4 - Headaches

Question 1

Red flags for headache

Answer 1

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

Question 2

Symptoms of a head ache associated with meningitis

Answer 2

Global headache

Fever

Neck stiffness

non blanching purpuric racsh

Can also be mistaken for TB

Question 3

Head ache associated with reasied ICP

Answer 3

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

Question 4

Head ache associated with Giant cell athritis

Answer 4

Constant headache

Unilateral scalp tenderness

loss of temporal artery pulsatility

Jaw claudication

Unilateral blindness = this is why GCA is a medical emergency

Question 5

How to treat Giant cell athritis

Answer 5

Give immediate steroid if suspected

Blood test for ESR and CRP

Reffer for temporal artery biopsy

Question 6

How is cerebral perfussion pressure calculated (CPP)

Answer 6

CPP = MAP - ICP

MAP = mean arterial pressure

ICP = intercranial pressure

Question 7

Monro-Kellie doctrine

Answer 7

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

Question 8

Xanthachromia CSF

Answer 8

Yellow CSF

due to blood break down products

indicates sub-arachnoid heamorrhage

Question 9

What is an aura?

Answer 9

neurological symptoms before or during a head ache including:

visual disturbances

parathesia form distal to proximal

Question 10

What is first line treatment for headcahes?

Answer 10

NSAIDS

Question 11

What is second line treatment for headaches?

Answer 11

Triptans

5-HT agoinst

modulates trigeminal nucleus cuadalis

vasoconstriction

Rebound headache - retake 2nd dose, 2 hours after

Question 12

Migrain prophylaxis

Answer 12

1st line: B-blockers, low does antitryptaline

2nd line: anti-epileptic, antihypertensives

Question 13

Symptoms of a migraine?

Answer 13

unilateral

throbbing

with visual aura

last 15 to 20 minutes

nasuea vomiting

photophobia

alodynia

Question 14

Symptoms of a cluster head ache?

Answer 14

cluster with periods of absence

10/10 pain

unilateral eye

lacrimation, miosis, patosis

Question 15

Symptoms of a tension headache?

Answer 15

bilateral throbbing

+/- tenderness

Question 16

Rebound headaches

Answer 16

caused by medication:

triptans

codeine

paracetamol

Question 17

Trigeminal neuralgia

Answer 17

Paroxysmal pain lasting seconds - “stabbing”

mandibular and maxillary branches

Face reacts to pain

Question 18

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

Answer 18

1) venous and CSF drainage
2) increase CPP
3) decrease metabolic demand
4) decrease cerebral oedema
5) avoid vasodilation –> increase blood in cranium

Question 19

Types of hydrocephalus?

Answer 19

Obstructive - tumours, intraventricluar heamorrhage

Communicating - meningitis, subarachnoid heamorrhage

Overproduction - choroid plexus papilloma

Question 20

What is the presentation of space occupying lession?

Answer 20

Raised ICP symptoms

focal neurological defecit

cortical/ meningeal irritaiton

hormonal dysregulation

Generally unwell

Question 21

Are most primary brain tumours benign or malignant?

Answer 21

maligant - 58%

begnin - 42%

Question 22

What is thought to be the pathophysiology of Migraine?

Answer 22

Cortical spreading depression

A slowly propgated wave of global depolarisation

Occurs alongside changes in cerebral blood flow

Question 23

What is the most common primary brain tumour?

Answer 23

Gliobastoma multiform (high grade gioma) - malignant

Meningioma - benign

Question 24

What type of brain tumour can surgery cure?

Answer 24

Benign

low grade