Headaches Flashcards
What are the types of primary headache?
- Migraine
- Cluster
- Tension
- Drug overdose
- (Trigeminal neuralgia)
Define migraines
Unilateral, throbbing usually with a specific trigger, with or without aura
What is an aura?
neurological changes that accompany or precede the headache; FULLY REVERSIBLE visual, sensory or other CNS symptoms
What are some symptoms of migraines?
2 of
- unilateral pain
- throbbing
- motion sickness
- mod-severely intense
1 of
- nausea and vomiting
- photophobia/ phonophobia
WITH NORMAL NEURO EXAM
Describe the pathophysiology of migraines
- Prodrome (days before the attack) mood change
- Aura (part of attack, minutes before headache) visual changes, zig zag lines
- Throbbing headache lasting 4-72 hrs
What are some triggers of migraines?
CHOCOLATE
Chocolate
Hangover
Orgasms
Cheese
Oral contraceptives
Lie ins
Alcohol
Tumult (noise)/ travel
Exercise
How do you diagnose migraines?
Clinical unless other pathology suspected
How do you treat migraines?
- At onset of headache - Triptans, 1st line is oral sumatriptan (or aspirin 900mg)
- Simple analgesia first and foremost; paracetamol or NSAIDs
- Prophylaxis - BB: Propranolol or Amitriptyline
- Antiemetic treatment includes buccal prochlorperazine
What medication should you avoid in migraines?
- Opiates: risk of dependence + worsens nausea
Define cluster headaches
Recurrent, unilateral headaches
centred around eye or temporal
region.
What are risk factors of cluster headaches?
- Male
- Smoking
- Genetics
How long are cluster headaches?
Short attacks (15-180 mins)
What are the signs of a cluster headache?
ipsilateral autonomic signs:
- lacrimation + conjunctival infection (watery bloodshot eyes)
- rhinorrhoea (runny nose)
- miosis (dilated unilateral pupil)
- ptosis (droopy eyelid)
- sweating
What are symptoms of cluster headaches?
- crescendo (rising in severity) unilateral periorbital moderate/excruciating pain and
restlessness or agitation - most disabling primary headache
How do you diagnose cluster headaches?
Clinically
5 or more similar attacks confirms
What investigations do you do for cluster headaches?
Investigations are often to exclude more severe pathologies
- CT head and MRI.
How do you treat cluster headaches?
- First line management is sumatriptan and short burst oxygen therapy
- verapamil (CCB) prophylactically
- Avoiding potential triggers
identified by the patient works too
Define tension headaches
Bilateral generalised headache, radiates to neck
Describe the pathophysiology of tension headaches
- Most common primary headache
- Bilateral, mild/moderate
intensity, not worsened by
routine physical activity
What are the symptoms of tension headaches
- Rubber band tight around the head presentation
- Bilateral
- NO nausea, NO photophobia or
phonophobia
What is a trigger of tension headaches?
Stress
What are red flags that may accompany tension headaches?
- Fever (Meningitis)
-Neoplasm history (Metastatic disease)
-Neurological deficit (Tumour) - Pregnancy (Pre-eclampsia)
-Sudden onset (Haemorrhage/injury) - Older onset (GCA)
- Reduced or loss in consciousness (Haemorrhage)
- Papilloedema (Idiopathic Intracranial Hypertension)
-Painful eye; autonomic features (Cluster headache) - Worsened by sitting or standing (CSF leak)
How do you treat tension headaches?
Simple analgesia
- Aspirin or paracetamol
Avoid opiates (dependence)
Define trigeminal neuralgia
Episodes of acute, severe facial
pain; electric shock in nature
