Neurology - Headaches Flashcards
What are key red flags associated with a headache indicating a possible serious underlying cause?
- Fever, photophobia or neck stiffness
- New neurological symptoms
- Visual disturbance
- Sudden-onset occipital headache
- Worse on coughing or straining
- Postural, worse on standing, lying or bending over
- Vomiting
- History of trauma
- History of cancer
- Pregnancy
Red flags can indicate conditions like meningitis, brain tumours, or intracranial hemorrhage.
What does papilloedema suggest in a patient with a headache?
Raised intracranial pressure
May be due to brain tumour, benign intracranial hypertension or intracranial bleed
What are common characteristics of tension headaches?
- Mild ache or pressure in a band-like pattern
- Develop and resolve gradually
- Do not produce visual changes
Tension headaches are very common.
What factors may be associated with tension headaches?
- Stress
- Depression
- Alcohol
- Skipping meals
- Dehydration
What is the first-line management for chronic or frequent tension headaches?
Amitriptyline
First line for chronic or frequent tension headaches
What conditions can cause secondary headaches?
- Infections
- Obstructive sleep apnoea
- Pre-eclampsia
- Head injury
- Carbon monoxide poisoning
Clear underlying cause
What is sinusitis?
Inflammation of the paranasal sinuses
Causes pain and pressure in the face after a recent viral URTI
Tenderness and swelling on palpation of affected areas
It typically causes pain and pressure following a viral upper respiratory tract infection.
How long does sinusitis usually last?
2-3 weeks
What is the first-line treatment for prolonged cases of sinusitis?
- Steroid nasal spray
- Antibiotics (phenoxymethylpenicillin)
Cases over 10 days
What are the characteristics of hormonal headaches?
- Related to low oestrogen
- Unilateral, pulsatile headache
- Associated with nausea
Sometimes called menstrual migraines
When can hormonal headaches occur?
- Two days before and the first three days of the menstrual period
- In the perimenopausal period
- Early pregnancy
How are hormonal headaches treated?
Triptans and NSAIDs e.g. mefanamic acid
What is cervical spondylosis?
Degenerative changes in the cervical spine
Causes neck pain, made worse by movement
What is trigeminal neuralgia?
Intense facial pain in the distribution of the trigeminal nerve
What are the branches of the trigeminal nerve?
- Ophthalmic (V1)
- Maxillary (V2)
- Mandibular (V3)
Can affect any combination of branches 90% are unilateral
What patients are more likely to experience trigeminal neuralgia?
MS patients
How does trigeminal neuralgia present?
Sudden pain that can last seconds to hours
Electricity like
Shooting
Stabbing
Burning pain
What is the first-line treatment for trigeminal neuralgia?
Carbamazepine
What triggers may lead to attacks of trigeminal neuralgia?
- Touch
- Talking
- Eating
- Shaving
- Cold
Attacks may worsen over time.
