8b.) Headaches Flashcards
(44 cards)
Headaches can be primary or secondary; what do we mean by this?
- Primary: due to a headache condition
- Secondary: due to another condition
Are the majority of headaches benign, non-life threatening headaches due to a primary headache disorder?
Yes
Are primary headache disorders life or sight threatening?
No, primary headache disorders are non-life threatening and non-sight threatening. Many of them are chronic
State 3 examples of primary headache disorders
- Tension headache
- Migraine
- Cluster headache
Secondary headaches can be life or sight-threatening; true or false?
True
State some broad causes for secondary headaches
- Space occupying lesions (although we think that secondary often present acutely- a SOL will often present with a chronic, gradually progressing headache)
- Intracranial haemorrhage
- Intracranial infections
- Other infections: e.g. sinusitis
- Opthalmic: e.g. acute glaucoma
- Temporal arteritis (giant cell arteritis)
- Medication-related and medication overuse
- Systemic: e.g. pre-eclampsia, hypertension
Describe some important aspects of the history that you take from someone presenting with a headache
- History of presenting complaint: SQITARS
- Past medical history: have you had headaches in past? How do they compare? Any conditions that could pre-dispose to headaches?
- Drug history: analgesic use- need to know what, how often and if it works to see if it is
- Family history: e.g. of migraines
- Social history: e.g stress, sleep, alcohol, caffeine, diet (triggers)
State what you typically find on clinical examination for a:
- Primary headache
- Secondary headache
- Primary: clinical examination typically normal
- Secondary: clinical examination MAY be abnormal
Describe some red flag features of a headache (include what each of the red flags could indicate)
(SNOOP)
- Systemic signs & disorders: e.g. of meningitis would have neck stiffness etc, hypertension, pregnant (could be pre-eclampsia)
- Neurological symptoms: point towards space occuping lesion, intracranial heamorrhage, glaucoma
- Onset new or changed & patient >50yrs: malignancy, giant cell arteritis
- Onset in thunderclap presentation: vascular (haemorrhage)
- Papilloedema, pulsatile tinnitus, positional provocation, precipitated by exercise: indicating raised ICP
Describe what your clinical examination, on someone who has presented with headache, should include
- Vital signs (BP, HR, temp)
- Neurological examination (cranial & peripheral)
- Other relevant systems to be guided by history
Order these headaches in terms of how common they are:
- Cluster headache
- Migraine
- Medication over-use
- Tension-type headache
MOST COMMON:
- Tension-type
- Migraine
- Medication over-use
- Cluster headache
Who are tension type headaches more common in; males or females?
At what age are tension type headaches common?
- More common in females
- Young (teens & young adults). If first onset is >50yrs unusual
Describe the pathophysiology of tension-type headaches
Thought to be due to tension in muscles of head & neck
Describe tension-type headaches, include:
- Where headache is felt
- Intensity
- When it is worse
- Aggrevating factors
- Response to simple analgesia
- Associated symptoms?
- Clinical examination findings
- Generalised in frontal & occipital regions (may be described as a band around head) and can radiate to neck. Non-pulsatile
- Worse at end of day
- Aggrevating factors: stess, posture, lack of sleep
- Often responds to simple analgesia
- Few associated symptoms- maybe nausea
- Clinical examination normal
Who are migraines more common in; males or females?
At what age do migraines typically present?
- Females
- Most have first attack early to mid-life (so should present before 30yrs if not unusual)
Are migraines common?
Yes (15 in every 100)
Describe the pathophysiology of a migraine
- Pathophysiology unclear
- Possible theories proposed e.g. vasodilation of meningeal vessels
Describe migraine headaches, include:
- Where headache is
- Quality of the headache
- Severity
- Duration
- Possible triggers
- Family history
- Response to simple analgesia
- Associated symptoms
- Clinical examination findings
- Unilateral (often in temporal or frontal region)
- Throbbing, pulsating
- Moderate-severe (disabling)
- Prolonged headache (4-72hrs)
- Triggers: certain foods, menstrual cycle, stress, lack of sleep
- Often there is family history
- Can respond to simple analgesia but may need triptans
- Associated symptoms: nausea & vomitting, photophobia & sometimes phonophobia, neurological symptoms (some get aura before migraine and some can get aura and no migraine)
- Clinical examination is normal
Who are medication over-use headaches more common in; males or females?
How often do medication over-use headaches ofen present?
- Females
- Present at least 15 days a month (constant)
Who do medication over-use headaches occur in?
ONLY occur in patients who are using analgesics regularly for headaches (has to be for headaches not analgesia for other pain and by regular we mean at least 10 days a month) due to underlying primary headache disorder. And the medication (over the counter medication) no longer works
What is a medication over-use headache?
What does it often co-exist with?
- Headache that is present for at least 15 days a month (constant) due to regular use of analgesics (at least 10 days a month) for a primary headache disorder leading to the headache not responding and hence causing a secondary headache disorder
- Co-exists with depression and sleep distuance
What analgesic is the most common cause/commonly used to create medication-over use headaches?
Co-codamol
How do you treat medication over-use headaches?
Discontinue medication (headache worsens before improves. Typically completely resolved by 2 months)
Describe the pathophysiology of medication over-use headaches
Up-regulation of pain receptors in meninges
