No previous headache history
  • Rarely sinister
33
Q

What are the causes of new daily persistent headache?

A
  • Raised ICP
  • Low ICP
  • Chronic meningitis
  • Head injury
34
Q

What is idiopathic intracranial hypertension?

A

Increased intracranial pressure in the absence of tumour/disease.

35
Q

Who is idiopathic intracranial hypertension common in?

A

Women of child bearing age.

-too much CSF&raquo_space; headache

36
Q

What is chronic daily headache?

A

Headache lasting >4 hours on >15 days per month, for >3 months.

37
Q

What causes chronic daily headache?

A
  • De novo

- Previous episodic headache (transformed migraine, etc.)

38
Q

What are treatment options for chronic daily headache?

A

Limited

  • withdraw overused analgesia
  • consider amitriptyline/topiramate for transformed migraine

Year 2 C&M symposia (11 decks)

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