4 - Headaches Flashcards
Red flags for headache
First and worst
Fever, neck stifness
New focal neurological deficit
Decrease in consciousness
Head trauma with in 3 months
Worse when lying down, coughing
Wakes up at night
Tenderness in temporal region
Eye pain
Symptoms of a head ache associated with meningitis
Global headache
Fever
Neck stiffness
non blanching purpuric racsh
Can also be mistaken for TB
Head ache associated with reasied ICP
decreased GCS
nausea vomiting
visual defect - blind spots, sixth nerve paulsy
HTN with bradycardia and respiratory depression
Worse in mornign, lying down and bending over
Coughing initiates headache
Papillodema
Head ache associated with Giant cell athritis
Constant headache
Unilateral scalp tenderness
loss of temporal artery pulsatility
Jaw claudication
Unilateral blindness = this is why GCA is a medical emergency
How to treat Giant cell athritis
Give immediate steroid if suspected
Blood test for ESR and CRP
Reffer for temporal artery biopsy
How is cerebral perfussion pressure calculated (CPP)
CPP = MAP - ICP
MAP = mean arterial pressure
ICP = intercranial pressure
Monro-Kellie doctrine
Brian is a closed system
Increase in either braintissue, blood and CSF lead to expulsion
Usually ICF and Blood is expelled first
Results in autoregulation of ICP
Xanthachromia CSF
Yellow CSF
due to blood break down products
indicates sub-arachnoid heamorrhage
What is an aura?
neurological symptoms before or during a head ache including:
visual disturbances
parathesia form distal to proximal
What is first line treatment for headcahes?
NSAIDS
What is second line treatment for headaches?
Triptans
5-HT agoinst
modulates trigeminal nucleus cuadalis
vasoconstriction
Rebound headache - retake 2nd dose, 2 hours after
Migrain prophylaxis
1st line: B-blockers, low does antitryptaline
2nd line: anti-epileptic, antihypertensives
Symptoms of a migraine?
unilateral
throbbing
with visual aura
last 15 to 20 minutes
nasuea vomiting
photophobia
alodynia
Symptoms of a cluster head ache?
cluster with periods of absence
10/10 pain
unilateral eye
lacrimation, miosis, patosis
Symptoms of a tension headache?
bilateral throbbing
+/- tenderness
Rebound headaches
caused by medication:
triptans
codeine
paracetamol
Trigeminal neuralgia
Paroxysmal pain lasting seconds - “stabbing”
mandibular and maxillary branches
Face reacts to pain
Why do the following routine actions in raised ICP?
1) Head tilt 30-45°
2) Avoid hyotension
3) sedation
4) eurovolemuia and hyperosmolatiry
5) maintian low pCO2
1) venous and CSF drainage
2) increase CPP
3) decrease metabolic demand
4) decrease cerebral oedema
5) avoid vasodilation –> increase blood in cranium
Types of hydrocephalus?
Obstructive - tumours, intraventricluar heamorrhage
Communicating - meningitis, subarachnoid heamorrhage
Overproduction - choroid plexus papilloma
What is the presentation of space occupying lession?
Raised ICP symptoms
focal neurological defecit
cortical/ meningeal irritaiton
hormonal dysregulation
Generally unwell
Are most primary brain tumours benign or malignant?
maligant - 58%
begnin - 42%
What is thought to be the pathophysiology of Migraine?
Cortical spreading depression
A slowly propgated wave of global depolarisation
Occurs alongside changes in cerebral blood flow
What is the most common primary brain tumour?
Gliobastoma multiform (high grade gioma) - malignant
Meningioma - benign
What type of brain tumour can surgery cure?
Benign
low grade
