CNS: Part 1 Headache

Question 1

what are the types of headaches

Answer 1

-Primary headaches, more common. Include: migraines, tension headaches and cluster headaches.

-secondary, may be infection, neoplastic (abnormal cell growth), vascular (blood vessel related), or drug induced. Requires referral

Question 2

symptoms of migraine

Answer 2

-unilateral throbbing, meaning only on one side of the head
-nausea and vomiting
-24 hours average
-photophobia
-aura (weird, temporary symptoms just before migraine e.g. visual, sensory changes)
-pulsating

Question 3

what causes migraines scientifically

Answer 3

dilation of blood vessels within or around the skull

Question 4

symptoms of tension headache

Answer 4

tight band feeling around the head, bilateral
-non pulsing
-mild moderate pain
-usually doesn’t disrupt normal activities

Question 5

what is the scientific reasoning for tension headaches

Answer 5

-muscle spasm in neck and scalp can cause tension in the muscles resulting in contracted capillaries and reducing blood flow, meaning lack of O2 to these areas

Question 6

cluster headache symptoms and causes scientifically

Answer 6

-unilateral
-sharp pain
-usually over 30 men
-lasts 15-3 hours
-refer

-associated with autonomic symptoms e.g. rhinitis, facial sweating, feeling of restlessness
-occurs at the same time of the year

Question 7

how long do chronic daily headaches last

Answer 7

headache for 15 days or more per month
-refer

Question 8

examples of secondary headaches

Answer 8

-sinusitis
-eye strain/glaucoma
-muscle strain in neck and upper back
-jaw and dental pain

Question 9

cause of secondary headache`

Answer 9

medication overuse headache that can last 3 days
-increase number of pain receptors that are turned on

Question 10

what medication can cause headaches

Answer 10

combined hormonal contraceptives

Question 11

what are traction headaches

Answer 11

caused by pulling of sensitive parts of the head e.g. the hair like tight ponytails

Question 12

when to refer for headaches

Answer 12

-chronic headaches that persist for more than 15 days a month
-cluster headaches
-if headaches don’t resolve over 1-2 weeks unless it is tension headaches

Question 13

what are space occupying lesions

Answer 13

abnormal mass or growth in the brain that takes up space, potentially causes by brain tumours, abscesses (collection of pus caused by infection and can lead to swelling and pressure inside the skull that can lead to headaches

Question 14

what does frontal headaches suggest

Answer 14

-idiopathic headaches
-nasal congestion
-sinusitis

Question 15

what does back of the head headaches suggest

Answer 15

-tension
-anxiety (esp if pain radiates over the top and sides of the head

Question 16

what does unilateral headaches suggest

Answer 16

-migraine
-sinusitis (can spread to both sides later
-shingles (one day before rash occurs

Question 17

what does behind the eye headaches suggest

Answer 17

-glaucoma if pain is in eye
-sinusitis
-migraine
-shingles

Question 18

what does temple headache sugest

Answer 18

temporal arteritis for over 50 years

Question 19

what does sudden pain suggest

Answer 19

haemorrhage

Question 20

what does throbbing and pounding pain suggest

Answer 20

vascular cause such as vasodilation caused by fever or migraine

Question 21

what does constant nagging pain suggest

Answer 21

tension headache

Question 22

what does severe-moderate pain suggest

Answer 22

migraine

Question 23

where is the pain on cluster headaches

Answer 23

in and around one eye

Question 24

where is the pain on sinus

Answer 24

behind brown bone or/and cheekbone

Question 25

what are some non drug measures for pain

Answer 25

relaxation methods e.g. massage, acupuncture -stop overusing medicines

Question 26

what does the NICE guidelines say about medication overuse to do with headaches

Answer 26

-headache ongoing for 15 days or more per month is due to the overuse of meds for headache for more than 3 months -using simple analgesics e.g. paracetamol for 15 days or more in a month -using triptans, opioids, ergots or combination analgesics for at least 10 days per month over 3 months

Question 27

treatment for headaches

Answer 27

-first line is paracetamol and NSAIDS (non opioid analgesics) -second line is opioid analgesics such as codeine for max 3 days

Question 28

antimigraine drugs/treatment

Answer 28

-try simply analgesics first -some have antihistamines for nausea like Buccastem -sumatriptan for 18-65 years. Must be an established pattern of migraine