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BRS YR2 > Headache > Flashcards

Headache Flashcards

1
Q

What are possible causes of acute, single headaches?

A
  • febrile illness, sinusitis
  • first attack of migraine
  • head trauma
  • subarachnoid haemorrhage
  • meningitis
  • tumour
  • drugs, toxins
  • stroke
  • thunderclap
  • low pressure
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2
Q

What are the possible causes of a dull headache, increasing in severity?

A
  • benign
  • overuse of medication
  • contraceptive pill
  • HRT
  • neck disease
  • temporal arteritis
  • benign intracranial hypertension
  • cerebral tumour
  • cerebral venous sinus thrombosis
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3
Q

What tends to cause a dull headache, unchanged for months?

A
  • chronic tension headache

- depressive, atypical facial pain

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4
Q

What are different forms of recurrent headaches?

A
  • migraine
  • cluster headache
  • episodic tension headache
  • trigeminal/post-herpetic neuralgia
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5
Q

What are the red flags for a headache?

A
  • onset
  • meningism
  • systemic symptoms
  • neurological symptoms or focal signs
  • orthostatic
  • strictly unilateral
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6
Q

What types of onset are red flags?

A
  • thunderclap
  • acute
  • subacute
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7
Q

What forms of meningism are red flags?

A
  • photophobia
  • phonophobia
  • stiff neck
  • vomiting
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8
Q

Which systemic symptoms are red flags?

A
  • fever
  • rash
  • weight loss
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9
Q

Which neurological symptoms are red flags?

A
  • visual loss
  • confusion
  • seizures
  • hemiparesis
  • papilloedema
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10
Q

What does orthostatic mean?

A

the headache is better when lying down

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11
Q

Which focal signs are red flags?

A
  • double vision
  • 3rd nerve palsy
  • Horner syndrome
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12
Q

How are subarachnoid haemorrhages caused?

A
  • ruptured aneurysm

- arteriovenous malformations

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13
Q

How do subarachnoid haemorrhages present?

A
  • sudden, generalised head ache (‘blow to the head’)

- meningism (photophobia, stiff neck)

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14
Q

How do you diagnose a subarachnoid haemorrhage?

A
  • 50% are instantly fatal
  • early neurological assessment
  • brain CT
  • lumbar puncture (RBC and xanthochromia)
  • MRA
  • Angiogram
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15
Q

How do you treat a subarachnoid haemorrhage?

A
  • vasospasm may stop the leak
  • nimodipine
  • blood pressure control
  • high future risk of a bleed
  • coiling an aneurysm
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16
Q

How do you manage aneurysm?

A
  • clip or wrap

- filled with a platinum coil to prevent rupture

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17
Q

How are most haemorrhages fatal?

A

due to coning

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18
Q

What is coning?

A
  • movement of the cerebellar tonsils down through the foramen magnum.
  • It leads to compression of the lower brainstem - leading to cardiovascular and respiratory instability
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19
Q

What is papilloedema?

A

optic disc swelling

- due to raised inter-cranial pressure

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20
Q

What can cause a trigger headache?

A
  • coughing, straining, exertion
  • coitus
  • food and drink
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21
Q

What are the symptoms of a carotid and vertebral artery dissection?

A
  • headache

- neck pain

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22
Q

When are carotid and vertebral arterial dissections most common?

A

mean: 40yo
carotid is more common than vertebral
(cause of 20% of ischaemic strokes in those <45yo)

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23
Q

How do you diagnose a carotid/vertebral dissection?

A
  • MRI/MRA
  • Doppler
  • Angiography
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24
Q

How do you treat a carotid/vertebral dissection?

A

aspirin or anticoagulation

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25
Q

How do chronic subdural haemorrhages present?

A
  • right frontal headache
  • unsteadiness
  • left limb weakness
    (dependent on side of the brain)
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26
Q

When is temporal arteritis most common?

A
  • > 55yo

- 3 x more common in females

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27
Q

How does temporal arteritis present?

A
  • constant unilateral headache
  • scalp tenderness
  • jaw claudication
  • elevated ESR and CRP
  • 25% polymyalgia Rheumatica-proximal muscle tenderness
  • blindness (involvement of posterior ciliary arteries)
  • inflamed and tortuous temporal artery
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28
Q

What investigations show temporal arteritis?

