Headache Flashcards
(46 cards)
1
Q
Risk factors Venous Sinus Thrombosis
A
- Hx of acute sinusitis
- Hx of facial/peri-orbital infection
- Prothrombic states
- COCP
- FH VTE
- pregnancy
- trauma
2
Q
What is Venous sinus thrombosis
A
A clot which can be of infective or non-infective origin that becomes stuck in one of the veins in the brain
3
Q
Symptoms of Venous Sinus thrombosis
A
- Headache: gradual onset but severe
- Nausea and vomitting
- Chemosis/proptosis/peri-orbital oedema
- Septic Sx if infective
- Mental state changes
4
Q
Investigations of Venous sinus thrombosis
A
- MR venogram
- contrast enhanced CT
- FBC: prothrombotic state
- Thrombophillia screen
5
Q
Management of Venous Sinus thrombosis
A
- Head at 30-45 angle to decreases intracranial pressure
- LMWH then warfarin
- Treat seizures with anticonvulsants
6
Q
Examples of differential diagnosis for ‘headache’
A
Tension headaches Migraines Cluster headaches Secondary headaches Sinusitis Giant cell arteritis Glaucoma Intracranial haemorrhage Subarachnoid haemorrhage Analgesic headache Hormonal headache Cervical spondylosis Trigeminal neuralgia Raised intracranial pressure (brain tumours) Meningitis Encephalitis
7
Q
What are the red flags of headache
A
- Fever, photophobia or neck stiffness
- New neurological symptoms
- Dizziness
- Visual disturbance (temporal arteritis or glaucoma)
- Sudden onset occipital headache
- Worse on coughing or straining
- Postural, worse on standing, lying or bending over
- Severe enough to wake the patient from sleep
- Vomiting (raised intracranial pressure or carbon monoxide poisoning)
- History of trauma (intracranial haemorrhage)
- Pregnancy (pre-eclampsia)
8
Q
What does papillodema indicate
A
Raised intracranial pressure
9
Q
What might raised intracranial pressure indicate
A
- brain tumour
- benign intracranial hypertension
- intracranial bleed.
10
Q
What are tension headaches
A
- very common
- mild ache across the forehead and in a band-like pattern around the head
- no visual changes
- ?muscle ache in the frontalis, temporalis and occipitalis muscles
- comes on and resolve gradually
11
Q
What are the associations of tension headaches
A
Stress Depression Alcohol Skipping meals Dehydration
12
Q
What is the management of tension headaches
A
Reassurance
Basic analgesia
Relaxation techniques
Hot towels to local area
13
Q
What are the causes of a secondary headache
A
Underlying medical conditions such as infection, obstructive sleep apnoea or pre-eclampsia
Alcohol
Head injury
Carbon monoxide poisoning
14
Q
What is a secondary headache
A
Like a tension headache but as a result of an underlying condition/ have a clear cause
15
Q
What is sinusitis
A
- headache associated with inflammation in the ethmoidal, maxillary, frontal or sphenoidal sinuses
- facial pain behind the nose, forehead and eyes
- tenderness over the effected sinus
16
Q
What is the management of sinusitis
A
- resolves within 2-3 weeks
- Mostly viral
- Nasal irrigation with saline
- Prolonged symptoms: steroid nasal spray
- Antibiotics are occasionally required.
17
Q
What is an analgesic headache
A
- long term analgesia use
- non-specific features to a tension headache
- Treatment is to withdraw medication
- may be worse initially but only management
18
Q
What is a hormonal headache
A
- related to oestrogen
- generic, non-specific, tension-like headache
- related to low oestrogen
19
Q
When may you get a hormonal headache
A
- Two days before and first three days of the menstrual period
- Around the menopause
- Pregnancy: worse in the first few weeks and improves in the last 6 months - CAUTION PRE-ECLAMPSIA
20
Q
What is the management of hormonal headache
A
COCP
21
Q
What is cervical spondylosis
A
- degenerative changes in the cervical spine
- Usually neck pain, usually made worse by movement, however if often presents with headache.
22
Q
What must you rule out before diagnosing cervical spondylosis
A
- inflammation
- malignancy
- infection
- spinal cord or nerve root lesions.
