Secondary Headaches Flashcards
Analgesia-induced, TMJ dysfunction, Space occupying lesions, GCA [look at MSK], Raised ICP, SAH, Idiopathic Intracranial HTN, Trigeminal Neuroglia
Name Secondary headaches (8)
May be due to structural, infective, inflammatory or vascular conditions
(1. ) Analgesia induced headaches
(2. ) Space occupying lesions
(3. ) Intracranial bleeding
(4. ) Raised intracranial pressure e.g. tumour, idiopathic intracranial HTN
(5. ) Infection
(6. ) Inflammatory disease e.g. GCA
(7. ) Referred pain e.g TMJ dysfunction
(8.) Trigeminal neuralgia (not classed as ‘headache’)
What is trigeminal neuralgia? Sx?
- Affects the face/jaw rather than head
- At least three attacks unilateral facial pain in distributions of trigeminal nerves, with no radiations beyond this
- Pain has at least three of the following four characteristics:
(1. ) Reoccurring in paroxysmal attacks from a second to 2mins
(2. ) Severe intensity
(3. ) Electric shock like, shooting, stabbing or sharp
(4. ) Precipitated by innocuous stimuli to the affected side of the face. Often - talking, eating, drinking, brushing teeth etc - No clinically evident neurological deficit
What is analgesia induced headache?
- Overuse of acute pain relief (>2-3 times/week) for a previously diagnosed primary headache disorder (usually migraines and tension headaches)
- Drugs that can cause these headaches include: Caffeine, Paracetamol, NSAIDs, Codeine, Triptans
Dx of analgesia induced headache
- Headache occurring 10-15d per month in patients with primary headache disorder AND regular overuse of pain relief for >3m
- Dull constant headache which is often worse in the mornings
- As each dose of medication wears off, the pain comes back
- The headache must not fit any other headache diagnosis better
Mx of analgesia induced headache
(1. ) Withdrawal of medication is the mainstay
- Paracetamol + NSAIDs should be withdrawn abruptly
- Discuss with neurology if opioids are involved, and these will need to be withdrawn gradually
(2. ) Medication should be avoided for at least a month
(3. ) Pt should be warned that Sx worsen at first, and improvements may not be seen for weeks
Temporomandibular Joint Dysfunction: What is it? Causes? Signs? Tx?
(1. ) Muscles + cartilage around TMJ joint become inflamed so the bones rub against each other
(2. ) Causes: Teeth grinding, wear and tear, arthritis, stress, uneven bite
(3. ) Pain around jaw, ear or temple, grinding noise when jaw is moved, difficulty fully opening the mouth, Jaw lock, headache around the temples
(4. ) Usually resolves itself, painkillers for headaches
List some causes of Space Occupying lesions (5)
- Metastases
- Haematoma
- Hydrocephalus
- Cerebral abscess
- Meningitis
Presentation of Space Occupying lesions
(1. ) Brain tumour headache = worse in the morning and on bending or Valsalva manoeuvre
(2. ) N + V
(3. ) Change in mental status or behavioural change
(4. ) Weakness, ataxia, disturbance of gait
(5. ) Deficits of speech or vision
(6. ) Generalised convulsions (involuntary contraction of muscles)
Management of Space Occupying lesions
(1. ) Surgery
(2. ) Radiation or Chemo
(3. ) Mx of raised ICP
(4. ) Tx of other complications e.g. anticonvulsants for seizures
(5. ) Dexamethasone (steroids)
- For those waiting for surgery
- Dampen brain oedema and reduces inflammation and pressure
What causes Subarachnoid haemorrhage (SAH)?
- Usually due to bleeding from a berry aneurysm in the Circle of Willis.
- Can also be due to arterio-venous malformation, encephalitis, vasculitis, tumour, idiopathic.
Signs and Sx of SAH
(1. ) Thunderclap headache i.e. maximum severity within seconds, ‘Worse ever’. SAH until proven otherwise
(2. ) Neck stiffness due to meningeal irritations
(3. ) Focal Sx and signs
- May suggest site of aneurysm
(4.) Other Sx: Vomiting, Collapse, Seizure, Coma
Ix for SAH (3)
(1.) CT SCAN: detects 95% of SAH
(2. ) LP can be used if CT scan in -ve
- Test for xanthochromia (RBC broken down and makes clear CSF yellow)
(3. ) Cerebral angiogram
- Check for aneurysm anywhere so can be treated urgently
Mx of SAH (6)
(1. ) Resuscitation
(2. ) Nimodipine (Ca-antagonist) - reduces vasospasm to prevent ischaemia
(3. ) Pain relief = morphine, codeine, paracetamol
(4. ) Consider Antiemetics, Anti-convulsants = N+V? Seizures?
(5. ) Surgery: coiling/clipping
- early prevention to prevent re-bleeding
- procedure to repair the affected blood vessel and prevent the aneurysm from bursting again
(6. ) Monitor complications
Rf for Idiopathic Intracranial HTN
(1. ) Obesity
(2. ) 3rd decade
(3. ) Drugs
(4. ) Endocrine abnormalities (Cushing’s, hypoparathyroidism)
(5. ) SLE
Presentation of Idiopathic Intracranial HTN
Sx are caused by high CSF pressures
(1. ) Headaches
(2. ) Neck pain
(3. ) Pulsatile Tinnitus
(4. ) Blurred vision +/- diplopia
(5. ) CN6 palsy
(6. ) Other: fatigue, memory problems, low mood, anxiety