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Clinical Neuroscience > 9.2.2 Primary Headache Disorders & Secondary Causes > Flashcards

9.2.2 Primary Headache Disorders & Secondary Causes Flashcards

1
Q

What are the most to least common types of headache?

A

Tension-type (primary)
Migraine (primary)
Medication over-use (secondary)
Cluster (primary)

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2
Q

Who is affected by tension-type headaches?

A

Females > males
Common
Young(teenagers) and young adults, 20-39

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3
Q

What age is presentation of tension-type headaches unusual?

A

> 50 years old

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4
Q

What causes tension-type headaches?

A

Tension in muscles of head and neck

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5
Q

What are the features of tension-type headaches?

A
  • Generalised pain in frontal and occipital regions
  • Tight, band-like, constriction, may radiate to neck
  • Mild-moderate intensity
  • Worse at the end of the day
  • Recurrent 30m-1hour
  • Stress, poor posture, lack of sleep aggravates
  • Responds to simple analgesics
  • Few associated symptoms, may be slight nausea
  • Normal clinical examination

Get Me Really Strong Analgesics For Terrible Days

Generalised pain
Mild-moderate intensity
Recurrent 30m-1hour
Stress, poor posture, lack of sleep
responds to simple Analgesics
Few associated symptoms
Tight, band like constriction
end of the Day

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6
Q

Who is affected by migraines?

A

Female > Male
(1 in every 5 females)
Common (15 in every 100)
Presents early to mid-life
Most have first attack by 30

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7
Q

What is the pathophysiology of migraines?

A

(Unclear)
Neurogenic inflammation of trigeminal sensory neurones innervating large vessels and meninges

Alters way pain is processed, brain becomes more sensitive to stimuli that would normally be ignored

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8
Q

What are the features of a migraine?

A
  • Unilateral, temporal or frontal
  • Can respond to simple analgesics, may need triptans, tend to want to lie down
  • Severe-moderate
  • Triggers
  • Throbbing, pulsating
  • Disabling, need to lie down
  • Prolonged, between 4-72 hours
  • Normal clinical examination

Usually Care Stops Terrible Throbbing D*ck Pain

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9
Q

How long do migraines last?

A

4-72 hours

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10
Q

What triggers migraines?

A

Certain foods
Menstrual cycle
Stress
Lack of sleep
Familial links

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11
Q

What symptoms can be associated with migraines?

A
  • Photophobia
  • Phonophobia
  • Nausea
  • Aura- period of vague neurological signs
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12
Q

Who is affected by medication over-use headaches?

A

Females > Males
30-40 years old
Headache present on at least 15 days/month (constant)
Occurs in patients with pre-existing headache disorder
Using regular analgesics, at least 10 days/month
-headache not responding

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13
Q

What are the features of medication over-use headaches?

A

Variable character- can be dull, tension-type or migraine-like

Co-exists with depression and sleep disturbance

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14
Q

How can medication over-use headaches be treated?

A

Discontinue medication

Headache will worsen before it improves

Typically resolved by 2 months

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15
Q

What is the pathophysiology of medication-overuse headaches?

A

Upregulation of pain receptors in meninges due to analgesics e.g.

Codeine and cocodamol

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16
Q

Who is affected by cluster headaches?

A

Male > Female
Smokers (risk factor)
1/1000
Usually between 30-40

17
Q

How are cluster headaches sometimes described?

A

Suicide headaches
Severe stabbing pain

18
Q

What is pathophysiology of cluster headaches?

A

Hypothalamic activation with secondary trigeminal and autonomic involvement

19
Q

What are some features of cluster headaches?

A
  • Unilateral, around or behind eye
  • Sharp, stabbing, penetrating often at night
  • Severe, intense, disability, agitated
  • 15 minutes-3 hours, occurs in clusters with periods of remission, 3 months to 3 years
  • Triggers
  • Simple analgesics ineffective, need oxygen and triptans
  • Ipsilateral autonomic symptoms
  • Evidence of autonomic features during an attack
20
Q

What are some triggers of cluster headaches?

A

Alcohol
Cigarettes
Volatile smells
Warm temperature
Lack of sleep

21
Q

What are the autonomic symptoms of a cluster headache?

A

Red, water eye
Blocked runny nose
Ptosis

22
Q

What are the features of space-occupying lesions?

A
  • Gradual, progressive
  • Dull, progresses in severity
  • Mild, worse in mornings
  • Early-morning, on waking
  • Worsened with posture, cough, vassalva manoeuvre, straining
  • Simple analgesics effective in early stages
  • Nausea, vomiting, focal neurological or visual symptoms
  • Clinical examination- focal (unilateral) neurological signs, papilloedema
23
Q

What is trigeminal neuralgia?

A

Compression of CN V due to loop of aberrant blood vessel

5% due to tumours/ skull base abnormalities or AV malformations

24
Q

Who is affected by trigeminal neuralgia?

A

Female > Male
25 per 100,000
50-60 years old

25
Q

What are the features of trigeminal neuralgia?

A
  • Unilateral, pain felt in >1 division of CNV
  • Sharp, stabbing ‘electric’ shock (sometimes burning)
  • Severe, lasts few seconds-2 minutes
  • Sudden onset
  • Light touch to face/scalp, eating, cold wind, combing hair
  • Simple analgesics not effective, can be difficult to treat
  • Preceding symptoms
  • Normal clinical examination
26
Q

What are the preceding symptoms of trigeminal neuralgia?

A

Tingling
Numbness which can radiate to areas in CNV distribution

27
Q

What is temporal arteritis/ Giant cell arteritis?

A

Vascular is of large and medium sized arteries of the head

Superficial temporal artery most commonly involved

28
Q

Who is affected by temporal arteritis?

A

Female > Male
>50 years old, most common in over 75s

29
Q

When should temporal arteritis be considered?

A

Consider in any >50 with abrupt onset of headache and visual disturbance or jaw claudication

30
Q

Why is there risk of vision loss in temporal arteritis?

A

Involvement of blood vessels supplying CNII

31
Q

Fill in the table

A
32
Q

Headache summary

A

Clinical Neuroscience (45 decks)

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