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INTERNAL MED 3+ conditions > Tension and Combination Headaches > Flashcards

Tension and Combination Headaches Flashcards

1
Q

General characterisitcs of tension headaches

A
  • Episodic or chronic

- Generalised throughout the head - symmetrical, bilateral tightness (predilection for frontal and occipital)

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2
Q

Tension headache epidemiology

A
  • Most common type of headache
  • 42% prevalence (2-3% chronic)
  • Onset 20-30 years old
  • M < F
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3
Q

4 causes of tension headache

A
  • Muscle contraction (precranial muscles)
  • Mental tension/psychological stress (central sensitisation)
  • Cervical dysfunction
  • Disrupted sleep/insomnia/sleep disorders
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4
Q

Pathophysiology of tension headaches

A
  • Release of inflammatory agents –> sensitisation of peripheral trigeminal afferents - central hypersensitivity
  • Major nociceptor = precranial musculature
  • Similar pathology to migraines (except nociceptors on blood vessels and meninges)
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5
Q

Combination headache is….

A

Tension and migraine occurring together (also called mixed headache syndrome)

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6
Q

4 classification criteria - ICHD

A
  1. Infrequent episodic - associated with pericranial tenderness or not
  2. Frequent episodic - associated with pericranial tenderness or not
  3. Chronic - associtaed with pericranial tenderness or not
  4. Probable tension-type headache - can be any of the types described above
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7
Q

What does ICHD stand for

A

International classification of headache disorders

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8
Q

Clinical picture - tension headaches

A
  • Rarely disabling
  • Dull
  • Non-pulsatile
  • Bilateral constricting pain
  • Pericranial pain is common
  • No significant N/V
  • NOT aggravated by physical activity
  • Associated muscle tenderness - SCM, trapezius, temporalis, lateral pterygoid, masseter
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9
Q

Risk factor for tension headaches

A
  • Mental tension
  • Stress
  • Fatigue
  • Missing meals
  • Analgesic overuse
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10
Q

DDX for tension headache

A
  • Chronic migraine
  • Medicine overuse - opioids, Barbiturates
  • Sphenoid sinusitis
  • GCA
  • TMJ disorder
  • Pituitary tumor
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11
Q

Acute management of tension headache

A
  • Analgesics - aspirin, paracetamol, ibuprofen, naproxen
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12
Q

Chronic management of tension headache

A
  • Antidepressants (Amytriptyline, Venlafaxine, Mirtazapine) - low doses and gradually increase
  • Non-pharmacological treatments
  • Muscle relaxants - Tizanidine (3-6 months)
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13
Q

Definition of a chronic tension headache (time)

A

> 7-9 days

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14
Q

Define a cluster headache

A
  • Unilateral headache over one eye (can shift sides between attacks)
  • 15-180 mins duration
  • Extremely painful
  • Associated with autonomic symptoms - para hyperactivity and symp hypoactivity
  • Can be chronic with daily attacks
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15
Q

Cluster headache epidemiology

A
  • M > F (3:1)
  • 0.2% prevalence
  • Onset 20-40 years old (rare in children)
  • 90% episodic (7 days to 1 year, >1 month remission)
  • 10% chronic (>1 year, <1 month remission)
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16
Q

Aetiology cluster headaches

A
  • UNKNOWN
  • Associated with head trauma, heavy cigarette smoking, heavy alcohol intake)
  • No causal relationship found
  • ?sleep apnoea
  • ?heritability
17
Q

3 cardinal features of cluster headache

A
  1. Trigeminal distribution of pain
  2. Ipsilateral cranial autonomic symptoms
  3. Circadian/circannual patterns of attack
18
Q

Pathophysiology cluster headaches

A
  • Increased firing of the parasympathetic fibres innervating facial structures
  • Trigemino-parasympathetic reflex arc
  • Role of hypothalamus - imaging shows activation of the posterior hypothalamic region ipsilateral to the pain during a cluster attack
19
Q

Classification criteria - ICHD - cluster headache - 5

A
  • Cluster headache (episodic or chronic)
  • Paroxysmal hemicrania (episodic or chronic)
  • SUNCT
  • SUNA
  • Probable trigeminal autonomic cephalalgia
20
Q

Cluster headache precipitating factors

A
  • Alcohol
  • Volatile smells
  • Warm temperatures
  • Sleep
21
Q

Clinical presentation of cluster headaches

A
  • Restless and agitated
  • Repeated episodes - unilateral pattern
  • Excruciating
  • Nausea and vomiting
  • Photophobia and phonophobia
  • Migrainous aura
22
Q

Autonomic features associated with cluster headaches

A
  • Ptosis
  • Conjunctival injection
  • Lacrimation
  • Rhinorrhoea
  • Nasal stuffiness
  • Eyelid/facial swelling
  • Aural fullness
  • Facial sweating/redness
23
Q

Risk factors for cluster headaches

A
  • Male
  • Family history
  • Head injury
  • Smoking, alcohol
24
Q

DDx for cluster headaches

A
  • Migraine
  • Paroxysmal hemicrania
  • Trigeminal neuralgia
  • Gluacoma
25
Q

Investigations for cluster headaches

A
  • CT/MRI brain
  • ESR (exclude GCA)
  • Pituitary function test
26
Q

Treatment for acute cluster headaches

A
  1. Subcut Sumatriptan (triptan class, treats migraines, contraindicated in PAD< CAD, cerebrovascular disease)
  2. Oxygen (decreases duration and intensity)
  3. Intranasal Zolmitriptan
  4. Intranasal Lidocaine
27
Q

Prevention of cluster headaches

A
  • Prednisolone
  • Nerve blocks
  • Verapamil and Lithium (prophylaxis)
28
Q

Prognosis cluster headaches

A
  • Symptoms tend to improve with age
29
Q

Combination headaches

A
  • Daily/chronic tension type headache + recurrent migraines
30
Q

Combination headache prophylaxis

A
  • Antidepressants - both the antidepressant effect and analgesic effect
  • Botox injection treatment

INTERNAL MED 3+ conditions (18 decks)

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