20 - headache Flashcards
Headache red flags…there’s loads so name a few
Fever, sudden onset, new neuro or cognitive deficit, change in personality, history of recent head trauma or malignancy, Valsalva positive, orthostatic features, HIV or immunocompromised
Sx of tension? triggers? mx? prevention?
Bilateral pressing sensation across the eyes with little other symptoms. Lasts 30 minutes.
Usually triggered by stress and dehydration.
Treat with aspirin, paracetamol or NSAID. Do not offer opioids. Reassure
TCAs and acupuncture may prevent in the long term.
Features of migraie?
When to investigate?
triggers?
Unilateral (can be bilateral) pulsating headache. Affects ADLs. Photo and phonosensitivity. Can occur with aura.
Investigate those who have motor weakness, reduced consciousness or diplopia.
Triggers of cheese, wine, menstruation, stress, chocolate, alcohol, coffee.
Migraine Mx? Prevention? what drug do you not give with migraine/aura?
Treat with sumatriptan and NSAID with or without an antiemetic
Manage with propranolol or topiramate. Consider TCAs or tranexamic acid.
Do not offer COCP
Features of cluster?
What to offer with first occurrence ?
Unilateral around the eye. Variable sharp or burning pain. Very severe. Nasal congestion, red eye, swollen eyelid, sweating, constricted pupil.
Occur like clockwork.
Offer neuroimaging with first occurrence.
Mx of cluster? treat/prevention
Treat: high flow oxygen, triptans (subcut or nasal)
Prevent: verapamil
Drugs often involved with medication overuse headache? Advice to give?
Headache which gets worse while taking paracetamol, triptans, NSAIDs or opioids etc.
Keep a headache diary.
Advise to stop taking the medication.
It gets worse before it gets better.
Who is more at risk with sinusitis / what is it? Usual cause? What to do if bacterial?
Other DDx?
Inflammation of sinuses with thick nasal plug and facial pain.
People with asthma, immunosuppression and CF are more at risk.
Common. Usually viral and self limiting.
Amoxicillin if bacteria are suspected.
DDX: tumours.
Sx of meningitis?
Fever, vomiting, lethargy, rash (if septicaemia), headache, neck stiffness, confusion, shock.
Mx of meningitis?
Abx…what if LP shows bacterial infection? Contacts get?
Urgent hospital care is warranted. IV or IM benpen (unless Hx anaphylaxis) IV Ceftriaxone (cefotaxime and ampicillin in children under 3/12) as soon as you see a rash.
Treat empirically but take bloods and LP.
Treat shock if present.
If LP shows evidence of bacterial infection than give dexamethasone.
Rifampicin or ciprofloxacin to all contacts.
2 signs for meningitis
Kernig - lift leg up
Brudzinski - Head and knees up
If you can’t picture these google
Normal ICP? 3 main causes?
Sx?
Mx?
Normall 7-15mmHg
Causes: trauma, bleed, mass,
Headache, vomiting (without nausea), papilloedema, ocular palsy,
Mannitol and treat underlying cause
What is the monro-kelie triad?
CSF, blood, and brain tissue
Cranial compartment is fixed in size
Therefore an increase in 1 must lead to a decrease in another
Cushings triad?
Response to raised ICP
regular, decreased respirations (caused by impaired brainstem function) Bradycardia. Systolic hypertension (widening pulse pressure)
SAH - Where is the bleed? preceeded by what usually? Features? Initial Ix? RF?
Bleeding between arachnoid and pia mater.
Usually preceded by trauma or vascular malformation.
20% of all thunderclap headaches. May be preceded by sentinel headaches.
Also: reduced GCS, seizures, vomiting, meningism,
Urgent CT (highly sensitive after 6 hours) and neurosurgery for coiling
Risks: ADPKD (Berry aneurysms)
