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HEADACHES - Coggle Diagram
HEADACHES
primary headache disorders
usually begin in childhood/early adulthood (<40 yrs)
Migraine
triggers: stress, foods, menstruation, medication, alcohol, sleep deprivation
neurovascular disorder with vascular changes secondary to abnormal neuronal activation
primary dysfunction in brainstem nuclei involved in nociceptive modulation of craniovascular afferents
spreading depression (initial depolarisation causes positive phenomenons e.g. scintillations and then followed by slowly spreading inhibition causing deficits e.g. visual loss
flashing lights (photopsia and teichopsia)
blurred/shimmering vision and scotomatous defects (hole in vision)
temporal vessels may be tender
headache
progressive and crescendo (gradual increase in intensity)
onset soon after awakening
last 4-72 hours (untreated)
moderate-severe pain
unilateral, pulsating, aggravation by physical activity
photophobia and phonophobia
N/V, auras
antiemetics
focal neurological deficits
mild: paracetamol, NSAIDs, acetylsalicylic acid, propoxyphene
severe: triptans (5-HT1B/1D receptor agonists)
must be used early
avoid narcotics due to rebound headache (medication overuse)
ergot alkaloids effective but cause vasospasm of coronary arteries
prophylaxis
antiepileptics, ß-blockers, anti-hypertensives, magnesium, etc.
tension headache
stress headache
gradual onset
tight banding pain bilaterally around temples and back of head/neck
non-pulsating
mild-moderate pain (less severe than migraine)
no sensitivity to light/sound, no N/V
triggers: stress, anxiety, depression (no aggravation by physical activity)
cluster headaches
(uncommon)
pain around one eye/side of face
brief but severe pain
occurs in 'clusters' e.g. time of day, seasons, etc.
associated with nasal stuffiness and eye watering on ipsilateral side
100% oxygen, steroids, migraine drugs, NSAIDs
prophylaxis with Ca2+ channel blockers e.g. verapamil
secondary/symptomatic headaches
intracranial haemorrhage
causes
following injury
spontaneous: aneurysm, AV malformation, reversible cerebrovascular spasm (due to cocaine, etc.)
raised intracranial pressure
irritation of meninges
neck pain/stiffness
very sudden onset, different quality, worst severity
thunderclap headache
primary TCH (recurs intermittently, spontaneous and benign)
secondary TCH (serious brain disorder)
pain worst at onset then improves
N/V, photophobia (similar to migraine)
low grade fever
focal neurological signs and maybe LOC
anticoagulants, elderly, HT
antihypertensives
CT and lumbar puncture
supportive, medications, surgery
meningitis
viral/bacterial infection of meninges
ENT/gastro infection symptoms preceding
meningococcal meningitis
rapidly progressive, medical emergency
chronic meningitis
slower progress (weeks-months)
TB, mycobacteria, cryptococcus, parasites
constant, generalised pain
photophobia
neck/back pain and stiffness
mental state changes/seizures
suggests encephalitis
tumour
increased ICP
progressive (weeks-months)
temporal/giant cell arteritis
always a differential if >55 years old
if untreated, leads to severe neurological deficits
temporal artery prominence/tenderness
severe pain
polymyalgia rheumatica (migrating pain in joints/proximal limbs)
visual symptoms/retinal signs
confirmed by elevated ESR
easily treated with steroids