Session 9 - Lecture 2: Headache Flashcards
Describe the basis of a primary headache.
Occurs due to the headache condition itself i.e. migraine, tension and cluster headache.
Describe the basis of a secondary headache.
Headache caused by another underlying condition e.g. meningitis, sinusitis, SAH and medication overuse.
What conditions would class as an emergency situation that needs to be ruled out when a patient presents with a headache.
Haemorrhages, intracranial bleed, sinus venous thrombosis, meningitis, encephalitis, abscess, acute glaucoma, tumours, giant cell arteritis, hypertension (e.g. preeclampsia).
Describe common symptoms of a space occupying lesion with someone presenting with a headache.
Gradual onset, progressive, associated neurology (e.g. change in vision), features of raised ICP (e.g. early morning headache, worse when coughing/bending).
Describe common symptoms a patient may present with migraine headache.
Unilateral, often frontal, sudden/gradual onset, throbbing/pulsating, lasts anywhere between 4-72 hours, photophobia, phonophobia, sleep will help, can gets auras and nausea and vomiting.
Describe common symptoms a patient may present with tension type headaches.
Usually bilateral, frontal, squeezing pain which is non-pulsatile, worse at the end of the day, can be caused by stress, poor posture and lack of sleep, can radiate to neck, can get ill nausea, over the counter drugs usually help.
Describe common symptoms a patient may present with medication overuse headaches.
Does not improve after OTC medications, usually caused by regular overuse (more than 3 months) of triptans, opioids, paracetamol, aspirin or NSAIDs. Usually resolves after 2 months following discontinuation of medication and may get worse before it gets better.
Describe common symptoms a patient may present with cluster headaches.
Around/behind one eye, sharp/penetrating, very severe pain at a constant intensity, rapid onset, mostly nocturnal, can last from 15 minutes to 3 hours, clusters last 2-12 weeks, remission lasts between 3 months to 3 years. Head injuries, alcohol and smoking are all causes. Eyes can become red and watery and can also get nasal congestion. Histamines, alcohol, GTN, heat, exercise, solvents and lack of sleep can all trigger.
Describe common symptoms a patents may present with trigeminal neuralgia.
90-95% caused by compression of trigeminal nerve (CN V) by loop of artery/vein and 5% are attributed to tumours. Often unilateral and over the eye area, stabbing, sharp pain commonly described as an ‘electric shock’, severe intensity, sudden onset, lasts few seconds to 2 minutes. Light touch, eating, cold wind and vibrations can all make the headache worse. This type of headache can be preceded by tingling and numbness.
If required, what further investigations could be conducted on a patient presenting with a headache with red flag symptoms?
Imaging (CT/MRI) and a headache diary.
What are common treatment therapies for headaches?
Analgesics, triptans (migraines) and high flow oxygen (cluster).
