Headache Flashcards

1
Q

what is the most common cause of headache

A

tension headache

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2
Q

what could be the causes of an acute single episode with meningism

A

if headache is severe, acute, felt over most of the head, neck stiffness- meningitis; encephalitis; subarach haemorrhage. admit urgently for CT head, do LP

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3
Q

symptoms meningitis

A

fever, photophobia, stiff neck, purpuric rash, coma

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4
Q

symptoms encephalitis

A

fever, odd behaviour, fits, decr conciousness

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5
Q

symptoms subarach haemorrhage

A

sudden onset, worst ever, often occipital, stiff neck, focal signs, consciousness decr

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6
Q

what happens to the headache in head injury

A

localised to site of injury but may be more generalised. often resistant to analgesia

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7
Q

symptoms venous sinus thrombosis

A

subacute or sudden headache, papilloedema

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8
Q

symptoms sinusitis

A

dull, constant ache- frontal and maxillary sinuses; tenderness and postnasal drip. pain worse on bending over.

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9
Q

what is low pressure headache due to

A

CSF leak

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10
Q

what can acute glaucoma cause

A

acute single episode headache

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11
Q

acute glaucoma symptoms

A

typically elderly, long sighted people. constant aching pain develops rapidly around one eye radiating to the forehead. reduced vision, N/V

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12
Q

signs acute glaucoma

A

red, congested eye; cloudy cornea; dilated non responsive pupil; decr acuity. treat- start acetazolamide 500 mg over several mins

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13
Q

what are headaches that recurrently attack

A

cluster headache, migraine, trigeminal neuralgia

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14
Q

headaches of subacute onset

A

giant cell arteritis- exclude in all >50 yrs- if headache lasted a few weeks. tender thickened pulseless temporal arteries, jaw claudication.

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15
Q

chronic headache types

A

tension, raised ICP, medication overuse (analgesic rebound)

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16
Q

what is tension headache

A

usual cause bilateral non pulsatile headache with scalp muscle tenderness without vomiting or sensitibity to head movement. stress relief

17
Q

what happens in raised ICP

A

typically worse on waking, lying, bending forward, coughing. vomiting, papilloedema, seizures, false localising signs, odd behaviour.

18
Q

what is contraindicated in raised ICP

A

LP until after imaging

19
Q

what medications can cause headache

A

mixed analgesics- paracetemol + codeine/opiates, ergotamine and triptans.

20
Q

what may be the cause of cluster headache

A

superficial temporary artery smooth muscle hyperreactivity to 5HT. hypothalamic grey matter abnormalities. commoner in smokers, onset any age. male: female 5:1

21
Q

symptoms cluster headache

A

rapid onset excruciating pain around one eye that may become watery and bloodshot with lid swelling, lacrimation, facial flushing, rhinorrhoea, miosis and ptosis.

22
Q

is pain uni or bilateral in cluster headache

A

strictly UNILATERAL- almost always affects the same side. lasts 15-160 min occurs once or twice a day often nocturnal.

23
Q

how long can clusters last

A

4-12 weeks followed by pain free periods of months or even 1-2 years before the next cluster

24
Q

treat acute attack cluster headache

A

100% O2 for 15 min via non re breathable mask, sumatriptan SC 6mg at onset

25
preventatives cluster headache
suboccipital steroid injections, intranasal civamide, verapamil, lithium, melatonin
26
trigeminal neuralgia symptoms
paroxysms of intense, stabbing pain lasting seconds in the trigeminal nerve distribution. unilateral affects mandibular and maxillary divisions. face screws up in pain
27
trigeminal neuralgia- triggers
washing affected area, shaving, eating, talking, dental prostheses
28
trigeminal neuralgia secondary causes
compression trigeminal root by aneurysmal intracranial vessels or a tumour, chronic meningeal inflammation, MS, zoster, skull base malformation
29
treatment trigeminal neuralgia
carbamazepine (100mg/12h PO), lamotrigine, phenytoin, gabapentin