[headache] Flashcards
meningeal irritation
Meningitis
Encephalitis
SAH
Encephalitis
Odd behaviour
reduced consciousness
fits
Meningitis
Occipital (often, not always)
Urgent CT
SAH presents with meningeal irritation
LP
infection or blood products in CSF
Subdural haematoma
Extradural haematoma
CT
Subdural haematoma
extra-dural haematoma
Venous sinus thrombosis
dull constant ache
frontal sinuses
maxillary sinuses
Rhinoviruses
Common cold
Low pressure CSF (leakage)
acute glaucoma
Acute glaucoma
IV Acetazolamide
pilocarpine
M3 muscle-r agonist. Causes cilliary contraction. Increases outflow of aqueous humour.
Carbonic anhydrase-i
Decreases secretion of aqueous humour
sudden onset
worst ever headache
Dilated and unresponsive
acute glaucoma
Medication overuse
(aka analgesic rebound headache)
Tension headache
Raised ICP
Coughing
Bending over
on waking
T
imaging to look for space occupying lesion (CT)
AFTER imaging
Odd behaviour
Papilloedema
seizures
vomiting
Bilateral non-pulsatile headache
not affected by head movement
analgesic overuse (esp. mixed analgesics)
6days/month
stress relief
no
Migraine
Cluster headache
Trigeminal neuralgia
Recurrent meningitis (Mollarets)
recurring headaches with menigeal irritation signs and fever each time
LP and send CSF for HSV2 pcr
Mollarets (recurring meningitis)
blindness (GCA affect retinal artery, ischaemia is v damaging)
> 50 yrs
pulseless
tender
thickened
jaw claudication
Sub acute
[Headache][cluster]: is more common in M or F?
M
5:1
[Headache][cluster]: time-course presentation?
rapid onset
[Headache][cluster]: where does the pain present?
around 1 eye
[Headache][cluster]: what eye-related features may be present on pain onset (4)
lacrimation
lid swelling
miosis
ptosis (20%)
[Headache][cluster]: do recurring attacks always affect the same eye?
YES
[Headache][cluster]: during what time do the attacks often occur
night time
[Headache][cluster]: how long does the cluster period last
4-12 weeks
[Headache][cluster]: how long can the latency period between cluster last
2 years
[Headache][cluster]: how long will the acute attack last
15 mins -2 hours
[Headache][cluster]: when is O2 CI
COPD
[Headache][cluster]: what is 1st line pharmacological Tx
Sumatriptan (sc)
[Headache][cluster]: how does sumatriptan work
5HT analog. receptor in cranial arteries, reduces vascular inflammation.
[Headache][cluster]: what should be given and 1st line Tx (non-pharmacological)
100% O2, non-rebreathe
CI in what?
[Headache][cluster]: what is an alternative to sumatriptan
Zolmitriptan nasal spray
[Headache][cluster]: Pain is strictly limited to …. side(s)
one side
[Headache][cluster]: this is the most debilitating headache T/F
T
[Headache][trigeminalneuralgia]: classical symptoms
paroxysmal stabbing pain
[Headache][trigeminalneuralgia]: where is the pain felt
Mandibular and maxillary usually
[Headache][trigeminalneuralgia]: unilateral or bilateral
unilateral
[Headache][trigeminalneuralgia]: length of symptoms
seconds
[Headache][trigeminalneuralgia]: explain ‘tic doloureux’
face screwing up with pain
[Headache][trigeminalneuralgia]: How is the pain frequently brought on (5)
washing shaving eating talking dental prostheses
[Headache][trigeminalneuralgia]: typical age of onset
> 50 yrs
[Headache][trigeminalneuralgia]: secondary causes (2)
compression of the trigeminal nerve meningeal inflammation (MS, zoster)
[Headache][trigeminalneuralgia]: 1st line Ix
MRI
[Headache][trigeminalneuralgia]: why is the 1st line Ix important
exclude secondary causes
[Headache][trigeminalneuralgia]: 1st line Tx?
Carbamazepine 100mg
[Headache][trigeminalneuralgia]: how does carbamazepine work
Stabilises Na channels. Neurons less excitable
[Headache][trigeminalneuralgia]: If 1st line tx does not work in relapse; 2nd line drugs? (3)
Lamotrigine
phenytoin
gabapentin
[Headache][trigeminalneuralgia]: how do lamotrigine/phenytoin and carbamazepine all work
Block Na gate channels
[Headache][trigeminalneuralgia]: if relapse still occurs, what is non-pharmacological option
surgical intervention of peripheral CN 5
> 2weeks
