Headache Flashcards
What is headache
Headache is a symptom
What are the causes of headache
some structural ie scalp, earache , pharmacological , psychological regions
What are the 5 types of headache
1) acute single headache
2) Dull headache increasing in severity
( 1 + 2 indicates smt more serious)
3) dull headache , unchanged over moths ( most common presenting complaint)
4) Triggered headache
5) Recurrent headaches
( 3 + 5 most common presenting complaint )
What are the causes of acute single headache and what are the symptoms
Febrile (fever) illness, sinusitis First attack of migraine Following a head injury Subarachnoid haemorrhage Meningitis Tumour Drugs Toxins Stroke
symptoms:
Thunderclap : headache like you’ve been hit by something
What are the causes of dull headache, increasing in severity
odeine) Contraceptive pill, HRT Neck disease Temporal arteritis (inflammation of temporal arteries) Benign intracranial hypertension Cerebral tumour Cerebral venous sinus thrombosis
what are the causes of dull headache, unchanged over months
Chronic tension headache
Depressive, atypical face pain
what are the causes of triggered headache
Coughing, straining, exertion
Coitus (sex)
Food and drink
What are the causes of recurrent headaches
Migraine
Cluster headaches
Episodic tension headache
Trigeminal or post-herpetic neuralgia
What is neuralgia
neuralgia
Intense, typically intermittent pain along the course of a nerve, especially in the head or face
what are the red flag symptoms of headache
Onset - thunderclap, acute, subacute
Meningism - Photophobia, phonophobia, stiff neck, vomiting
Systemic symptoms - fever, rash, weight loss
Neurological symptoms or facial signs - visual loss, confusion, seizures, hemiparesis, double vision, 3rd nerve palsy, Horner syndrome, papilledema
Orthostatic ( headache when upright but better lying down)
Strictly unilateral ( headache in exactly same spot every time)
Focal Signs:
Double vision
3 rd nerve palsy – oculomotor (Posterior communicating artery aneurysm can rupture and cause hemorrhage damaging oculomotor nerve)
Symptoms: Ptosis ( droopy eye muscle) and dilated pupil, down and outward gaze.
These are things that are innervated by the CNIII
Superior oblique and lateral rectus functional.
Horner syndrome – Sympathetic cervical chain of ganglia affected aka sympathetic nervous system to eye is affected causing:
eye to drop , enophthalmos , smaller pupil
what is 3rd nerve palsy
oculomotor (Posterior communicating artery aneurysm can rupture and cause hemorrhage damaging oculomotor nerve)
Whar are symptoms of CNIII palsy
Symptoms: Ptosis ( droopy eye muscle) and dilated pupil, down and outward gaze.
These are things that are innervated by the CNIII
Superior oblique and lateral rectus functional.
What is horner’s syndrome
Horner syndrome – Sympathetic cervical chain of ganglia affected aka sympathetic nervous system to eye
What are they symptoms of horner’s syndrome
eye to drop , enophthalmos , smaller pupil
what are the 6 categories of the causes of headaches
1) vascular and circulatory causes
2) Infectious
3) intercranial pressure
4) Facial pain
5) trauma
6) cervicogenic pain
What are the 7 vascular and circulatory causes of headache
1) Subarachnoid
2) aneurysm ( ie subarachnoid haemorrhage)
3) Acute intracerebral bleed
5) carotid and veterbral artery dissection
6) chronic subdural haemorrhage
7) temporal arteritis
8) cerebral venous thrombosis
What are the causes and symptoms of subarachnoid haemorrhage
thunderclap headache, sudden onset often described as “ hit on the head”
common cause: ruptured berry aneurysm
rare: arteriovenous malformations .
Can get unexplained SA haemorrhages
Symptoms → meningism: accumulation of blood within subarachnoid space irritates the meninges → stiff neck + photophobia
50% fatal bc aneurysm
what are the causes , treatments and investigation for a headache caused by aneurysm
50% fatal
Treatment:
Vasospasm to minimise bleeding.
Nimodipine & BP control
Early neurosurgical assessment to confirm bleed and establish cause as patient is at high risk of further bleeds:
CT brain, lumbar puncture (will be pink or read due to RBC and xanthochromia) and MRA, angiogram.
Note only do lumbar puncture if no visible blood on CT scan
Always do MRA, angiogram though
Treatment: fill aneurysm with platinum coils so it no longer fills with blood ( see pic on left)
What is coning?
fatal haemorrhage
falx + tentorium cerebelli: weak points → brain exhibits compliance ( aka can tolerate bleed up to a certain point without raising intracranial pressure) to accomodate large blood clot . However when volume is too large compliance is lost
What is falcine / tentorial herniation
high intracranial pressure →falcine/ tentorial herniation ( herniation causes brain to distend ( aka squeeze out of ) through foramen magnum) → compression of lower brainstem and upper cervical SC
what can an acute intracerebral bleed lead to ?
Coning
and falcine / tentorial herniation
what is paillodema
igh intracranial pressure →falcine/ tentorial herniation ( herniation causes brain to distend ( aka squeeze out of ) through foramen magnum) → compression of lower brainstem and upper cervical SC
what is the causes of carotid and vertebral artery dissection
20% of ischaemic strokes <45 years (young stroke)
Mean age: 40, carotid dissection more common > vertebral
Be due to Traumatic vs Spontaneous ( ehlers danlos)
Why does headache occur due to carotid and vertebral artery dissection
Headache can occur due to pathology in large arteries of the neck
artery dissection: tear in arterial lumen - blood accumulates within teared lumen to the extent that a false lumen appears → causes turbulent flow in true lumen as false lumen gets larger
this causes clots to occur
what is arty dissection
artery dissection: tear in arterial lumen - blood accumulates within teared lumen to the extent that a false lumen appears → causes turbulent flow in true lumen as false lumen gets larger
what causes clot formation
clot formation: turbulent flow potentiates thrombotic environment
what are the symptoms of headache caused by carotid and vertebral artery dissection
Common symptoms : headache + neck pain
occipital headache occur due to vertebral artery dissection
phantom of opera mask pain distribution: carotid artery dissection
what ehlers Danlos syndrome
predisposes individuals to a dissection.
what are the investigations and treatments for carotid and vertebral artery dissection
Investigations: MRI/MRA, doppler, angiography ( inject dye into blood vessels to see blood vessels)
Treatment: Aspirin or anticoagulation (6/12) – to minimise the risk of embolism, stroke and blood clot.
what are the causes , treatment and investigation
of headaches caused by chronic subdural haemorrhage
Disrupted cortical veins → subdural bleed.
Tendency to bleed increases in patients with anticoagulants.ie old ppl
Asymmetric herniation
Asymmetric deviation of the ventricles.
CT note : Blood is hypodense (degradation of blood – thus the age of the blood can be determined by the degree of hypodensity. Aka blood left for longer is dark and new blood is light
