L13 - Headache Flashcards
(22 cards)
Primary headache
Normally recurrent
Due to headache condition
Non life threatening
Secondary headaches
Due to another condition
Acute
Severe pain
More likely to be life or sight threatening
Primary headache disorders
Tension headache
Migraine
Cluster headache
Secondary headache conditions
Stroke Space occupying lesion: - tumour - cerebral abscess Intracranial haemorrhage Acute sinusitis Otitis media intracranial spread of infection Temporal arteritis Closed angle glaucoma Medication over use Hypertension Pre-eclampsia
SNOOP - red flag signs of headaches
Systemic:
- meningitis - fever, neck stiffness, photophobia
- cancer
- HIV
- pregnancy - pre-eclampsia
Neurological symptoms:
- SOL
- intracranial haemorrhage
- closed angle glaucoma
Onset new/ changed in under 50 yr olds
- malignancy
Onset in thunderclap headache
- subarachnoid haemorrhage
Papilloedema - increased ICP
- pulsatile tinnitus
- positional provocation
- precipitated by exercise
Who does tension type headaches affect?
More common in females and young adults
Normally have first onset before 50 yrs old
Tension type headache
Sight: generalised frontal and occipital
Quality: tight band like pain +/- radiating into the neck
Intensity: mild or moderate
Time: worst at the end of the day, lasting for about 1 hour and recurrent
Aggravating factors: stress, poor posture, lack of sleep
Relief: analgesics
Secondary symptoms: slight nausea
Clinical exam: normal
Who gets migraines
More common in females
Presents in early to mid life
Most have first attack by 30
Possible pathophysiology
Vasodilation of meningeal blood vessels
Migraine
Sight: unilateral frontal or temporal
Quality: throbbing or pulsating
Intensity: moderate- severe, go to bed or avoid light
Time: prolonged headache
Aggravating factors: stress, certain food, lack of sleep, menstrual cycle, FHx
Relief: analgesics and triptans
Secondary symptoms: nausea and vomiting, aura, sensory deficit, neurological symptoms
Clinical exam: normal
Medication over use headache
Affects females more
Headache occurs for more than 15 days per month
Occurs in patients with pre- existing headache disorders due to overuse of regular analgesics for at least 10 days per month
Headache does not respond to medication or another type of headache
occurs
Co-exists with depression and sleep disturbances
Advice for medication over use headache
Shouldn’t take analgesics for more than 2 days per week
Discontinue medication if headaches become worse - headache will worsen before improves but normally resolved completely by 2 months
Common drug that causes medication over use headaches
Cocodamol
Who gets cluster headaches?
More common in males
1 in 1000
Usually begins in 30-40s
Signs of cluster headache
Red conjunctiva
Nasal congestion
Ptosis
Tearing
On the same side as the headache
Cluster headache pain
Sight: unilateral around or behind the eye
Quality: sharp, stabbing and penetrative pain
Intensity: severe suicidal
Time: 15 mins - 3 hours, occurs in clusters with periods of remission
Aggregating factors: alcohol, smoking, warm temperature, volatile smells, lack of sleep
Relief: oxygen and triptans
Secondary symptoms: ipsilateral autonomic symptoms e.g. tears, red conjunctiva, ptosis, nasal congestion
Clinical exam: autonomic features
Space occupying lesion pain
Sight: dependent on SOL
Quality: dull and variable, gradual and progressive
Intensity: mild
Time: worse in the morning when waking
Aggregating factors: cough, poor posture I.e. leaning forward, valsava manoeuvre (raised ICP)
Relief: analgesics
Secondary symptoms: Nausea, vomiting, neurological symptoms, visual symptoms e.g behaviour change, seizures (dependent on site of SOL)
Clinical exam: unilateral neurological signs, papilloedema
Trigeminal neuralgia
More common in females
50- 60 year olds
Pathophysiology of trigeminal neuralgia
Compression of the trigeminal nerve due to a looped blood vessel
5% due to tumours/ skull base abnormalities or AV malformations
Trigeminal neuralgia pain
Sight: unilateral felt in 1+ divisions of CNV Commonly Va causes headaches
Quality: sharp, shooting pain like stabbing electric shock
Intensity: severe
Time: 2 secs - 2mins sudden onset
Aggregating factors: light touch to face/ scalp, eating, cold wind, combing hair
Relief: difficult to treat
Secondary symptoms: preceding symptoms = numbness or tingling
Clinical exam: normal
Temporal arteritis
Vasculitis involving small or medium sized arteries of the head most commonly the superficial temporal artery
Most affects females over the age of 50
Risk of irreversible loss of vision due to ischemia of CN II therefore treat with prednisone and confirm with a biopsy
When to consider temporal arteritis
Sudden onset headache in over 50s with jaw claudication and visual disturbance
