Headache Flashcards
What are potential causes for acute single headaches?
Febrile illness, sinusitis First attack of migraine Following a head injury Subarachnoid haemorrhage Meningitis, tumour, drugs, toxins, stroke Thunderclap (sudden onset), low pressure FSM HHMT
What are potential causes for a dull headache that increases in severity?
Overuse of medication (e.g. codeine) Contraceptive pill, hormone replacement therapy Neck disease Temporal arteritis Benign intracranial hypertension Cerebral tumour Cerebral venous sinus thrombosis
What are causes for a dull headache that doesn’t change over months?
Chronic tension headache
Depressive, atypical facial pain
What are causes of recurrent headaches?
Migraine
Cluster headache
Episodic tension headache
Trigeminal or post-herpetic neuralgia
What are potential triggers for headaches?
Coughing, straining, exertion
Coitus
Food and drink
What are 6 red flags for headaches?
- Type of onset - thunderclap, acute, subacute
- Meningism - Photophobia, phonophobia, stiff neck, vomiting
- Systemic symptoms - fever, rash, weight loss
- Neurologic symptoms/focal signs - Visual loss, confusion, seizures, hemiparesis, double vision, 3rd nerve palsy, Horner syndrome, papilloedema
- Orthostatic - if better when lying down
- Strictly unilateral
What is oculomotor palsy and why does it occur?
Oculomotor palsy occurs when nerve is compressed or blood supply lost due to aneurysm. Supplies all muscles except lateral rectus and superior oblique. Main signs are ptosis as levator supply affected and loss of pupil reflex (dilated pupils) if dropping eyelid lifted.
What is Horner syndrome?
Sympathetic supply of eye is affected resulting in eyelid droop.
What are markers of a subarachnoid haemorrhage and what causes one?
Marked by a sudden generalised headache and meningism (photophobia + stiff neck). Most are caused by a ruptured aneurysm, a few from arteriovenous malformations and some are unexplained. Ruptured berry aneurysms common cause (usually occur in Circle of Willis).
How is a subarachnoid haemorrhage managed and treated?
50% instantly fatal but vasospasm may stop leak. High risk of further bleed.
- Neurosurgical assessment - confirm bleed + establish cause
- CT of brain + Lumbar puncture to check for RBC and xanthochromia (bilirubin in CSF which is sometimes the only sign of a SH) + MRA + angiogram
- Nimodipine and BP control - nimodipine is a calcium channel blocker and relaxes + dilates blood vessels in the brain allowing greater supply of blood and preventing brain damage.
How is an aneurysm treated?
Used to be clipped/wrapped but now filled with platinum coils.
How does coning cause an acute intracerebral bleed?
Coning refers to when the brain is squeezed out of the skull. The brain has weak points and is made of components. If there is an increase in blood volume due to blood products, brain can tolerate up to a certain limit without an increase in pressure. However, past that point, for a small increase in volume, pressure climbs quite dramatically. As pressure rises, brain starts to seep under these areas of weakness – subfalcine/tentorial herniation.
Why is coning fatal?
Brainstem contains control centres for vital respiratory activities so if that is squashes and loses blood supply, results in death.
What does papilloedema signify?
Raised intracranial pressure as can be seen at back of retina via optic disk swelling
What is carotid/vertebral artery dissection?
Carotid artery surrounded by layers of tissue but this can sometimes split and cause a pooling of blood in the split layers. Therefore turbulent flow of blood occurs leading to formation of blood clots which can lodge in different parts of the brain and also cause pain.
How are carotid and vertebral artery dissections differentiated?
Vertebral artery dissections cause pain in the occipital region of the head while carotid artery dissections cause pain in a phantom of the opera mask region of the head.
Describe epidemiology of carotid/vertebral artery dissections
Makes up for 20% of ischaemic strokes <45 years (young stroke). Mean age is 40 years and carotid more common than vertebral. Usually occurs following a trauma event to the carotid/vertebral arteries. Can however be spontaneous sometimes.
How are carotid/vertebral artery dissections investigated and treated?
Investigated through MRI/MRA, Doppler, Angiography
Treatment: Aspirin and anticoagulants to prevent formation of blood clots and therefore strokes.
Describe the epidemiology and symptoms of temporal arteritis?
3x more common in women. Mainly affects those over the age of 55. Constant unilateral headache, scalp tenderness and jaw claudication.
JUS 355
What are causes of temporal arteritis?
25% Polymyalgia Rheumatica-proximal muscle tenderness.
Involvement of the posterior ciliary arteries causes blindness.
Caused by disruption of internal elastic lamina
What are characteristics of temporal arteritis?
Elevated ESR and CRP.
Temporal artery are usually inflamed and tortuous.
Visible on ultrasound.
Biopsy shows inflammation and Giant Cells.
Treated with a high dose of steroids and aspirin
ETUBS
What is cerebral venous thrombosis and what causes it?
Thrombosis in dural venous sinus or cerebral vein. Unusual amount of headache due to raised ICP.
Caused by:
Non-territorial ischaemia “venous infarcts”
Haemorrhage
Thrombophilia, pregnancy, dehydration, Behcets
What are the viral, bacterial and fungal causes of meningitis?
Viral- Coxsackie, ECHO, Mumps, EBV
Bacterial - Meningococci, Pneumococci, Haemophilus
Tuberculous
Fungal - Cryptococci
What are other causes of meningitis?
Granulomatous- Sarcoid, Lyme, Brucella, Behçet’s, Syphilis
Carcinomatous
