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AAClinical school conditions > Headache > Flashcards

Headache Flashcards

1
Q

Concerns in hyperacute headaches

A

Intracranial haemorrhage

Meningitis

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2
Q

Recent onset not hyperacute headache - probable causes

A

In over 55s, giant cell arteritis (can cause blindness),
Raised intracranial pressure
Ear infection
Skull based lesions (infective/inflammatory, tumour)

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3
Q

Onset of benign headaches - age

A

Young or middle-aged adults

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4
Q

Timing of SAH

A

Hyperacute onset - like being hit in the back of the head.

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5
Q

Characteristics of SAH

A

Very severe global headache with neck stiffness

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6
Q

Associated symptoms of SAH

A

20% have neurological stroke like deficits.
Altered consciousness
Vomiting or collapse

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7
Q

Timing of intracerebral haemorrhage

A

Seconds to minutes.

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8
Q

Characteristics of intracerebral haemorrhage

A

Headache of variable severity.

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9
Q

Associated symptoms of intracerebral haemorrhage

A

Focal neurological deficit in most cases

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10
Q

Timing of meningitis headache

A

Depends on aetiology – viral/bacterial: hours Tuberculous: hours to days. Malignant or inflammatory: days to weeks

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11
Q

Characteristics of meningitis headache

A

Global headache often severe neck stiffness.

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12
Q

Associated symptoms of meningitis headache.

A

Fever in infective causes. Altered consciousness common.
Cranial nerve palsies and focal neurological deficits especially in more chronic forms. Purpuric rash, septicaemia and collapse in bacterial meningitis.

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13
Q

Timing of raised intracranial pressure headache

A

Onset usually over days but can be hours to weeks.

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14
Q

Characteristics of raised intracranial pressure headache.

A

Global headache typically worse after lying down, for example on waking in the morning, but this feature is often absent.

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15
Q

Associated symptoms of raised intracranial pressure headache.

A

Often with nausea and vomiting. As elevated pressure becomes more severe there is often ataxia and then drowsiness. Neurological deficits may occur from the causative lesion.

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16
Q

Timing of temporal arteritis headache.

A

Onset usually days to weeks.

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17
Q

Characteristics of temporal arteritis headache

A

Typically temporal tenderness, for example on combing the hair. Pain on chewing which causes the jaw to lock up (claudication). Some have predominantly nuchal pain.

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18
Q

Associated feature of temporal arteritis headache.

A

Often weight loss and malaise over a few weeks.
Transient or permanent neurological deficits due to ischaemia, especially visual loss in one or both eyes and cranial nerve palsies, especially III, IV and VI.
20% have had or will have polymyalgia rheumatica with limb girdle pain.

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19
Q

Timing of migraine headache

A

Onset usually over minutes to 1 hour.

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20
Q

Characteristics of migraine headache

A

Often unilateral but side may vary between different attacks. Typically throbbing.

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21
Q

Associated features of migraine headache.

A

Usually nausea, often photophobia. Sleep helps the headache which usually lasts 4-72 hours. Sometimes neurological symptoms in a migraine aura, such as flashing lights or tingling down one side of the body.

22
Q

Papilloedema in GCA

A

Seen in ischaemia of the optic nerve head due to GCA and may be unilateral.
Usually more severe visual symptoms and signs with reduced acuity and visual fields than one sees in papilloedema due to raised intracranial pressure, where vision is often normal or near normal apart from an enlarged blindspot.

23
Q

Causes of third nerve palsy + headache.

A

An aneurysm of the posterior communication artery and associated subarachnoid haemorrhage.
In comatose pt: tentorial herniation and compression due to raised ICP.

24
Q

Multiple cranial nerve palsies with headache

A

Uncommon usually a subacute or chronic meningeal infiltrative process: chronic infection, malignant deposits in the CSF.

25
Q

Treatment of GCA

A

High dose prednisolone 40-60 mg OD, then titrated down.

26
Q

Secondary causes of trigeminal neuralgia

A 
Compression of nerve by aneurysm or tumour. 
Chronic meningeal inflammation.
MS
Zoster
Skull base malformation.
27
Q

Typical trigeminal neuralgia patient

A

Over 50, asian.

