Week 8: Headache Flashcards
What is a secondary headache?
something else is causing the headache
Explain the different types of onset of a headache and give examples of each?
- acute (seconds to minutes): SAH/haemorrhage/thunderclap
- evolving (hours to days): infection/inflammatory/increased ICP
- chronic - chronic daily headache/increased ICP
what is an episodic headache? give examples
at least a few days free between attacks e.g migraine/trigeminal neuralgia
What might be some causes of chronic headache?
medication overuse/chronic migraine
What are some associated features of headaches?
- diurnal variation/postural element
- nausea and vomiting
- photophobia/phonophobia
- autonomic features (lacrimation, horners, red eye)
- premonitory/prodromal
What are the red flag associated features of a headache?
- cognitive effects
- seizures
- fever
- visual disturbance
- vomiting
- weight loss
- sudden onset or older onset
What behaviours can be noticed in a patient with chronic headaches?
- lies down in dark room (migraine)
- agitation/pacing (cluster)
What top disabiling condition is often familial?
migraine
What signs should you look for in a patient with headache?
fever rash neck stiffness increased BP organomegaly fundal changes (papilloedema - swelling of the optic nerve) cranial nerve signs/horners syndrome focal abnormalities e.g right arm being weak
Give 7 primary head ache syndromes
- migraine
- tension headache
- cluster headache
- paroxysmal hemicrania
- exertional headache
- ice-pick headache
- coital headache
- hypnic headache
Give 7 secondary head ache syndromes
- SAH
- intra cerebral haemorrhage/stroke
- meningoencephalitis
- intracranial venous thrombosis
- giant cell arteritis
- tumour with raised ICP
- cervicogenic headache
- benign intracranial hypertension
What does exotropic mean and what is it a sign of?
means eyes are looking outward (unable to look medially)
sign of 3rd nerve palsy
When examining a patient, if you can’t see the optic nerve, what might that mean?
- caused by papillary oedema
- suggesting increased ICP
What are the potential causes of raised intracranial pressure?
- mass effect (brain tumour, abscess)
- brain swelling (hypertensive encephalopathy)
- increased venous pressure
- CSF outflow obstruction (hydrocephalus)
- increased CSF production (meningitis/SAH)
What are the symptoms of raised ICP?
Headache
vomiting
seizures
What are the symptoms of temporal arteritis?
weight loss myalgia transient loss of vision jaw claudication tender non-pulsatile temporal artery
Who might get temporal arteritis?
patients above 50
F>M
What are the signs of a migraine?
UNILATERAL
nausea
photophobia
dizziness
What are thought to be triggers of migraines?
sleep deprivation
hunger
stress
oestrogens
What are the 3 methods of managing migraines?
- Brain imaging
- Conservative measures
- avoid caffiene
- increase water intake
- avoid tyramine foods (cheese/chocolate/red wine)
- sleep hygiene and regular meals - Analgesia
- triptans/naproxen/NSAIDs
What substance is released during a migraine?
CGRP
What is erenumab?
first licensed CGRP receptor antagonist specifially designed to prevent migraines
How long and often might cluster headaches occur?
30-180 mins
1-8 per 24hrs
How long and often might paroxysmal hemicrania headaches occur?
2-30 minutes
What is SUNCT/SUNHA?
-short unilateral neuralgiform headache with conjuctival infections and tears (rare, seconds, up to 200 attacks per 24 hrs)
How do we manage cluster headaches?
- sumatriptan (class A), high flow 100% oxygen, neurostimulation
- prevention is predinosolone
What is a tension headache?
- non specific description of ‘constricting’ / ‘tight band’
- paracetamol doesn’t resolve
What can be some causes of new daily persistent headaches?
- raised ICP / (IIH - idiopathic intracranial hypertension)
- low ICP
- chronic meningitis
- post head injury
What is the main treatment for idiopathic intracranial hypertension?
loosing weight
If headaches change from episodic to chronic, what should you consider?
analgesia overuse