A
  • biopsy shows inflammation and Giant cells

- visible on ultrasound

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29
Q

How do you treat temporal arteritis?

A
  • high dose steroids

- aspirin

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30
Q

What is temporal arteritis?

A

the disruption of the internal elastic lamina

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31
Q

What is a cerebral venous thrombosis?

A

thrombosis in dural venous sinus or cerebral vein

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32
Q

How does a cerebral venous thrombosis present?

A
  • unusual amount of headache due to raised ICP
  • non-territorial ischaemia (venous infarcts)
  • haemorrhage
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33
Q

What are risk factors for a cerebral venous thrombosis?

A
  • thrombophilia
  • pregnancy
  • dehydration
  • Behcets
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34
Q

What are the different types of causes of meningitis?

A
  • viral
  • bacterial
  • tuberculous
  • fungal
  • granulomatous
  • syphilis
  • carcinomatous
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35
Q

What are the viral causes of meningitis?

A
  • coxsackie
  • ECHO
  • Mumps
  • EBV
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36
Q

What are the bacterial causes of meningitis?

A
  • Meningococci
  • Pneumococci
  • Haemophilus
  • Tuberulous
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37
Q

What are the fungal causes of meningitis?

A

cryptococci

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38
Q

What are the granulomatous causes of meningitis?

A
  • Sarcoid
  • Lyme
  • Brucella
  • Behcets
  • Syphilis
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39
Q

What are the presenting symptoms of meningitis?

A
  • malaise
  • headache
  • fever
  • neck stiffness
  • photophobia
  • confusion
  • alteration of consciousness
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40
Q

How does Herpes Simplex Encephalitis look like on a scan?

A

classic haemorrhagic changes in the temporal lobes

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41
Q

How do you manage meningitis?

A

treat then diagnose

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42
Q

How do you treat meningitis?

A

antibiotics

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43
Q

How do you diagnose meningitis?

A 
Blood and urine culture
Lumbar puncture
- increased WCC
- decreased glucose
- antigens 
- cytology 
- bacterial culture
CT/MRI
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44
Q

How does bacterial meningitis look on a scan?

A

cerebral oedema with effacement of ventricles and sulci and inflamed meninges

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45
Q

How does sinusitis present?

A
  • malaise
  • headache
  • fever
  • blocked nasal passages
  • loss of vocal resonance
  • anosmia
  • nasal or postnasal catarrh
  • local pain and tenderness
    frontal pain starts 1-2 hours after rising and clears at noon
46
Q

How does Idiopathic Intracranial Hypertension present?

A
  • headache
  • visual obstructions
  • diplopia
  • tinnitus
  • papilloedema +/- visual field loss
47
Q

When is Idiopathic Intracranial Hypertension common?

A

young, obese women

48
Q

What is a risk factor of Idiopathic Intracranial Hypertension?

A
  • hormones
  • steroids
  • antibiotics
  • vitamin E
49
Q

What is the treatment for Idiopathic Intracranial Hypertension?

A
  • weight loss
  • diuretics
  • optic nerve sheath decompression
  • lumboperitoneal shunt
  • stenting of stenosed venous sinuses
50
Q

How does raised intracranial pressure look on a scan?

A

cerebral oedema with effacement of ventricles and sulci but no mass lesion

51
Q

What can cause a low pressure headache?

A

CSF leak due to a tear in dura

  • traumatic post lumbar puncture
  • spontaneous
52
Q

What is the treatment for a low pressure headache?

A
  • rehydration
  • caffeine
  • blood patch
53
Q

How does a low pressure headache look like on a scan?

A

meningeal enhancement (bright white)

54
Q

What is a Chiari malformation?

A
  • brain that sits low in the skull
  • cerebellar tonsils descend through the foramen magnum
  • descends further when coughing and tug on the meninges, causing a cough headache
55
Q

What are the characteristics of sleep apnoea?

A
  • history of loud snoring
  • apnoeic spells
  • depression
  • impotence
  • poor work performance
  • non-refreshing sleep
  • CO2 retention
  • hypoxia
56
Q

How do you diagnose sleep apnoea?

A

sleep study

57
Q

What is the treatment/management of sleep apnoea?