28
Q

Symptoms of trigeminal neuralgia

A

Paroxysms of intense stabbing pain lasting seconds in the trigeminal distribution.
Unilateral.
Triggers can include washing, shaving, eating, talking or dental prostheses.

29
Q

What is the treatment for cluster headaches?

A

Oxygen, sumatriptan at onset.

Preventatives not well evidenced, but possibly suboccipital steroid injections.

30
Q

What are the symptoms of cluster headache?

A

Rapid onset of excruciating pain around one eye that may become watery and blood shots with lid swelling and lacrimation.
Pain is strictly unilateral.
Lasts 15-16 minutes, often nocturnal, with clusters lasting 4-12 wks.

31
Q

What is a common cause of a chronic headache which has evolved out of episodic headaches?

A

Medication overuse headache.

32
Q

What is the likely cause a chronic headache that is worse on waking, lying, bending forward or coughing, and associated with vomiting, seizures, localising signs or odd behaviour?

A

Raised intracranial pressure

33
Q

What is the likely cause of a chronic bilateral non-pulsatile headache with scalp tenderness, but without vomiting or sensitivity to head movements?

A

Tension headache

34
Q

What must you exclude as a cause in all patients over 50 with a headache that has lasted a few weeks? What are the signs of this type of headache?

A

Giant cell arteritis.

Tender, thickened, pulseless temporal arteries, jaw claudication, ESR above 40.

35
Q

What single headache is associated with constant aching pain developing rapidly around one eye, with markedly reduced vision, visual haloes and nausea. How does the eye appear?

A

Acute glaucoma headache.

Red congested eye, cloudy cornea, dilated non-responsive pupils,

36
Q

What single headache is associated with travel abroad?

A

Tropical illness: malaria, typhus.

37
Q

What single headache is associated with dull constant ache of frontal or maxillary sinuses with tenderness.

A

Sinusitis.

38
Q

What single headache is associated with subacute or sudden headache and papilloedema?

A

Venous sinus thrombosis

39
Q

What single headache is associated with head injury?

A

Headaches common at site of trauma, usually lasting 2 weeks.

Need to exclude subdural and extradurea haemorrhage, especially if there is drowsiness or focal signs.

40
Q

Which single headache is acute, severe, felt all over the head and associated with meningism, ‘worst ever’ headache, often occipital, stiff neck, focal signs and decreased consciousness?

A

SAH

41
Q

Which single headache is acute, severe, felt all over the head and associated with meningism, fever, odd behaviour and fits or decreased consciousness?

A

Encephalitis

42
Q

Which single headache is acute, severe, felt all over the head and associated with meningism, fever, photophobia and a stiff neck?

A

Meningitis.

43
Q

What must you exclude if a single headache is acute, severe, felt all over the head and associated with meningism?

A

Meningitis, encephalitis and SAH.

Do urgent CT head

44
Q

What are the classic symptoms of migraine?

A

Visual or other aura for 15-30 minutes followed within 1 h by unilateral throbbing headache.
OR isolated aura with no headache
OR episodic single headaches without aura usually premenstrual, unilateral with nausea, vomiting and photophobia/phonophobia.

45
Q

Different types of migraine aura

A

Visual
Somatosensory
Motor
Speech

46
Q

Criteria to diagnose migraine if no aura

A

More than 5 headaches lasting 4-72 h with nausea/vomiting/photophobia/phonophobia and any 2 of unilateral, pulsing and impairing routine activity.

47
Q

Triggers for migraine: CHOCOLATE

A 
Chocolate
Hangovers
Orgasms
Cheese
Oral contraceptives
Lie-ins
Alcohol
Tumult
Exercise
48
Q

Migraine treatments

A

Consider NSAIDs or triptans.

49
Q

Migraine prevention

A

Propranolol
Amitriptyline
Topiramate

50
Q

Why should you not give high dose contraceptive pill to those suffering migraine?

A

It increases risk of Pill-related ischaemic stroke. Progesterone only or non-hormonal contraception is fine.

51
Q

Prophylaxis for premenstrual migraine

A

If no contraindications, give NSAID across menstrual period with transdermal oestradiol patches.

AAClinical school conditions (32 decks)

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