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Neurology and Neuroscience > Headache > Flashcards

Headache Flashcards

1
Q

What is a headache?

A

Is a symptom

Can be due to:

  • structural
  • pharmacological
  • psychological
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2
Q

What patterns of headache are there?

A
  • Acute headache
  • Dull headache increasing in severity
  • Triggered headache
  • Recurrent headaches
  • Dull unchanging headache
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3
Q

What red flags are there with headaches to distinguish what is serious?

A

Onset : thunderclap, acute, subacute

Meningism : photophobia, phonophobia, stiff neck, vomiting

Systemic symptoms : fever, rash, weight loss

Neurological symptoms: visual loss, confusion, seizures, hemiparesis, double vision, 3rd nerve palsy, Horner syndrome

Orthostatic- better lying down

strictly unilateral

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4
Q

How does a subarachnoid heamorrhage headache feel?

A

Sudden generalised headache ‘blow to the head’

meningism - stiff neck and photophobia - blood is irratant in subarachnoid space

Most are caused by ruptured aneurysm, some from arteriovenous malformations

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5
Q

How to deal with a subarachnoid haemorrhage?

A

50% are fatal

Vasosppasm may stop the leak, use nimodipine and BP control

there is a high risk of further bleed

Can do a lumbar punction ( RBC, xancthochromia ) to double check if there is a bleed in the brain

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6
Q

How do we coil an aneurysm?

A
  • Used to be clipped or wrapped by skull removed

- Nowdays it is filled with platinum coils through a cathetar from groin

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7
Q

Why is intracranial bleeding so bad because it raises pressure?

A
  • Raised intracranial pressure = ICP

There is a weak point at falx and tenant, foramen magnum

if there is a bleed or tumour the brain can tolerate to a certain point without pressure raising.

After this point pressure climbs extensively

Brain will start seeping into areas of weakness : falcine / tentorial herniation

This is the MECHANISM OF CONING = brain will squeeze out and squash it, loses its blood supply and hence brain stem death

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8
Q

What is papilloedema and what is its clinical relevance?

A

Optic disk swelling due to raised ICP : can se swelling at the back of the eye

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9
Q

How can pathology of the large arteries of the neck cause headaches?

A

The layers of tissue in the vessels can split and blood can collect there causing turbulent flow ( artery dissection )

Cause of headache + neck pain

Common cause of stroke in young people

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10
Q

If a px gets a carotid artery dissection what is the pain pattern?

A
  • phantom of the opera mask distrubution : eye and forehead pain
  • More common than vertebral artery.
  • due to trauma e.g. seatbelt snag
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11
Q

If a px gets a vertebral artery dissection what is the pain pattern?

A

Occipital headache at back of head and neck

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12
Q

What can ehlers danlos syndrome increase the risk of?

A
  • large artery dissection
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13
Q

How to diagnose artery dissection?

  • how to treat?
A

MRI and MRA, angiogram

US of blood vessels to see flow

treat with aspirin or anti-coagulants to stop clotting and prevent strokes

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14
Q

What is a subdural haemorrhage?

A

Due to vein ruptures ( veins are thin and suceptible )

common in elderly due to falls and anticoagulants

  • if it is a chronic subdural haemorrhage the blood will look dark on CT
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15
Q

What is Temporal arteritis?

A

Common in women over 55

constant unilateral headache, scalp tenderness, jaw claudification

polymyaglia rheumatica proximal muscle tenderness

this involves posterior ciliary arteries and so can cause blindness so very important!

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16
Q

How to test for temporal arteritis?

A

Elevated ESR + CRP
temporal artery are usually inflamed and tortuous

visible on US

biopsy to see signs of inflammation + giant cells

Give high dose of steroids and aspirin

17
Q

What would you see in a arteritis biopsy?

A

disruption of internal elastic lamina

in temporal : lots of giant cells * also called giant cell arteritis

18
Q

What is a cerebral venous thrombosis?

A

In dural venous sinus or cerebral vein

unusual headache due to raised ICP

non-territorial ischaemia ‘venous infarcts’

Haemorrhage

Thrombophilia, pregnancy, dehydration and Behcets ( all makes blood sticky * check headaches in post partum women )

19
Q

What is Meningigtism what causes it?

A

Viral : Coxsackie, ECHO, Mumps, EBV

  • the one we worry about is Bacterial - Meningococci, Pneumococci, Haemophilus Tuberculous

Fungal - Cryptococci

Granulomstous - Sarcoid, lyme, Brucella, Syphilis

Carcinomatous

20
Q

What is the presenting symptoms of meningitas?