23
Q
What branches make up the trigeminal nerve
A
Ophthalmic (V1)
Maxillary (V2)
Mandibular (V3)
24
Q
What is trigeminal neuralgia
A
- Unclear cause but thought o be branches of the trigeminal nerve being compressed
- 90% unilateral
- 5-10% of patients with MS have TN
25
What is the presentation of trigeminal neuralgia
- Intense facial pain comes on spontaneously and last anywhere between a few seconds to hours. It is often described as an electricity-like shooting pain. Attacks often worsen over time.
26
What are common triggers of trigeminal neuralgia
- Cold weather
- spicy food
- caffeine
- citrous fruits.
27
What is the management of trigeminal neuralgia
- carbamazepine
| - Surgery: Decompress or damage the nerve
28
What are cluster headaches
- severe and unbearable unilateral headaches, usually around the eye
- Come on in clusters then disappear for months-years
- attacks last between 15-30 minutes
29
COmmon triggers of cluster headaches
alcohol
strong smell
exercise.
30
Symptoms of a cluster headaches
Symptoms are generally unilateral
- Red, swollen and watering eye
- Pupil constriction (miosis)
- Eyelid drooping (ptosis)
- Nasal discharge
- Facial sweating
31
What is the acute management of cluster headaches
Triptans (e.g. sumatriptan 6mg injected subcutaneously)
| High flow 100% oxygen for 15-20 minutes (can be given at home)
32
What is the prophylactic management of cluster headaches
Verapamil
Lithium
Prednisolone (a short course for 2-3 weeks to break the cycle during clusters)
33
What types of migraine are there?
Migraine without aura
Migraine with aura
Silent migraine (migraine with aura but without a headache)
Hemiplegic migraine
34
What are the typical symptoms of Migraines
```
Moderate to severe intensity
Pounding or throbbing in nature
Usually unilateral but can be bilateral
Discomfort with lights (photophobia)
Discomfort with loud noises (phonophobia)
With or without aura
Nausea and vomiting
```
35
How long do migraines last
4-72 hours
36
What is aura
- visual changes associated with migraines.
- Sparks in vision
- Blurring vision
- Lines across vision
- Loss of different visual fields
37
What is a hemiplegic migraine
- can mimic stroke
| - essential to act fast and exclude a stroke
38
What are the symptoms of a hemiplegic migraine
```
Typical migraine symptoms
Sudden or gradual onset
Hemiplegia (unilateral weakness of the limbs)
Ataxia
Changes in consciousness
```
39
What different types of triggers are there for migraine
```
Stress
Bright lights
Strong smells
Certain foods (e.g. chocolate, cheese and caffeine)
Dehydration
Menstruation
Abnormal sleep patterns
Trauma
```
40
What are the 5 stages of migraine?
Premonitory or prodromal stage (can begin 3 days before the headache)
Aura (lasting up to 60 minutes)
Headache stage (lasts 4-72 hours)
Resolution stage (the headache can fade away or be relieved completely by vomiting or sleeping)
Postdromal or recovery phase
41
What is the acute management of migraines
Paracetamol
Triptans (e.g. sumatriptan 50mg as the migraine starts)
NSAIDs (e.g ibuprofen or naproxen)
Antiemetics if vomiting occurs (e.g. metoclopramide)
42
What are triptans?
- abort migraines when they start to develop
- 5HT receptors agonists (serotonin receptor agonists)
- various mechanisms of action and it is not clear which mechanisms are responsible for their effects on migraines.
43
What is the best way to identify triggers of migraines and monitor treatment response
head ache diary
44
What can be used as prophylaxis of migraines
- Propranolol
- Topiramate (this is teratogenic and can cause a cleft lip/palate so patients should not get pregnant)
- Amitriptyline
- Acupuncture
45
What is the prognosis of migraines
Migraines tend to get better over time and people often go in to remission from their symptoms.
46
Triggers for migraines
```
Chocolate
Hangovers
Orgasms
Cheese
Caffeine
The oral contraceptive pill
Lie-ins
Alcohol
Travel
Exercise
```
