Headaches Flashcards
(24 cards)
What causes of headaches have ocular involvement?
Papilloedema
Shingles
Migraine
GCA
ACG
Which of the migraine types is more common?
Common migraine
What are the characteristics of common migraine?
No aura
Last 4-48 hours
Occur 1-4x per month
Dull ache which increases to throbbing pain
Mood change
Poor concentration
Yawning
Nausea
Skin pallor
Psychological changes
What are the characteristics of classic migraine?
Visual aura
Speech disturbance
Hemiparesis
Hemiparaesthesia
Dull ache which increases to throbbing pain
Pain lasts < 1 hour, preceded by visual disturbance
What is the term for a visual aura without a headache?
Acephalgic migraine
What are the types of visual aura that may happen?
Teichopsia
Chevaux de frise
Scotoma
Pure hemianopia
Heat haze
What is teichopsia?
Zig zag line around a scotoma
Start centrally and move out (can be opposite)
Most common visual aura
What is chevaux de frise?
Crazed glass appearance
What causes teichopsia?
Planar waves of neural activity passing through V1
Moves slower when closer to fovea (due to cortical magnification)
How should migraines be managed?
Avoid precipitating factors
Medically control
Prophylactics
What are the precipitating factors for migraines?
Contraceptive pill
Excessive sleep
Lactose, chocolate, nuts, red wine
Give an example of a type of medical control for migraines.
Aspirin
Codeine
Give and example of a type of prophylactic treatment for migraines.
ACE inhibitors
Beta blockers
What are some types of headaches not usually associated with visual problems?
Tension
Cluster
Acute meningitis
Subarachnoid haem
Trigeminal neuralgia
Ankylosing spondylitis
Rheumatoid arthritis
What substances/environments can cause headaches?
Alcohol
High altitude
Diving
Cold stimulus
Low blood sugar
Lack of caffeine
Prolonged exercise
What are the characteristics of a tension headache?
Bilateral steady pain frontal (over eyes)
Doesn’t worsen with activity
No other sxs
Recurrent
Usually towards end of day
What are tension headaches associated with?
Stress/anxiety
Poor sleep
What are the characteristics of a cluster headache?
Sudden onset but brief
Sharp, burning pain
Unilateral
Oculotemporal
Occur at night
Recurrent
Last 2-4 hours
What might a cluster headache be accompanied by?
Lacrimation
Conj injection
Sweating
Horner’s syndrome
What are the signs of a headache caused by acute meningitis?
Non-specific throbbing
Very severe headache
Neck stiffness
Either rapid or gradual onset
What are the signs of a headache caused by subarachnoid haemorrhage?
Initial sudden headache which becomes persistent
Pain present on waking and worse on coughing
Can lead to CNIII palsy
What are the signs of a headache caused by trigeminal neuralgia?
Elderly
Unilateral
Intermittent ‘red hot poker’ pain
What are the signs of a headache caused by ankylosing spondylitis?
Nagging pain in the morning
What are the signs of a headache caused by rheumatoid arthritis?
Pain around the eyes, or unilateral temple or occipital zone
