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1 Neurology > Headache > Flashcards

Headache Flashcards

1
Q

Differentials for acute onset headache

A

SAH
Raised ICP
Meningitis
Venous sinus thrombosis

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2
Q

Where is the headache/pain located in SAH?

A

occpital region

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3
Q

Where might you see blood in CT of a patient with SAH?

A

circle of willis and ventricles

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4
Q

What is a cause of SAH?

A

berry aneurysm

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5
Q

What is the treatment for SAH?

A

vasospasm- nimodipine

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6
Q

Which organism is the most common cause of meningitis in very young and old patients?

A

listeria

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7
Q

Name a virus that causes meningitis

A

HSV

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8
Q

Why do you treat meningitis with steroids?

A

to prevent hearing loss

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9
Q

Aside from taking CSF sample to investigate SAH/meningitis, what else must you do?

A

take serum sample to compare glucose, WCC etc

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10
Q

How would the CSF of fungal meningitis compare to viral cause?

A

fungal- low glucose and raised lymphocytes
viral- normal glucose and raised lymphocytes
bacterial- low glucose and raised neutrophils

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11
Q

Treatment for trigeminal neuralgia?

A

carbamazipine

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12
Q

Name two types of brain tumours

A

meningioma, glioblastoma multiforme, schwannoma

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13
Q

Which brain tumour has the worst prognosis?

A

glioblastoma multiforme

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14
Q

Which is the most common type of brain tumour?

A

secondary mets

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15
Q

Describe the headache seen with tension headaches

A

band across head

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16
Q

Describe the headache seen in cluster headaches

A

unilateral

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17
Q

Name the accompanying features of cluster headaches

A

lacrimation, conjunctival erythema, rhinorrhoea

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18
Q

What is an important differential for migraine?

A

seizures, due to visual aura

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19
Q

Which antibiotics used for meningitis in immunocompromised/older patient?

A

ceftriaxone + amoxicillin

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20
Q

Which bacteria typically causes meningitis in older/immunocompromised patients?

A

listeria monocytogenes

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21
Q

In listeria meningitis, will the CSF culture be positive?

A

less likely to be positive in CSF compared to other organisms but more likely to be positive in blood cultures

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22
Q

Which organism that causes meningitis is associated with hyponatraemia?

A

listeria

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23
Q

What is you differential diagnosis for young female with headache, nausea, papilloedema? (+seizure)

A

raised ICP: SOL, cerebral venous sinus thrombosis, idiopathic intracranial hypertension (this would not cause a seizure)

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24
Q

Investigations for raised ICP due to venous sinus thrombosis?

A

CT venogram

CT head

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25
What are the risk factors for venous sinus thrombosis?
OCP, thrombophilia, infection, dehydration (e.g. following diarrhoeal illness)
26
What is the treatment for venous sinus thrombosis?
anticoagulation for several months
27
What percentage of people with cerebral venous sinus thrombosis present with seizure?
30-40%
28
When can LP be performed in SAH?
12 hours after onset of headache
29
What is the treatment of SAH?
Reduce blood pressure + surgical input (coiling or clipping) + nimodipine (to reduce risk of secondary vasospasm)
30
WHat is the most common cause of SAH?
ruptured cerebral aneurysm (ant communicating artery)
31
Patient with headache and neck pain. The headache disappears when he lies down and is worse when standing or sitting. He had LP performed one week ago to investigate optic neuritis.
Low pressure headache due to CSF leak (spontaneous or LP)
32
What is the treatment of low pressure headache?
``` conservative rest and lie down fluids analgesia caffeine can help ```
33
List three types of primary headaches
migraine cluster headache trigeminal neuralgia tension type headache
34
Which acronym can you use for migraine?
``` POUND Pounding/throbbing hOurs in duration Unilateral Nausea/vomiting/photo/phonophobia Disabling intensity (go to bed, no work) ```
35
Name two triggers for migraines
``` chocolate cheese alcohol aspartame mesntruation ```
36
Patient with hemiplegia. Should migraine be differential?
yes- hemiplegic migraine
37
What is the treatment for acute migraine?
``` aspirin NSAIDs paracetamol triptans anti-emetics (limit use to max 2 days per week) ```
38
Which analgesia could exacerbate headache?
opioids
39
Which co-morbidity is contraindicated with triptans?
cerebral vascular disease (triptans cause vasoconstriction)
40
What is the prophylaxis for migraines?
propranolol (first line, do not use in asthma) topiramate duloxetine amitriptyline
41
In which group of people should you exert caution when prescribing topiramate for migraines?
pregnant women
42
For how long should prophylactic therapy be tried on patient before deeming ineffective?
6 weeks
43
Which sex are cluster headaches and migraines more common?
migraine- female 3:1 | cluster headache- men 4:1
44
List three autonomic features
``` arise ipsilaterally lacrimation orbital oedema nasal congestion facial sweating ptsosis/miosis ```
45
Will a person with cluster headache be sitting still to improve symptoms?
no, they will be agitated and pacing around
46
What is the treatment of cluster headaches?
acute- high flow O2 and subcut triptan
47
What is the prophylactic treatment for cluster headaches
verapamil
48
Name two triggers for trigeminal neuralgia
brushing teeth shaving combing hair
49
Differentials for trigeminal neuralgia aside from other headaches?
MS | Tumour
50
Name one prophylactic treatment for trigeminal neuralgia?
carbamazepine, amitriptyline, lamotrigine
51
What is the timing for trigeminal neuralgia
refractory period, occurs over seconds
52
Name three red flags for secondary headache
``` SNOOP systemic features (Weight loss, fever) neuro signs Older pop with new headache (>50) Onset- thunderclap Progression of headache (change in severity) ```
53
List three secondary headaches
``` SAH cerebral sinus thrombosis meningitis temporal arteritis dissection idiopathic intracranial HTN SOL ```
54
Does meningism arise in SAH?
yes!!
55
Three presenting features of temporal arteritis?
scalp tenderness jaw claudication visual disturbance
56
Which nerve palsy is associated with idiopathic intracranial HTN?
6th nerve
57
What are the visual features of idiopathic intracranial HTN?
optic disc swelling, enlarged blind spots, reduced visual acuity, colour desaturation
58
Which drugs can raise ICP?
antibiotics used for acne!!! lymecyline
59
Which drug can be used to treat IIH?
acetozolamide
60
What prophylactic treatment can be used in migraines in a patient with asthma?
topiramate | propranolol contraindicated

1 Neurology (24 decks)

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