Headache Flashcards
A 28 year old lady presents with a headache for the last 4 weeks. She said it is worst in the morning and worse when she sneezes or coughs. What examination should you do?
Opthalmoscopy to look for papilloedema
A 28 year old lady presents with a headache for the last 4 weeks. She said it is worst in the morning and worse when she sneezes or coughs. What do you expect to see on opthalmoscopy?
Papilloedema. Blurred disc
A 28 year old lady presents with a headache for the last 4 weeks. She said it is worst in the morning and worse when she sneezes or coughs. She also says twice she has vomitted over the last week. On opthalmoscopy the disc looks slightly blurred - what is the most likely diagnosis?
Raised intracranial pressure
A 28 year old lady presents with a headache for the last 4 weeks. She said it is worst in the morning and worse when she sneezes or coughs. She also says twice she has vomitted over the last week. On opthalmoscopy the disc looks slightly blurred. What test do you need to do?
Brain CT or MRI
Where is the blood gathering in a sub dural haematoma?
Between the dura and the brain
Where is the blood in an epidural haematoma?
Betwen the dura and the skull?
What artery has most likely ruptured in an epidural haemmorhage?
Middle meningeal
What vessels are most often damaged in a subdural bleed?
Bridging veins
A man presents to hospital after falling off his bike. This is his CT scan, what is the diagnosis?
Acute subdural haemmorhage (Distinctive crescent shape)
A 45 year old lady presenst to her GP with a headache. She says this has been going on for 6 weeks and is worse is the morning though she is particularly worried becauae she is now experiencing some visual loss. On further questioning she admits to being in a small car accident 7 weeks ago. This is her CT scan.
Subdural haematoma
What drug treatments are used to tread idiopathic intracranial hypertension?
Acetazolamide
What non drug treatments are available for the treatment of idiopathic intracranial hypertension?
Lumbar Puncture (may be repeated)
An overweight women with drug controlled idiopathic intracranial hypertension comes to you complaing on tingling in her hands. What drug is most likely causing this symptom and why?
acetazolamide. It is known to cause hypokaleamia which can present as tingling in the fingers and muscle weakness.
An overweight women with drug controlled idiopathic intracranial hypertension comes to you complaing on tingling in her hands. What electrolyte imbalance are you worried about?
Hypokalaemia. Can be caused by acetazolamide which is the firts line drug treatment in idiopathic intracranial hypertension.
An overweight women has just been diagnosed with idiopathic intracranial hypertension. She is currently trying for a baby.
Acetazolamide is contraindicated in pregnancy. Lumbar punture would be best.
An overweight women with drug controlled idiopathic intracranial hypertension comes to you complaing on tingling in her hands. You want to change her medication; what are your options?
Change acetazolamide to a thiazide diuretic.
An overweight women has severe idiopathic intracranial hypertension which has not been significantly reduced by medicationo or repeat LPs. What is the next treatment option?
ventriculoperitoneal shunt.
What is the most common form on non communicating hydrocephalus?
Cerebral aqueductual stenosis
What is meant by non communicating hydrocephalus?
The CSF in the ventricles can not reach the subarachnoid space. This results from obstruction of interventricular foramina, cerebral aqueduct, or the outflow foramens of the fourth ventricle (median and lateral apertures).
What is meant by communicating hydrocephalus?
The obstruction of CSF flow is in the subarachnoid space from prior bleeding or meningitis. This causes thickening of the arachnoid leading to blockage of the return-flow channels
What is the first line treatment for acute migraine?
Oral triptan + NSAID or Paracetamol. Young people should consider a nasal triptan. Also consider an anti emetic such as metclopramide
A patient who has suffered from migraines for many years comes in. She has been on prophylactic treatment which has worked but she says that recently she has started to get bad headaches frequently. What might be causing these?
Overuse of triptans
A 28 year old women has been suffering with migraine. for 2 years now. She says they happen around twice a month. What prophylaxis shoudl you offer her? She is trying for a baby.
Propanolol
A 28 year old man has been suffering with migraine. for 2 years now. She says they happen around twice a month. What prophylaxis shoudl you offer him?
Propanolol
Topiramate
When shoudl you take triptans to get maximum migraine relief?
The onset of aura
A 28 year old women has been suffering with migraine. for 2 years now. She has tried propanolol and topiramate already and they haven’t worked. She want a non drug treatment, what might you recommend?
Accupunture
A 28 year old women has been suffering with migraine. for 2 years now. She has tried propanolol and topiramate already and they haven’t worked. What drugs might work for her?
Gabapentin
Topiramate
What drugs might help recurrent tension headaches?
Amitriptyline or Dothiepin
A man comes to you saying that twice in the last 3 months he has had episodes of excrutiating headache. They last around an hour and feel like they are just above his eye. He has also noticed that his eyes water and his nose runs during these attacks.
Cluster headache
A man comes to you saying that twice in the last 3 months he has had episodes of excrutiating headache. They last around an hour and feel like they are just above his eye. He has also noticed that his eyes water and his nose runs during these attacks. What drug might help him during acute attacks?
Subcutaneous sumatriptan
A man comes to you saying that twice in the last 3 months he has had episodes of excrutiating headache. They last around an hour and feel like they are just above his eye. He has also noticed that his eyes water and his nose runs during these attacks. What drugs might help to terminate this run of attacks?
Verapamil
Prednisolone
Lithium
A 67 year old lady present with a headache that has been there for around a month. She describes it has being at the side of her head. Her jaw and arms are also sore (she says this is typical for the end of the day)
Giant cell arteritis
A 67 year old lady present with a headache that has been there for around a month. She describes it has being at the side of her head. Her jaw and arms are also sore (she says this is typical for the end of the day) What is the definitive test for this condition?
Temporal artery biopsy
A 67 year old lady present with a headache that has been there for around a month. She describes it has being at the side of her head. Her jaw and arms are also sore (she says this is typical for the end of the day) What is the first investigations you would do at the GP?
ESR/Plasma Viscosity
A 29 year old man presents saying he has been suffering from headaches. They are down the left side of his face only and are worse around his eye. She also finds his eye droops during these attacks.
Trigeminal autonomic cephalgia
A lady presents to her GP saying she has had a persistent pain in the right side of her head for 6 months. She has no pain free periods but sometimes they pain is more severe. She also has found that she has watering of her right eye. What is the diagnosis?
Hemicrania continua
A lady presents to her GP saying she has had a persistent pain in the right side of her head for 6 months. She has no pain free periods but sometimes they pain is more severe. She also has found that she has watering of her right eye. What treatment is used?
Hemicrania Continue
Responds only to daily indomethacin
What kind of drug is indometacin?
NSIAD
An 87 year old lady presents to you saying she has started to get bad headaches when she is trying to sleep. She describes them as throbbing in nature. She is not photophobic or nauseaus during attacks.
Hypnic headaches
An 87 year old lady presents to you saying she has started to get bad headaches when she is trying to sleep. She describes them as throbbing in nature. She is not photophobic or nauseaus during attacks. What drug treatment would you start?
(Hypnic headache)
Lithium carbonate at bedtime.
Verapamil or Indomethaxin
What is the first line preventative treatment for cluster headache?
Verapamil