A
  • nocturnal NIV

- surgery

58
Q

What is trigeminal neuralgia?

A
  • electric shock like pain in the distribution of a sensory nerve
  • any division of trigeminal
  • neurovascular conflict at point of entry of the nerve to the pons
59
Q

What can trigger trigeminal neuralgia?

A

often innocous stimuli

60
Q

What is the treatment for trigeminal neuralgia?

A
  • carbamazepine
  • lamotrigine
  • gabapentin
  • posterior fossa decompression
61
Q

What is atypical facial pain?

A

daily, constant, poorly localised deep aching or burning

62
Q

How does atypical facial pain present?

A
  • in facial or jaw bones, may extend to the neck, ear or throat
  • no lancinating
  • no conformation to the anatomical distribution og any nerve
  • no sensory nerve
63
Q

What is needed to diagnose atypical facial pain?

A
  • exclusion of pathology in teeth, temporomandibular joints, nasopharynx and sinuses
  • unresponsive to analgesics, opiates and nerve blocks
64
Q

How do you manage atypical facial pain?

A

tricyclics

65
Q

What correlates with the incidence of a post-traumatic headache?

A

a previous history of headache

66
Q

What does the incidence of post-traumatic headaches depend on?

A

the nature of the injury

  • high in car accident victims
  • low in car accident perpetrators
  • low in sports injuries
67
Q

What are the mechanisms of post-traumatic headaches?

A
  • neck injury
  • scalp injury
  • vasodilation (autonomic damage)
  • depression (delayed)
68
Q

How do you manage a post-traumatic headache?

A
  • clear education
  • prevent analgesic abuse
  • NSAIDS (ibuprofen, naproxen)
  • Tricyclic antidepressants (amitriptyline)
    (takes 3-4 years)
69
Q

What is cervical spondylosis?

A

narrowing of joint space due to a worn disc

70
Q

What is the presentation of cervical spondylosis?

A
  • bilateral
  • occipital pain, radiating forwards to the frontal region
  • steady pain
  • no nausea or vomiting
  • worsened by neck movement
71
Q

What is the management for cervical spondylosis?

A
  • rest
  • deep heat
  • massage
  • anti-inflammatory analgesics
  • over-manipulation may be harmful
72
Q

How does migraine disorder present?

A
  • tendency of repeated attacks
  • triggers
  • easily hung over
  • visual vertigo
  • motion sickness
73
Q

What are the different forms of migraine attacks?

A
  • pain only
  • pain and focal sings
  • focal symptoms only
74
Q

What are the 5 phases of a migraine?

A
  • prodrome
  • aura
  • headache
  • resolution
  • recovery
75
Q

What is the prodrome phase of a migraine?

A

changes in:

  • mood
  • urination
  • fluid retention
  • food craving
  • yawning
76
Q

What is the aura phase of a migraine?

A
  • visual changes
  • sensory numbness/paraesthesia
  • weakness
  • speech arrest
77
Q

What is the headache phase of a migraine?

A
  • head and body pain
  • nausea
  • photophobia
78
Q

What is the resolution phase of a migraine?

A
  • rest

- sleep

79
Q

What is the recovery phase of a migraine?

A
  • disturbed mood
  • food intolerance
  • hungover
80
Q

What visual symptoms happen during the aura phase of a migraine?

A

positive and negative symptoms simulatenously:

  • scintillations
  • blindspots
  • expanding C’s
  • elemental visual disturbances
81
Q

What is the treatment for an acute migraine attack?

A
  • NSAIDS (aspirin, ibuprofen)
  • Anti-emetic (paracetamol, metoclopramide)
  • soluble preparations
  • triptans-tablets, melts, nasal sprays, sc injections (vasoconstrictors)
  • CAUTION: analgesic abuse
  • TMS
  • nap
82
Q

How does TMS help treat acute migraine attacks?

A

interrupts complex networks that trigger and perpetuate migraines - caused by spreading electrical depression across the cerebral cortex

83
Q

What are the long term treatments for migraines?

A
  • lifestyle issues due to overstimulation
  • identify and avoid triggers
  • hydrate and avoid caffeine
  • avoid ready meals and take-aways
  • good sleep
84
Q

What prophylaxis can be taken for migraines?

