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Neurology > Headache > Flashcards

Headache Flashcards

1
Q

Are migraines more common in men or women?

A

Women

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2
Q

Are migraines more often uni or bilateral?

A

Unilateral

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3
Q

Decribe the pain in migraine

A

Dull & throbbing

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4
Q

How do you treat migraine?

A

Analgesia: NSAIDs & paracetamol/aspirin & metoclopramide/ Naproxen/Diclofenac *beware analgesic headache
Antiemetics
Triptans: s/c sumatriptan
Final stage: Botox injections for chronic migraine.

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5
Q

What prophylaxis is used for migraine?

A

Beta blockers (propanolol), or topirimate, amytriptyline or 2md line sodium valproate

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6
Q

How many attacks needed for diagnosis of migraine?

A

5 lasting 4-72 hours

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7
Q

When are triptans contraindicated?

A

Hypertension, coronary artery disease, CV disease and pregnancy

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8
Q

What are the differentials for single episode headache?

A 
Head Injury
Sinusitis
Tropical Disease
Acute Glaucoma
Low Pressure Headache (CSF leak)
Meningitis
Encephalitis
SAH
Venous Sinus Thrombosis
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9
Q

What are signs of sinusitis?

A

Dull, constant, tender over sinuses, worsened by leaning forward

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10
Q

What are signs of tension headache?

A

Tight band across forehead, bilateral pain, non pulsatile +/- scalp tenderness
“head in a vice”
7 days long
No vomiting or sensitivity to head movement.

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11
Q

What are signs of cluster headache?

A

Rapid onset & cessation, severe, unilateral eye pain (bloodshot and swollen & flushed face)
Occurs 1-2 daily for 1-3 months with month symptom-free between.

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12
Q

How do you treat tension headache?

A

Stress relief and NSAIDs

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13
Q

How do you treat cluster headache?

A 
S/c sumatriptan and high flow O2.
Prednisolone 5 days for short term prophylaxis or Verapimil used for long term (CHECK ECG)
or lithium (CHECK LFTs) or melatonin injections
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14
Q

What are signs of Giant Cell Arteritis (GCA)?

A

Temporal headache with scalp tenderness, jaw claudication and a non pulsatile temporal artery

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15
Q

What is the risk of GCA?

A

Irreversible bilateral vision loss

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16
Q

What is treatment of GCA?

A

Prednisolone

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17
Q

Signs of Trigeminal Neuralgia?

A

Unilateral stabbing pain in V3 region severe and breif, face screws up- triggered by shaving or washing face. Normal neuro exam

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18
Q

Treatment of trigeminal neuralgia?

A

Carbamazepine & surgical decompression

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19
Q

Raised ICP signs

A

Worse on coughing, leaning forwards, and in the morning. Papilloedema and vomit & seizures & odd behaviour.

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20
Q

What pain relief most cause analgesic headaches?

A

Tricyclics

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21
Q

Signs of Idiopathic Intercranial Hypertension (IIH)?

A

Constant throbbing, worse in the morning, blurred/double vision.

22
Q

IIH is usually found in who?

A

Overweight women

23
Q

What is the sign on CT of Venous Sinus Thromboembolism?

A

Empty Delta sign

24
Q

Venous Sinus Thromboembolism treatment

A

Anticoagulate: LMW Heparin then Warfarin

25
Q

Which gender get cluster headache more?

A

Male

26
Q

Trigger for cluster headache?

A

Alcohol, Exercise & GTN

27
Q

Where in head is SAH pain?

A

Occipital

28
Q

Which nerve palsy seen in SAH?

A

IIIrd

29
Q

ECG changes on SAH?

A

Deep T wave inversion

30
Q

Management of SAH

A

CT (less sensitive with more time)- CT angiography to find aneurysms.
LP (delay for 12 hours for xanthochromia)
NIMODIPINE for vasospasm
Saline hydration
Endovascular clipping or coil.
DEXAMETHASONE for cerebral oedema.

31
Q

SAH prognosis

A

30% full recovery
30% die
30% disability

32
Q

What is a berry aneurysm?

A

defect in media and elastica of cerebral arteries such that the media bulges out

33
Q

What diseases are SAH associated with?

A

PCK & coarctation of aorta

34
Q

What are signs of extradural haemorrhage?

A

Occur due to skull fracture affecting MIDDLE MENINGEAL ARTERY. LUCID PERIOD then blown pupil, limb weakness, and neuro signs. Lens shape. Coning risk and slow increase in ICP.

35
Q

Extradural haemorrhage treatment?

A

Mannitol for ICP

Decompression surgically

36
Q

Subdural haemorrhages are caused by?

A

Trauma - Bleeding from bridging veins between cortex and venous sinuses leading to haematoma between dura and arachnoid.

37
Q

Subdural haemorrhages more common in?

A

AGE, ALCOHOL & ANTICOAGS (& low ICP & brain metastases)

38
Q

What to subdural haemorrhages cause?

A

MIDLINE SHIFT & hemiparesis

fluctuating consciousness, slowing physically and intellectually,

39
Q

How long do subdural haemorrhages take to develop

A

Can be over months

40
Q

CT Subdural Haemorrhage?

A

Crescent shaped

41
Q

Subdural Haemorrhage treatment

A

Burr Hole Craniotomy

42
Q

How do you manage trigeminal neuralgia?

A

Carbamazepine

43
Q

What causes trigeminal neuralgia pain?

A

Compression of trigeminal nerva

44
Q

What often occurs alongside trigeminal neuralgia?

A

MS

45
Q

What are complications of trigeminal neuralgia?

A

Poor dentition as cant brush teeth

46
Q

What are common symptoms of trigeminal neuralgia?

A

Pain on wind on face
Pain in teeth
Cant brush hair

47
Q

When do you refer trigeminal neuralgia?

A

When meds dont work

When eyes involved

48
Q

Medication overuse headache Disorder

A

15+ days per month with pre existing headache disorder
Use for over 3 months of drugs used for headaches
10+ days of opioids or ergotamine OR 15+ days of ibuprofen etc

49
Q

How is MOH treated?

A

Stop medications causing
Advise it takes 2 months to improve and might get worse first- keep headache diary
Review and assess underlying headache disorder
Prevent relapse- awareness and management

50
Q

When cant you take COCP?

A

Migraine with aura

51
Q

What drugs are worst for MOH?

A

Triptans

Neurology (25 decks)

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