Headaches Flashcards
What are primary headaches?
Headaches without an underlying cause, including migraines, tension-type headaches, and cluster headaches.
What are secondary headaches?
Headaches caused by an underlying condition, such as infections, trauma, or vascular disorders.
What are red flag symptoms in headaches?
Sudden onset, “worst ever” headache, focal neurological signs, fever, altered consciousness, or signs of raised intracranial pressure.
What is a migraine?
A primary headache characterised by unilateral, throbbing pain, often associated with nausea, photophobia, and phonophobia.
What are the diagnostic criteria for migraines?
At least five attacks of headache lasting 4–72 hours with two of the following: unilateral location, pulsating quality, moderate or severe pain, and aggravation by physical activity, plus nausea or sensitivity to light/sound.
What is an aura in migraine?
A reversible focal neurological symptom, such as visual disturbances or sensory changes, that precedes or accompanies the headache.
What are tension-type headaches?
A primary headache characterised by bilateral, pressing, or tightening pain of mild-to-moderate intensity without nausea.
What triggers tension-type headaches?
Stress, poor posture, lack of sleep, or eye strain.
What are cluster headaches?
Severe, unilateral headaches around the eye, often associated with autonomic symptoms like lacrimation or nasal congestion.
What is the typical duration of a cluster headache?
Cluster headaches last 15 minutes to 3 hours and often occur in cyclical patterns or “clusters.”
What is a medication-overuse headache?
A chronic headache caused by the overuse of pain relief medications, particularly for more than 15 days a month.
What are common secondary causes of headache?
Subarachnoid haemorrhage, meningitis, temporal arteritis, sinusitis, and brain tumours.
What is the pathophysiology of migraines?
It involves activation of the trigeminovascular system, cortical spreading depression, and release of inflammatory neuropeptides.
What investigations are required for headache with red flags?
Neuroimaging (CT/MRI), lumbar puncture, and blood tests.
What is the initial treatment for acute migraine attacks?
Simple analgesics (paracetamol or NSAIDs) and triptans (e.g., sumatriptan).
What prophylactic medications are used for migraines?
Beta-blockers (e.g., propranolol), tricyclic antidepressants (e.g., amitriptyline), and antiepileptics (e.g., topiramate).
What is the treatment for tension-type headaches?
Simple analgesics like paracetamol or NSAIDs, and addressing lifestyle factors such as stress or poor posture.
How are cluster headaches treated?
Acute treatment includes oxygen therapy and subcutaneous or intranasal triptans. Prophylaxis involves verapamil or corticosteroids.
What is temporal arteritis, and how does it present?
Temporal arteritis is an inflammation of the temporal arteries causing headache, jaw claudication, and visual disturbances.
What investigation is key for diagnosing temporal arteritis?
Raised erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), followed by temporal artery biopsy.
What is the treatment for temporal arteritis?
High-dose corticosteroids to prevent complications like vision loss.
What are the clinical features of subarachnoid haemorrhage?
Sudden, severe “thunderclap” headache, often associated with neck stiffness, photophobia, and altered consciousness.
What investigation confirms subarachnoid haemorrhage?
CT head (within 6 hours of onset) and lumbar puncture (if CT is negative) to detect xanthochromia.
What lifestyle modifications help reduce primary headache frequency?
Regular sleep, hydration, exercise, stress management, and avoiding known triggers like caffeine or alcohol.
