Patho- Headaches Flashcards
What are the important things to look for in a headache history?
Onset Peak Relief/exacerbators Associated symptoms Red flags
What should you ask about the onset of the headache?
Acute or chronic onset
What should you ask about the peak of the headache?
Worst at onset or progresses to it.
What kind of things can relieve or exacerbate a headache?
Worse on standing/better on lying- Low ICP
Worse on lying/better on standing- High ICP
What can be associated features with a headache?
N+V
Photo/phonophobia
Ptosis
Nasal stuffiness
What are the red flags of headache?
New onset>55 Malignancy Immunosuppression Wakes them up Worse on cough/sneeze
What are primary headaches?
Headaches not caused by another condition
Give some examples of primary headaches
Migraine
Tension
Trigeminal Autonomic Cephalgias: cluster, Paroxsymal hemicrania
What is the pathophysiology of a migraine?
Serotonin release causes vasoconstriction the dilation
SP irritates blood vessels and nerve causing pain
What are the symptoms of a migraine?
+/- aura- visual, sensory or motor symptoms
Moderate/severe unilateral throbbing pain
Worse on movement
Photo/phonophobia
Worse with time
What can trigger a migraine?
Stress Sleep deprevation Diet- Dark chocolate, cheese Hormones Physical exertion
How do you treat a migraine?
Avoid triggers
Relaxation/stress management
Pharmacological
What is the pharmacological management for acute migraine?
NSAIDS
Triptans- 5-HT3 agoinst
What is the prophylaxis pharmacological management for migraine?
Amitriptyline
Propranolol
Topiramate
BtTx
When does a patient get BtTx for migraines?
If failed 3 previos treatments
What are some side effects of amityiptyline?
Dry mouth
Postural hypotension
Sedation
WHo should not take propranolol?
Asthmatics
Peripheral vascular disease
What are some side effects of topiramate?
Impaired conc
Paresthesia
Weight loss
What is the pathophysiology of tension headaches?
Neurovascular irritation
What are some symptoms of tension headaches?
Pressing tingling feeling
Pressure behind eyes
Mild and bilateral
No N+V or photophobia
How do you treat tension headaches?
Antidepressants
Relaxation
Avoid precipetants
Give some examples of Trigeminal Autonomic Cephalgias
Cluster
Paroxsymal hemicrania
Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT)
What are some general features of Trigeminal Autonomic Cephalgias?
Trigeminal distribution of pain
Ipsilateral cranial autonomic features: ptosis, nasal stuffiness, tearing, eye oedema
What group classically get cluster headaches?
Men in 30-40s
What are some symptoms of a custer headache
10/10 pain Unilateral Worse on rest 45-90 minutes 1-8 a day Bouts last weeks-months
How do you treat cluster headaches?
High flow O2
Sumatriptan
Steroird
What can be used for cluster headache prophylaxis?
Verapamil
Who tends to get Paroxysmal hemicrania
Elderly women
What are some symptoms of Paroxysmal hemicrania?
Severe unilateral headache
Autonomic features
10-30 minutes
1-40 a day
How do you treat paroxysmal hemicrania
Indomethicin
What are some symptoms of SUNCT?
Excruciating unilateral headache
Lasts seconds to minutes
Conjunctival injections
Tearing feeling
How do you treat SUNCT?
Lamotrigine
Gabapentin
What should you do to those with new onset unilateral headache with autonomic symptoms?
MRI
What is a secondary headache?
Headache caused by another condition
Give some examples of secondary headaches
Idiopathic intracranial hypertension Trigeminal neuralgia Temporal arteritis Pressure Subarachnoid heamorrhage
What are some symptoms of idiopathic intracranial hypertension?
Morning N+V
Visual loss
Diurnal headache
Elevated ICP- seen as papilloedema
How do you treat IIH?
Weight loss
Acetazolamise
Shunt- only do to save vision
What should you never do in a patient with IIH unless their CT is normal?
LP
Who tends to get trigeminal neuralgia?
Elderly women
What are some symptoms of trigeminal neuralgia?
Pain on touching V2/3 areas
Severe stabbing unilateral pain
Lasts 1-90s
Can have 100s in a day
How do you treat trigeminal neuralgia?
Surgery- decompress nerve or ablate it
Pharma- Carbamazepine, Gabapentin, Phenytoin, Baclofen
What are some symptoms associated with temporal arteritis headaches?
Jaw pain
Scalp tenderness
How do you diagnose temporal arteritis?
Raised ERS and CRP
Biopsy
How do you treat temporal arteritis?
High dose steroids
How does a subarachnoid headache present?
Very painful sudden onset
What kind of headaches can wake you from sleep?
Those caused by raised intracranial pressure such as tumors