A

( very similar to subarachnoid haemorrhage )

  • Malaise
  • Headache
  • Fever!! give away
  • Neck stiffness
  • Photophobia
  • Confusion
  • Alteration of consciousness
21
Q

What is Herpes Smplex Encephalitis?

A

Classic haemorrhagic changes in the temporal lobe

  • when infection affects the matter of the brain not just CSF
22
Q

How to handle a meningitis patient?

A

Treat first then diagnose

  • Antibiotics
    then take blood and urine culture, then lumbar culture to check :
  • increased w.b.c
  • decreased glucose
  • antigens
  • cytology
  • bacterial culture
23
Q

Why do you have to do a CT or MRI before a meningitis lumbar puncture?

A

The brain swells in bacterial meningitis

if you put a needle in someones back it decrompresses the high pressure and brain can collapse down foramen magnum

24
Q

What is Sinusitis?

A

Infection * wont kill you

  • Malaise
  • Headache
  • Fever
  • BLOCKED nasal passages
  • loss of vocal resonance
  • Anosmia
  • Nasal or postnasal
  • Local pain and tenderness
25
Q

What is a glioblastoma multiforme?

A

Shows on Ct scan with swelling

A lot of pressure that causes sulcus markings missing on hemisphere under pressure
* in high pressure on Ct shows small ventricles and less sulcus markings

26
Q

What is idiopathic intracranial hypertension?

A

Pressure may suggest tumour but if there isnt any it is Pseudotumor cerebri

Often young obese women
Visual obscuration, diplopia, tinnitus
Papilloedema +/- visual field loss

Can be caused by hormes e.g. OCP, steroids, antibiotics, vit E

27
Q

What are the treatments for idiopathic intracranial hypertension?

A
  • Weight loss!!
  • Diuretics
  • optic nerve sheath - decrompression
  • Lumboperitoneal shunt
  • Stenting of stenosed venous sinuses
28
Q

What are Low pressure headaches caused by?

How can we treat this?

A

CSF leak due to tear in dura

Traumatic post lumbar puncture or spontaneously

Rehydration, caffeine, blood patch ( px own blood injected to fill up hole )

  • orthostatic headache hallmark
29
Q

How to diagnose low pressure headaches?

A

Intense meningeal enhancement ( very white ) when looking at MRI with contrast injection

30
Q

What is Chiari Malformation?

A

Normal brain but it sits very LOW within the skull

  • Cerebellar tonsils are so low they are descending through foramen magnum

If a px sneezes or coughs it descends more and snags on meninges and causes really bad short lived pain

31
Q

How to treat Chiari Malformation?

A

Surgery to remodel skull to remove snagging

treat coughs and sneezes

32
Q

How does obstructive sleep apnoea cause headaches?

A
  • History of loud snoring and apnoeic spells
  • Hypoxia and CO2 RETENTION = vasodilator

Causes banging headache

Symtoms of depression, impotence, poor performance at work

Require sleep study and can give CPAP ( Nocturnal NIV ) or surgery

33
Q

What is a Trigeminal Neuralgia?

A
  • electric shock like pain in the distribution of a sensory nerve
  • triggered by innocuous stimuli
  • due to blood vessels around nerves and sometimes flows too close so when blood vessel touches nerve it can cause pain
  • first division of trigeminal does scalp and face sensation so can cause headaches

Can be a symptom of M.S

34
Q

How to treat trigeminal neuralgia?

A

( anti convulsants )

  • Carbamazepine
  • Lamotrigine
  • Gabapentin
  • Posterior fossa decompression for really bad cases, separete nerve from blood vessel
35
Q

What is atypical facial pain?

A

Depressed / anxious middle aged women

Deep localised aching or burning pain in cheek or jaw or down neck and ear

Treat with painkillers, opiates, nerve blocks and tricyclics

36
Q

How to treat post traumatic headache?

A

( more common in victims of trauma e.g. not the person who caused the car accident the person in the other car * so has a psychological element )

Prevent analgesic abuse
Non-steroidal anti-inflammatories, ibuprofen / naproxen

Tricylic antidepressents - amitrypline

37
Q

What is cervical spondylosis?

A

Commonest cause of new headache in older px:

bilateral
occipital pain radiating to front
Steady pain
No nausea or vomiting
But worsened when moving the neck
38
Q

How to treat cervical spondylosis?

A
  • rest
  • deep heat
  • massage
  • anti inflammatory analgesics

Neurology and Neuroscience (21 decks)

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