Headaches - 1 Flashcards

(26 cards)

1
Q

What is a primary headache?

A

No underlying medical cause
Tension type headache, migraine and cluster headache

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2
Q

What is a secondary headache?

A

Has identifiable structural or biochemical cause
Tumour, meningitis, vascular disorders, systemic infection, head injury and drug-induced

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3
Q

Describe the pathophysiology of a primary headache

A

Sensitisation of normal pain pathways
Involves brainstem, cortical structures and trigemino-vascular system
Calcitonin gene related peptide a key transmitter

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4
Q

What is used for management for primary headache?

A

Modifiable lifestyle triggers - sleep, dehydration, stress
Abortive treatment
Transitional treatment
Preventative treatment

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5
Q

What is the aim of preventative treatment?

A

Adjust threshold for developing headache - reduce sensitivity

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6
Q

What is the identifiable structural or biochemical cause of secondary headache?

A

Headache occurring for first time in close temporal relation to another disorder known to cause headache
Pre-existing primary headache becoming significantly worse in close temporal relationship another disorder known to cause

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7
Q

What are the specific headache features that give clues to diagnosis of secondary headache?

A

Thunderclap in SAH
Postural headache in low pressure headache
Biology is mainly migraine and migrainous features

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8
Q

What is the investigations for headaches?

A

Primary - look for underlying cause, usually need no investigation but can have MRI or CT
Secondary - CT and CT angiogram, MRI

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9
Q

Describe a tension type headache

A

Most frequent primary headache
Not disabling
Is mild, bilateral headache with pressing or tightening quality
Aggravated by routine exercise

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10
Q

What is the treatment for tension type headache?

A

Acute - paracetamol or NSAIDs
Preventative - Tricyclic antidepressants (Amitriptyline)

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11
Q

Describe a migraine

A

Most disabling primary headache
A chronic disorder with episodic attacks and complex changes in brain

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12
Q

What are the symptoms of a migraine?

A

During - headache, nausea, vomiting, phonophobia, photophobia and functional disability
In between attacks - anticipatory anxiety

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13
Q

Describe the course of a migraine

A

Premonitory - mood changes, fatigue, cognitive changes, muscle pain and food craving
Aura
Early headache - dull, muscle pain and nasal congestion
Advanced headache - unilateral, throbbing, nausea
Postdrome - fatigue and cognitive changes

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14
Q

Describe aura in migraines

A

Transient neurological symptoms resulting from cortical or brainstem dysfunction
May involve sensory, visual, motor or speech systems
Is a slow evolution of symptoms
Duration - 15 to 60 mins
Can be confused with transient ischaemic attack

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15
Q

Describe chronic migraine

A

Headache more than 15 days a month of which more than 8 days are migraine, for more than 3 months
Transformation can occur with or without escalation of medication use

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16
Q

What is a transformed migraine?

A

History of episodic migraine, increasing frequency of headache over weeks/months, migraine symptoms become less frequent and severe

17
Q

Describe medication overuse headache

A

Headache present more than 15 days a month which have developed or worsened whilst taking regular symptomatic medication
Can occur in primary headache

18
Q

What can medication overuse headache be caused from?

A

Use of triptans, ergots, opioids and combination analgesics more than 10 days a month
Use of simple analgesics more than 15 days a month
Caffeine overuse

19
Q

What are some modifiable lifestyle triggers for a migraine?

A

Dehydration, diet, environmental stimuli, changes in oestrogen in women, stress, hunger and sleep disturbance

20
Q

What is used for acute treatment of migraines?

A

Aspirin and NSAIDs
Triptans
Limit to 10 days per month

21
Q

What is used for prophylactic treatment for migraines?

A

Propranolol, Candesartan
Anti-epileptics - topiramate and valproate
Tricyclic antidepressants
Flunarizine
Botox
CGRP monoclonal antibodies

22
Q

What is the treatment for medication overuse headache?

A

Prevention - limit treatment to 2 days a week
Abrupt withdrawal of medication
Best strategy is not clear

23
Q

What are specific headache issues in women?

A

Migraine without aura is better in pregnancy and with doesn’t change
First migraine can occur in pregnancy
Combined OCP is contraindicated if migraine with aura
Avoid anti-epileptics in women of child bearing age

24
Q

What is the treatment of migraine is women is pregnant?

A

Acute attack - paracetamol, triptans and NSAID
Preventative - propranolol and amitriptyline

25
Describe new daily persistent headache
Distinct and clearly remembered onset, with pain becoming continuous and unremitting within 24hrs Medication overuse is common Diagnosis and exclusion of secondary cause
26
What are the clinical features of primary new daily persistent headache?
2 subtypes Self-limiting - usually resolves within months even without therapy Refractory - resistant to aggressive treatment Headache can resemble chronic migraine or chronic tension type headache