A
  • over the counter
  • tricyclic antidepressants
  • beta-blockers
  • serotonin antagonists
  • calcium channel blockers
  • anticonvulsants
  • greater occipital nerve blocks
  • botox
  • suppress ovulation
  • Erenumab
85
Q

What are the over-the-counter options to prevent migraines?

A
  • feverfew
  • coenzyme Q10
  • riboflavin
  • magnesium
  • EPO
  • nicotinamide
86
Q

Which Tricyclic antidepressants can be taken to prevent migraines?

A

amitriptyline 7pm

87
Q

What beta-blockers can be taken to prevent migraines?

A
  • propranolol

- atenolol

88
Q

What serotonin antagonists can be taken to prevent migraines?

A
  • Pisotifen

- Methysergide

89
Q

What calcium channel blockers can be taken to prevent migraines?

A
  • Flunarazine

- Verapamil

90
Q

What anti-convulsants can be taken to prevent migraines?

A
  • Valproate
  • Topiramate
  • Gabapentin
91
Q

What is Erenumab?

A
  • injectable drug
  • monoclonal antibodies
  • disables calcitonin gene-relates peptide or its receptor (CGRP mAbs)
  • halved migraines
92
Q

What can Erenumab treat?

A
  • episodic migraines
  • chronic migraines
  • cluster headaches
93
Q

What is a tension headache?

A

tight muscles around the head and neck bilaterally

94
Q

What is the treatment for tension headaches?

A
  • NSAIDS (ibuprofen, naproxen, diclofenac)
  • Paracetamol
  • Tricyclic antidepressants (amitriptyline 50-75mg daily)
95
Q

What is a cluster headache?

A

severe unilateral pain lasting 15-180 minutes untreated

classified as: trigeminal autonomic cephalgia

96
Q

How does a cluster headache present?

A
  • forehead and facial sweating
  • miosis and/or ptosis
  • restlessness or agitation
  • 1-8 daily
  • (at least one) ipsilaterally:
    conjunctival redness and/or lacrimation
    nasal congestion and/or rhinorrhea
    eyelid oedema
    (most common site of pain is the eye)
97
Q

What is the acute treatment of a cluster headache?

A
  • inhaled oxygen (inhibits neuronal activation in the trigeminocervical complex)
  • s/c or nasal sumatriptan
98
Q

What can prevent a cluster headache?

A
  • Verapamil
  • Prednisolone
  • Lithium
  • Valproate
  • Gabapentin
  • Topiramate
  • Pizotifen
99
Q

What is the difference in distribution between migraines and cluster headaches?

A

migraines are more common in women, vice versa for cluster headaches

100
Q

What is the difference in duration between migraines and cluster headaches?

A

migraines last 3-12 hours

cluster headaches last 45min-3 hours

101
Q

What is the difference in frequency between migraines and cluster headaches?

A

migraines: 1-8 monthly

cluster headaches: 1-3 daily (often at night)

102
Q

What is the difference in remission between migraines and cluster headaches?

A

remission is longer in cluster headaches

103
Q

What is the difference in nausea between migraines and cluster headaches?

A

nausea and vomiting is common in migraines but rare in cluster headaches

104
Q

What is the difference in symptoms between migraines and cluster headaches?

A

migraines: visual or sensory auras

cluster headaches: eye waters, blocked nose and ptosis

105
Q

What is the difference in pain between migraines and cluster headaches?

A

migraines: pulsating hemicranial pain

cluster headaches: steady, severe, localised, unilateral)

106
Q

What is the difference in activity between migraines and cluster headaches?

A

migraine: lie in dark

cluster headaches: pacing common

107
Q

What are the most common primary headaches?

A
  • migraine
  • tension headaches
  • cluster headaches
108
Q

What should be given to treat migraine without aura?

A
  • nasal sumatriptan

- oral, oro-dispersable wafers

109
Q

What should be used to treat cluster headaches?

A
  • s/c or nasal triptan
  • home/ambulatory oxygen
  • Verapamil (Ca channel blocker) for prophylaxis
110
Q

What should NOT be given to treat cluster headaches according to NICE?

A
  • paracetamol
  • NSAIDS
  • oral triptans
  • ergots
  • opiods

BRS YR2 (70 decks)

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