Flashcards in Managing Headaches Deck (38):
How many people are affected by headaches in their lifetime?
What normally causes acute onset headaches (secs-mins)? (4)
What normally causes evolving onset headaches (hours-days)? (3)
What normally causes chronic onset headaches (weeks-months)? (2)
-Chronic daily headache
What types of headache are episodic? (2)
What types of headache are chronic? (3)
What are autonomic associated features of headaches? (3)
What are red flag symptoms?
-Weight loss (systemic)
What sort of behaviour does a migraine normally cause?
Patient lies down in dark room.
What sort of behaviour does a cluster headache normally cause?
Patient in agitated/pacing.
What sort of headache often has a family history (60%)?
Give some examples of 1* headache syndromes.
What is a secondary headache syndrome?
A headache that is caused by another condition.
Give some examples of secondary headache syndromes.
-woke with severe sudden onset head pains
-vomiting & confused
-ocular movements impaired (R eye down & dilated)
DIAGNOSIS: occulomotor (III) nerve palsy & migraine
MANAGEMENT: pain relief & refer to neurology
-72 hours evolving headache & nausea
-hyper-reflexia in right arm & leg
TEST: S. pneumoniae in blood culture
MANAGEMENT: -broad spectrum antibiotics (cefotaxime)
What causes raised intra-cranial pressure? (4)
-Mass effect (e.g. tumour)
-Increased venous pressure
-CSF build up
What are the symptoms of raised intra-cranial pressure? (3)
-Headache (worse when lying)
What are the signs of raised intra-cranial pressure? (2)
-Left temporal headache for 2 weeks (>> jaw)
-Visual disturbance this morning
DIAGNOSIS: temporal arteritis
MANAGEMENT: -high dose steroids (prednisolone)
-temporal artery biopsy
What is temporal arteritis?
Condition where medium/large arteries in the head and neck become inflamed.
What are the signs & symptoms of temporal arteritis?
-Transient vision loss
-Non-pulsatile temporal artery
-3 month episodic headache (R temporal/occipital)
-Nausea & dizziness
- Black dots in vision
-Left hemi-sensory disturbance
MANAGEMENT: -brain imaging
-analgesics (e.g. triptans)
-Preventative treatment (e.g. propanolol)
What are the triggers for migraines?
What is the pathophysiology of migraines?
Cortical spreading depression (brain waves slow down).
What are coloured dots in the visual field likely to be due to?
What are black and white dots in the visual field likely to be due to?
Likely to be due to migraines.
-severe gradual onset unilateral right orbital pain
-agitated & tachycardia
-streaming red eye with eyelid droop
DIAGNOSIS: trigeminal autonomic cephalgias
CHARACTERISTICS: short-lasting headaches & autonomic features (e.g. eyelid droop)
MANAGEMENT: -pain relief (sumatriptan)
What is trigeminal autonomic cephalgias?
Pain on one side of head.
-activation of trigeminal systems.
What are the 3 types of trigeminal autonomic cephalgias?
-intermittent bilateral headache for few months
('tight band around head')
DIAGNOSIS: tension headache (mild migraine)
What is new daily persistent headache?
-Similar to tension headache
-No previous headache history
What are the causes of new daily persistent headache?
What is idiopathic intracranial hypertension?
Increased intracranial pressure in the absence of tumour/disease.
Who is idiopathic intracranial hypertension common in?
Women of child bearing age.
-too much CSF >> headache
What is chronic daily headache?
Headache lasting >4 hours on >15 days per month, for >3 months.
What causes chronic daily headache?
-Previous episodic headache (transformed migraine, etc.)