Lecture 5.2: Headaches Flashcards

1
Q

Examples of Primary Headaches

A
  • Migraine
  • Tension Headaches
  • Cluster Headaches
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2
Q

Reasons for Secondary Headaches

A
  • Head Trauma
  • Medication Overuse
  • Cancer
  • Infection
  • Vascular
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3
Q

Mechanisms of Headaches (6)

A
  • Skeletal Muscle Tension
  • Arterial Dilatation
  • Traction on Arteries
  • Traction or Dilatation on Venous Sinuses
  • Inflammation
  • Referred Pain
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4
Q

Stages of Migraines (4)

A
  • Prodromal Fatigue (vague change in mood/appetite)
  • Aura Phase
  • Headache Phase
  • Resolution
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5
Q

Acute Management of Migraines (3)

A
  • Analgesia
  • Triptans
  • Antiemetic
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6
Q

Chronic Management of Migraines (3)

A
  • Precipitant Avoidance
  • Beta Blockers/Topiramate
  • Acupuncture
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7
Q

Precipitating Factors of Migraines (6)

A
  • Foods
  • Alcohol
  • Emotion
  • Menses
  • Bright Light
  • COCP
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8
Q

How common are Tension Headache?

A

Most common type of headache in primary care

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9
Q

Characteristics of Tension Headaches (6)

A
  • Bilateral Pressure
  • Rarely Systemic Upset
  • No Aura
  • Gets worse during the day
  • Lasts 30mins to 7days
  • Ranges from infrequent attacks to daily pain
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10
Q

Management of Tension Headaches: Lifestyle (6)

A
  • Stress
  • Alcohol
  • Exercise
  • Mood
  • Medication Abuse
  • Reassurance
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11
Q

Management of Tension Headaches: Medications (3)

A
  • OTC medicine – paracetamol, ibuprofen
  • NB – avoid codeine based products
  • Low dose amitriptyline >2days/week
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12
Q

Characteristics of Migraine Headaches (4)

A
  • Unilateral
  • Pulsatile
  • Aura
  • Triggers
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13
Q

Characteristics of Cluster Headaches (6)

A
  • Bouts of severe orbital pain lasting from 15mins to
    3hrs
  • a/w conjunctival injection, lacrimation and nasal
    blockage
  • Occasionally ptosis and Horner’s syndrome
  • Makes patient restless (unlike migraine)
  • Occur frequently (daily for several weeks)
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14
Q

Acute Management of Cluster Headaches (2)

A
  • Oxygen
  • Triptan
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15
Q

Prophylaxis of Cluster Headaches (3)

A
  • Specialist Advice
  • Verapamil / Li
  • Avoidance of Triggers (alcohol, nicotine)
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16
Q

Causes of Secondary Headaches (10)

A
  • Temporal Arteritis
  • Trigeminal Neuralgia
  • Subarachnoid Haemorrhage
  • Medication Overuse Headache
  • Raised Intracranial Pressure
  • Tumour
  • Idiopathic Intracranial Hypertension (benign
    intracranial hypertension)
  • Sinusitis
  • Toothache
  • Meningitis
17
Q

Red Flags for Headaches (12)

A
  • Worsening headache with fever
  • Sudden-onset headache reaching maximum intensity
    within 5 minutes
  • New-onset neurological deficit
  • New-onset cognitive dysfunction
  • Change in personality
  • Impaired level of consciousness
  • Recent (typically within the past 3 months) head
    trauma
  • Headache triggered by cough, Valsalva (trying to
    breathe out with nose and mouth blocked) or sneeze
  • Headache triggered by exercise
  • Orthostatic headache (headache that changes with
    posture)
  • Symptoms suggestive of giant cell arteritis
  • Symptoms and signs of acute narrow-angle glaucoma
18
Q

What is Chronic Pain? (2)

A
  • Pain which persists beyond the natural healing time * Usually >3months
19
Q

Chronic Pain a Vicious Cycle (6)

A
  • Acute Pain
  • Immobility
  • Increasing BMI
  • Further Pain
  • Increased Immobility/BMI
  • Further Injury
20
Q

What does Inflammation Alter? (4)

A
  • Ion channels on Neurones
  • Sensitivity of Neurones/Receptors
  • Decreases the threshold for firing
  • Alters the trigger for firing
21
Q

Central Effect of Chronic Pain (4)

A
  • Spontaneous Firing from Dorsal Horn
  • Altered Descending Inhibition
  • Personality/Perception
  • Psychology
22
Q

Complex Region Pain Syndrome (CRPS)

A
  • COMPLEX: Varied and dynamic clinical presentation
  • REGIONAL: Non-dermatomal distribution of symptoms
  • PAIN: Out of proportion to the precipitating events
  • SYNDROME: Constellation of signs and symptoms
23
Q

What is Complex Region Pain Syndrome (CRPS)?

A

A broad term describing excess and prolonged pain and inflammation that follows an injury to an arm or leg

24
Q

Complex Region Pain Syndrome: Type 1

A

No identifiable lesion (5-10%)

25
Q

Complex Region Pain Syndrome: Type 2

A
  • After nerve injury (causalgia)
  • Linked to the sympathetic nervous system
  • Triggered by variety of stimuli
  • Minor trauma, bone fracture, surgery, stroke,
    myocardial infarcts
26
Q

Presentation of Complex Region Pain Syndrome (7)

A
  • Triad of Symptoms: Autonomic, Sensory, Motor
  • Pain (spontaneous, hyperalgesia, allodynia)
  • Distal Oedema
  • Skin Temperature Changes
  • Skin Colour Changes
  • Altered Sweating
  • Bone Changes (peri-articular osteoporosis, joint
    stiffness)
27
Q

Motor Symptoms of CRPS (4)

A
  • Weakness
  • Tremor
  • Dystonia
  • Myoclonus
28
Q

Mechanism of CRPS (3 Hypothesis)

A
  • Neurogenic inflammation
  • Autonomic dysfunction
  • Neuroplastic changes in CNS
29
Q

Management of Complex Regional Pain Syndrome (7)

A
  • Steroids
  • Analgesia
  • Neuropathic Meds
  • Physiotherapy
  • Occupation Therapy
  • Psychotherapy – CBT
  • Sympathetic Nerve Blocks