Headache Flashcards
How is headache divided?
Primary Headache
- Most headache (90% GP vs 60% A+E)
- No underlying medical cause
Secondary Headache
- Has identifiable structural or biochemical cause
- Not all secondary is sinister
Give examples of primary headache
Tension Type Headache
Migraine
Cluster Headache
Give examples of secondary Headache
Tumour Meningitis Vascular disorder Systemic infection Head injury Drug-induced
What is Primary headache?
Increased sensitivity of normal intracranial pain pathways to what is going on in the environment
Describe tension-type headaches
Most frequent primary headache, but is NOT disabling and rarely presents to doctors
Lifetime prevalence of 42% in men and 49% in women
Mild, bilateral headache which is often pressing or tightening in quality, has no significant associated features and is not aggravated by routine physical activity
What is the difference between Infrequent ETTH, Frequent ETTH and CTTH?
Infrequent Episodic Tension-Type Headache (/= 15 days / month)
What is the treatment for tension-type headache?
Absorptive treatment:
- Aspirin or paracetamol
- NSAIDs
- Limit to approx 2 days per week to avoid the development of medication overuse headache
Preventative treatment:
-Rarely required
-Tricyclic antidepressents
(AMITRIPTYLINE, dothiepin, nortriptyline)
What is migraine?
A chronic disorder with episodic attacks
Complex charges in the brain that lead to activation and sensitisation of the trigeminal system
Most frequent DISABLING primary headache
What are the symptoms during attacks of migraine?
One of the following symptoms should be present along with headache:
- Nausea and/or vomiting
- Photophobia,
- Phonophobia
What are the symptoms between attacks of migraine?
Enduring predisposition to future attacks
Anticipatory anxiety
What is the criteria for a migraine?
Both with an without aura, headaches must last for 4 to 74 hours.
In addition the headaches must have at least 2 of the following features:
-Unilateral location
-Pulsating quality
-Moderate or severe pain
and/ or aggravation by or causing avoidance of routie physical activity (e.g. walking, climbing stairs
What are the triggers of migraines?
STRESS Hunger Sleep disturbance Dehydration Diet Environmental stimuli Changes in oestrogen levels in women
How does migraine evolve over time?
Migraine is manifested clinically as a constellation of symptoms that evolve through the various phases of a migraine attack.
Clinical experience indictaes that symptoms typically associated with each phase of an attack often recur during other pases of the attack, resulting in continuum of symptoms, rather than a succession of distinct phases.
Describe the premonitory phase of a migraine attack
70% with or without aura experience premonitory symptoms
Often seen as predictors of the headache attack
Mood alterations, muscle pain, food cravings, cognitive changes, fluid retention, yawning
What is an aura?
Transient neurological symptoms resulting from cortical or brainstem dysfunction
May involve visual, sensory, motor or speech symptoms
-Show a slow evolution of symptoms from 1 area to the next (e.g. vision -> sensory -> speech)
Aura symptoms are believed to arise from an electrical disturbance called cortical spreading depression (CSD)
Describe the aura phase of migraine
Involves focal, fully reversible neurologic symptoms that often precede headache.
Visual somatosensory symptoms often described
Duration = 15-60 mins
Describe the early headache phase of migraine
Mild pain without the associated symptoms of migraine
Nasal congestion
Muscle pain
Describe the advanced headache phase of migraine
Moderate to severe unilateral throbbing pain with associated symptoms of:
-Nausea, photophobia, phonophobia or disability.
Describe the postdrome phase of migraine
Phase of migraine associated symptoms beyond the resolution of the headache (often entails significant disability that can last for 1 or 2 days)
Fatigue
Cognitive changes
Muscle pain
Summarise the phases of migraine by listing them in order
Premonitory Aura Early headache Advanced headache Postdrome
What can aura symptoms be confused with?
How do you differentiate?
TIA:
TIA differs in that it involves:
- Loss of function
- Sudden onset
- Symptoms all start at same time and can be localised to a specific vascular area
What is chronic migraine?
Headache on >/= 15 days per month, of which >/= 8 days have to be migraine, for more than 3 months
What is Medication Overuse Headache?
Headache present on >/= days/month which has developed or worsened whilst taking regular symptomatic medication
Can occur in any primary headache:
- Migraineurs are particularly prone to MOH
- Migraineurs taking pain medication for another reason can develop chronic headache
What causes Medication Overuse Headache?
Use of triptans, ergots, opioids and combination analgesics >10days/month
Use of simple analgesics >15 days per month
Caffeine overuse: coffee, tea, cola etc
