Tension + Cluster headaches

Question 1

what are the features of a tension headache

Answer 1

tight band around the head + neck –> due to stiff + tight muscles
bilateral
non pulsatile pain
peri cranial tenderness

no nausea, vomiting, aura or aggravation by activites of daily living
less painful than migraine

can be stress related
can co-exist with migraine

Question 2

what is the treatment for tension headaches

Answer 2

analgesia - aspirin, paracetamol or NSAID (ibruprofen, naproxen, diclofenac)

resolving the stress that they are associated with

Question 3

what are the features of cluster headaches

Answer 3

severe, intense sharp** unilateral **stabbing pain
pain is located in area of V1 trigeminal nerve - phantom of the opera
pain always affects same side

past lasts 15mimns-3hrs (untreated)

ipsilaterally accompanied by at least 1 of (autonomic features):
lacrimation and/or conjuctival redness
nasal congestion and/ or rhinorrhea
eyelid oedema
facial sweating
miosis and ptosis

sense of restlessness + agitation during an attack

Question 4

how often do cluster headaches occur

Answer 4

long remissions between attacks - need to be at least 3 months pain free

frequency between 1 every other day to 8 per day (normally aorund 4)

diurnal variation - worse at night + wake from sleep

Question 5

how are cluster headaches treated

Answer 5

prophylaxis:
verapamil - do an ECG before and after starting to check for conduction delays
avoid triggers - alcohol, exercise, sleep

treatment during acute attacks:
inhaled 100% oxygen - relieves pain fast
subcut or nasal sumatriptan

(Avoid NSAIDs, opioids, paracetamol and oral triptans)

Question 6

why is caution advised to patients taking simple analgesics or triptans for headaches

Answer 6

they can cause medication overuse headache –> chronic daily headache

managment is to stop taking the drugs

Question 7

who gets cluster headaches

Answer 7

much more common in men than women

Question 8

constrast cluster headaches vs migraines

Answer 8