S8. headache from quizlet Flashcards
What are the two types of headache?
- Primary headache due to a headache disorder and is usually non life/site threatening
- Secondary due to another condition which is less common but can potentially be life/site threatening
What are some primary headaches?
Tension type headaches
migraine
cluster headache
What are some secondary headaches?
-life threatening eg tumour, haemorrhage, meningitis
- Site threatening eg giant cell ateritis and closed angle glaucoma
- non life threatening such as medication overuse, sinusitis, trigeminal neuralgia
How do we take the history of a headache? -
History of presenting complaint eg SQITARS
- Past medical history
- Drug history
- Family history
- Social history eg stress, lack of sleep, alcohol and caffeine
How do we remember the red flags for headache and what do they stand for?
SNOOP
S-systemic signs and disorders
N-Neurological symptoms
O- onset new or changes symptoms in patients over 50
O- onset in thunderclap
P-papilledema, positional provocation, precipitated by exercise
What clinical examination do we carry out for headache?
- Vital signs
- Neurological exam including cranial and peripheral nerves, GCS
- Other relevant systems from the history
What are the most common types of headache?
Tension type headache, Migraine, Medication overuse, Cluster headache
What is the pathophysiology of a tension type headache?
is more common in females and more common in younger patients and is thought to be due to tension in the muscles of the head and neck
How does a tension type headache present? -
tight/band like
- Generalised pain commonly in frontal and occipital - radiate into the neck a
- mild/moderate intensity
- responding to simple analgesics
- pain worst at the end of the day
- recurrant lasting 30- 60 minutes
- aggrivated by stress, poor posture and lack of sleep
- few associated symptoms with normal neurological exam
What is the pathophysiology of migraines?
more common in females presenting in early to mid life with most having a first attack by 30, unclear how it comes about but may be due to:
-neurogenic inflammation of CNV sensory neurones innervating the large vessels and meninges altering how the brain processes pain, sensitising us to normally ignored stimuli
What is the presentation of migraines?
- Unilateral temporal or frontal pain
- throbbing and pulsating,
- moderate to severe
- disabling
- respond to simple analgesia but may need triptans
- prolonged lasting between 4-72 hours
- Triggers- food, mesntrual cycle, stress
- Aura, photo and phono phobia but a normal clinical examination between episodes
What is the pathophysiology of a medication overuse headache?
more common in middle aged females and occurs in patients with a pre-existing headache disorder who are using regular anaglesics for more than 10days/month leading to upregulation of pain receptors so the headache does not respond- cure by discontinuing medicine
How does a medication overuse headache present?
- Present on at least 15 days/month with variable character
- co-exists with depression and sleep disturbance
What is the pathophysiology of cluster headaches?
more common in males with a history of smoking occuring between 30-40 years and may be due to hypothalamic activation with trigeminal autonomic involvement
How do cluster headaches present?
- unilateral sharp, stabbing intense disabling pain around the eye with the patient being agitated and usually lasting 15 mins-3 hours with periods of remission
- triggers- alcohol, cigarretes, smells, temp
- analgesia ineffective and oxygen and triptans are used
- ipsilateral autonomic symptoms eg red watery eye, ptosis (may be seen on exam during an attack)
