Headache Flashcards
types of primary headache
tension-type headache
migraine
trigeminal autonomic cephalgias (including cluster headaches)
primary stabbing headaches and benign exertional headaches
what are secondary headaches
headaches due to underlying condition
infection (meningitis, covid, flu)
vascular (aneurysmal bleed, stroke, giant cell arteritis)
raised intracranial pressure (trauma, tumour)
medication side effects
symptoms of tension-type headaches
whole head
dull pressing character
mild-moderate severity
usually no associated features and rather non-specific
only considered a disease if they arise frequently and spontaneously
treatment of tension headaches
NDSAIDs
preventative tricyclic antidepressant if anything
presentation and pathology of trigeminal autonomic cephalgias
activation of trigeminal and autonomic pathways
presenting as unilateral headache attacks with ipsilateral autonomic features
often circadian
distinguished by their duration and frequency
autonomic features of TAC headaches
red eye, ptosis (drooping of upper eyelid), lacrimation, rhinorrhea (runny nose)
types of TAC
cluster headaches
paroxysmal hemicrania
hemicrania continua
short-lasting unilateral neuralgiform with conjunctival injection and tearing (SUNCT)
short-lasting unilateral neuralgiform headache and autonomic features (SUNA)
features of cluster headache
tend to occur at night
maybe 3 or 4 times a day
can last for 6 weeks
makes people really agitated
features of migraine
often unilateral/retro-orbital
severe pulsating, throbbing
last 4-72 hrs
associated features include photophobia, phonophobia, nausea, vomiting, desire to lie still, exacerbated by movement
what is a migraine with aura
precedes the headache
duration of <60mins
spreads over time (different to stroke)
90% visual
can affect sensation in face and hand (usually tingling rather than numbness)
speech issues (dysphasia)
can have aura without the headache (this can be mistaken for TIA)
what are the prodromal and postdromal features of a migraine
tiredness
irritability
yawning
poor concentration
what are the two types of migraine
episodic - with or without aura
chronic - headache for more than 15 days per month for 3 months, characteristic features for more than 8 days a month (often associated with analgesia overuse)
migraine risk factors
postpubertal women 3 times more likely, peaks at 35-40 years
hormonal factors - gender, puberty, periods, pregnancy, menopause, combined oral contraceptive pill
environmental triggers - emotional stress, change in sleep pattern, certain foods, weather changes
migraine pathophysiology
incompletely understood
current thinking is it involves activation and sensitisation of trigeminovascular pathways
disorder of sensory processing and altered brain excitabilityt
what is the acute treatment of migraines
aspirin - ideally soluble and high dosage (600-900mg)
NSAIDs
triptans - try several types and several routes before giving up (only work for ~50%)
avoid analgesic overuse
