Headache Flashcards
What is a headache?
Is a symptom
Can be due to:
- structural
- pharmacological
- psychological
What patterns of headache are there?
- Acute headache
- Dull headache increasing in severity
- Triggered headache
- Recurrent headaches
- Dull unchanging headache
What red flags are there with headaches to distinguish what is serious?
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
How does a subarachnoid heamorrhage headache feel?
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
How to deal with a subarachnoid haemorrhage?
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
How do we coil an aneurysm?
- Used to be clipped or wrapped by skull removed
- Nowdays it is filled with platinum coils through a cathetar from groin
Why is intracranial bleeding so bad because it raises pressure?
- 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
What is papilloedema and what is its clinical relevance?
Optic disk swelling due to raised ICP : can se swelling at the back of the eye
How can pathology of the large arteries of the neck cause headaches?
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
If a px gets a carotid artery dissection what is the pain pattern?
- phantom of the opera mask distrubution : eye and forehead pain
- More common than vertebral artery.
- due to trauma e.g. seatbelt snag
If a px gets a vertebral artery dissection what is the pain pattern?
Occipital headache at back of head and neck
What can ehlers danlos syndrome increase the risk of?
- large artery dissection
How to diagnose artery dissection?
- how to treat?
MRI and MRA, angiogram
US of blood vessels to see flow
treat with aspirin or anti-coagulants to stop clotting and prevent strokes
What is a subdural haemorrhage?
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
What is Temporal arteritis?
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!
How to test for temporal arteritis?
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
What would you see in a arteritis biopsy?
disruption of internal elastic lamina
in temporal : lots of giant cells * also called giant cell arteritis
What is a cerebral venous thrombosis?
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 )
What is Meningigtism what causes it?
Viral : Coxsackie, ECHO, Mumps, EBV
- the one we worry about is Bacterial - Meningococci, Pneumococci, Haemophilus Tuberculous
Fungal - Cryptococci
Granulomstous - Sarcoid, lyme, Brucella, Syphilis
Carcinomatous
What is the presenting symptoms of meningitas?
( very similar to subarachnoid haemorrhage )
- Malaise
- Headache
- Fever!! give away
- Neck stiffness
- Photophobia
- Confusion
- Alteration of consciousness
What is Herpes Smplex Encephalitis?
Classic haemorrhagic changes in the temporal lobe
- when infection affects the matter of the brain not just CSF
How to handle a meningitis patient?
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
Why do you have to do a CT or MRI before a meningitis lumbar puncture?
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
What is Sinusitis?
Infection * wont kill you
- Malaise
- Headache
- Fever
- BLOCKED nasal passages
- loss of vocal resonance
- Anosmia
- Nasal or postnasal
- Local pain and tenderness
