Primary headaches Flashcards
Three main categories
- Tension type headaches
- Migraines
- Trigeminal autonomic cephalagias
Main properties of tension type headache
- Mild
- Bilateral
- Pressing/tightening sensation
- Not aggravated by exercise
Classicification of a TTH?
- Infrequent: less than 1 day per month
- Frequent: 1-14 days per month
- Chronic: more than 15 days a month
Treatment for TTH?
Abortive:
- aspirine/ paracetamol
- NSAIDs
- 10 days per month
Preventative
- Rarely used
- Tricyclic antidepressants
What are the symptoms of migraine
During attack
- Headache
- Nausea
- Photophobia
- Phonophobia: fear of sound
In-between attacks:
- Anticipatory anxiety
- Predisposition
Description of the phases of beaches in migraine
1-Pre-monitary:
- Mood changes
- Fatigue
- Cognitive changes
- Muscle Pain
- Food cravings
2-Aura :
- Reversible
- Neurological changes
- Visual somatosensory
3-Early headache: No associated symptoms of migraine
- Dull
- Nasal congestion
- Muscle pain
4-Advanced headache
- Unilateral
- Throbbing
- Nausea
- Photophobia
- Phonophobia
- Osmophobia
5-Postdrome : migraine symptoms remain despite resolution of headache
- Fatigue
- Muscle pain
- Cognitive changes
What is an aura
Transient neurological symptoms resulting from cortical/brainstem dysfunction.
Affects the visual/motor/ sensory/ speech systems
Spreads from one area to another slowly
Usually lasts between 15-60 mins
Differences between a TIA and an AURA
TIA is sudden onset
Complete loss of function in TIA
Symptoms all start at the same time and can be localised to one area in a TIA
Triggers for a migraine
Current thoughts are that people who are predisposed to triggers are more likely to be over-responsive to these triggers: Dehydration Sleep deprivation Stress Diet Changes in oestrogen levels in women Environmental stimuli
Treatment for migraine
Abortive: only 10 days a month to prevent MOH
- Aspirin/NSAIDs
- Triptans
Prophylactic treatment:
- Tricyclic antidepressants
- Anti-epileptics
- Propanarol, candesartan
- Venlafaxine
Facts about migraine specific to women
- First migraine can occur during pregnancy
- Migraine with aura usually improves during pregnancy
- Migraine without aura usually does not improve during pregnancy
- Combined OCP is non indicated for women with migraine with aura
- Avoid anti-epileptics in women of child bearing age
- Treatment: Acute: paracetamol, Preventative: propanarol/amitriptaline
what is the definition of a chronic headache
Headache which presents for more than 15 days a month, of which 8 or more are migraneous, for over 3 months.
what are medication overdose headaches
Headache for 15 or more days a month- which has become more severe as a result of medication overuse
Example of drug use which can lead to medication headache overdose
Opiods, triptans for over 15 days a month
Simple analgesics for more than 10 days a month
Overuse of caffeine, tea..,
Definition of a migraine
Chronic disorder with reversible episodes of pain due to complex changes in the Brian (cortex, meninges, Trigeminal ganglion, brainstem)
Symptoms of a chronic headache which develops from migraines
- Increased frequency of headaches over weeks, months, years
- Migraneous symptoms become less severe/ less frequent
- Could be a result of overuse of medication- when this is the case, the removal of medication can drastically improve the symptoms
Definition of trigeminal autonomic cephalagias
A group of headache disorders characterised by attacks of moderate to severe unilateral pain in the head or face, with associated ipsilateral cranial autonomic features such as lacrimation, conjunctival injection, rhinorrhoea, nasal congestion, eyelid oedema and ptosis.
Cluster headaches properties
Orbital/temporal Unilateral Rapid onset- usually within 9 mins Can last from 15mins to 30 mins Rapid cessation ‘suicide headaches’ due to level of agony Patients are restless Ipsilateral autonomic symptoms Usually present with premonitory aura symptoms 1-8 attacks a day
Paraoxymal hemicrania properties
Orbital/temporal
Unilateral
Rapid onset
2-30 mins duration
Prominent ipsilateral autonomic symptoms
Very severe
50% of sufferers are agitated and restless
Migraneous symptoms may be present
In 10% of cases symptoms may be precipitated by bending/rotating the head
No circadian rhythm
2-40 attack per day
What does SUNCT stand for?
Short-lasting Unilateral Neuralgiform headache with Conjunctival injection and Tearing
SUNCT properties
Orbital/ supraorbital/ temporal pain Stabbing pain 10-240 second duration Cutaneous triggers: wind, chewing, touch 3-200 per day Conjectival infection/lacrimation
Trigeminal neuralgia properties
Unilateral maxillary/mandibular division pain greater than ophthalmic pain Stabbing pain Duration:5-10 seconds Cutaneous triggers Uncommon autonomic features
What does SUNA stand for
Short unilateral neuralgiform headache with autonomic symptoms
Which are the main categories of trigeminal autonomic cephalagias
- Cluster headaches
- Paraoxysmal
- SUNCTA
- SUNA
- Unilateral head pain
Episodes of pain in Cluster headaches
- Attacks lasting 1-3 months with up to 1 month remission
- Frequency: 1 attack every other day for up to 8 days
- Continuos background pain in-between attacks
- Circadian rhythm: usually occurs around same time of day/ around same time each year
- In some patients: chronic clusters lasting a year with less than 1 month remission
How do you treat SUNA SUNCTA
Treatment
•No abortive treatment
•Prophylaxis: –Lamotrigine (anti-epilectic drug) –Topiramate –Gabapentin -Carbamazepine / Oxcarbazepine
How do you treat cluster headaches??
Abortive:
Subcutaneous sumatriptan
Oxygen
Preventative:
-Corticosteroids: verapamil
How do you treat Paraoxymal hemicranial
Indomycin
How do you treat trigeminal neuralgia?
- Carbamezapine
- Gabapentine
- Lamotrigine
Surgery:
- Decompressive
- Radiosurgery
- Glycerol ganglion injection
