Headache Flashcards
Pathophysiology of headache
Headache pain is produced by:
Muscle contraction (tension type headache)
Inflammation or dilatation of extra cranial nerves
Stretching of meninges due to increase in CSF pressure
Stretching of cranial nerves
Dilation of intracranial blood vessels
Meningitis inflammation 👀📌✨
International classification of headache
Primary- cluster , migraine and tension headache
Secondary -from organic causes ie hemorrhage, infection, neuropathy, stroke and tumor
Give 8 categories of secondary headaches
1.headache attributed to head and or neck trauma including chronic post traumatic headache
2. Headache attributed to cranial or cervical vascular disorder
3.. attributed to non-vascular intracranial disorder ie attributed to intracranial neoplasm
4.headache attributed to substance or it’s withdrawal ie alcohol included , ergotamine overuse
5. Headache attributed to infection
6. Attributed to disorder of homeostasis
7. Facial pain or headache attributed to disorder of neck, eyes, nose, teeth mouth or other cranial structures
8.attributed to psychiatric disorder
IHS diagnostic criteria for migraine with aura
A.At least 2 attacks which meet criteria B and C
B. Aura, consist of at least 1 and is fully reversible
$visual symptoms, including positive feature ie flickering lights and negative features ie loss of vision
$retinal
$motor weakness
$ brainstem
$difficulty with speech
C. At leas 3 of
At least one aura symptom is positive
At least one aura symptoms is unilateral
2 or more aura symptoms occur in succession
D. Not better accounted for by another ICHD-3 diagnosis
IHS diagnosis criteria for migraine without aura
A. At least 5 attacks fulfill criteria B to D
B. Headaches attacks lasting 4-72h ( untreated or unsuccessful treated)
C. Headache has at least 2 of the following
Unilateral location
Pulsating quality
Moderate or severe pain intensity
Aggravating by physical activity
D. During headache , at least one of the following
N/V
Photophobia
E. Not attributed to another disorder
Red flags for secondary headaches
New headache in individual over 50years
Pregnant women on 3rd trimester- eclampsia
Progressive headaches over weeks /months -intracranial lesion
Clinical features of migraine
Clinical features dived into five phases
1.Prodrome- food cravings, yawning
- usually occurs 10hr before attack
2.Aura- visual or sensory symptoms
Seeing lights, starburst lighting, tunnel vision
3.Headache- pulsating and often associated with photophobia, photophobia, N/V . Vomiting nah relieve headache
Worsen by movement
- headache can be unilateral/ bilateral
May be associated with cutaneous allodynia
Ie combing hair, showering
4.Resolution - sleep
5.Recovery -patient feels drained and exhausted
Classic of migraine based on aura
With aura-classic
No aura-common migraine
Trigger factors for migraine
Bright lights/loud noise
Menstruation
Diet-alcohol/citrus fruits
Missing meals/sleep
Stenosis exercise
Management of migraine according to NICE
Throbbing pain lasting hours
Sensitivity to stimuli
Aura if present last minutes to hours
Chronic migraine (>15 headaches days per month of which >8are migraine)
Combination of oral triptan + nsaid/paracetamol. Can also give monotherapy
Consider antiemetic even in absence of N/V
Manage tension type headache (NICE)
Band like ache
Mostly featureless
Can have mild photo or phonophobia but no nausea
Txt: aspirin, paracetamol, NSAIDS
Cluster headache management (nice)
More common men
Severe pain last 30-120 mins
Unilateral
Agitation, pacing
Unilateral cranial automatic feature ie tearing
Txt: oxygen and /or subcut triptan
For oxygen use 100% at a flow rate of 12L/min with nonbreathing mask and reservoir bag
Triptan overuse headache
Can be migranous/tension type
Triptan intake >10days per month for >3months
Txt:stop triptan for 2-3months
Analgesic overuse headache
Can be migranous/tension type
Analgesic >15 days per month or opiates for >10 days for >3 months
Treatment: stop analgesic for 3 months
Prophylaxis for migraine indications
Patients with possible risk factors such as stress, chemical triggers like alcohol Present treatment
Increase in frequency of headaches
Can’t take suitable treatment
At least 2 attacks for a months
