Headache Flashcards
How do tension headaches typically present?
Generalised, bilateral headaches that feel like a ‘tight band’
Anaglesics are useful
Associated with stress and disturbed sleep
How should you manage Tension headaches?
Conservative - Avoid Triggers and Analgesia
Look out for Medication-Overuse Headaches
How do Migraines present?
Unilateral, Paroxysmal
Pulsating
Aura, Photophobia, Phonophobia
Visual Changes, Tingling, Numbness
Sitting in a dark, quiet room helps
What can trigger migraines?
CHOCOLATE
Hangovers
Orgasms
Cheese/Caffeine
Oral Contraceptive
Lie-ins
Alcohol
Travel
Exercise
How do you manage a Migraine?
Conservative
Acute Medical - Simple Analgesics, Triptans
Preventative - Beta Blockers, Antiepileptics (topiramate), Amitryptiline (Antidepressant)
How do Cluster Headaches present?
Recurrent, Sever, Unilateral Headaches.
Cyclical Pattern
Typically Behind the eye
The eye may become red and water
Ptosis, Nasal Congestion
What is Trigeminal Neuralgia?
Facial pain in the distribution of 2 or more of the divisions of the Trigeminal Nerve.
Associated with Multiple Sclerosis
What are the triggers of Trigeminal Neuralgia?
Things that compress the affected area:
Eating
Washing your face
Brushing Teeth
How does trigeminal neuralgia present?
Unilateral headache along the trigeminal division
Lasts for a few seconds
Stabbing, shooting pains
What are the most common causes of meningitis in babies?
E.Coli
Group B Strep
What are the most common causes of meningitis in children?
H. influenzae
Strep. pneumoniae
What is the most common cause of meningitis in adults?
Neisseria meningitidis
What are the most common causes of meningitis in the elderly?
Strep. pneumoniae
Listeria monocytogenes
How does meningitis typically present?
Meningism - Neck Stiffness, photophobia
Fever
Non-blanching rash
Vomiting
Seizures
What is Kernig’s Sign?
Passive Knee extension is painful when the hips are flexed.
What is Brudzinski’s Sign?
Flexion of the hips and knees occurs when the neck is flexed.
What does the presence of a non-blanching rash indicate in meningitis?
Meningococcal cause
How should you investigate a suspected case of Meningitis?
1) CT if focal neurological signs are observed.
2) CSF Analysis if not
How will CSF appear in Bacterial meningitis?
Turbid
Neutrophils (Polymorphs)
Low Glucose
High Protein
How will CSF appear in Viral Meningitis?
Clear
Lymphocytes
Normal Glucose and Protein (Protein may also be high)
How will CSF appear in TB Meningitis?
Fibrin Web
Raised Lymphocytes
Low Glucose
Raised Protein
How should you manage a case of Meningitis?
Benzylpenicillin IV/IM instantly & refer to hospital if Bacterial Meningitis suspected.
Broad Spectrum Antibiotics (Ceftriaxone, Benzylpenicillin, Acyclovir - if viral)
IV dexamethasone to reduce cerebral oedema.
What can cause Encephalitis?
Viral - HSV, CMV, EBV, HIV, Measles
Non-Viral - Bacterial Meningitis, TB, Malaria, Listeria, Lyme Disease, Legionella
How does Encephalitis present?
Acute-Onset
Fever
Headache
Altered Mental State - Memory, personality, psychiatric changes, impaired consciousness
Seizures
Focal Neurological Signs
How do you investigate a suspected case of Encephalitis?
LP
Bloods
EEG
CT/MRI
What can cause raised ICP?
Space-Occupying Lesion - Tumour, Abscess, Haemorrhage
Hydrocephalus
How does raised ICP present?
Headache - Bilateral, Gradual, Throbbing, Worse in the morning
Vomiting
Altered GCS
Seizures
Which signs may you see in a patient with raised ICP?
Focal Neurological Signs
Papilloedema
Cushing’s Reflex (SBP raise, Irregular Breathing, Bradycardia)
‘Cheyne-Stokes Respiration’
How should you investigate a suspected case of Raised ICP?
Urgent CT Head
How does an Extradural Haemorrhage typically present?
Post-Trauma, commonly shearing of the Middle Meningeal Artery
Acute headache, followed by a Lucid Interval
Increasingly severe headache
How do you investigate a suspected Extradural Haemorrhage?
Urgent Non-Contrast CT scan - Lemon Shaped
How do Subdural Haemorrhages typically present?
Elderly and Alcoholics (Brain Atrophy)
Gradual onset, continuous headache
Fluctuating Consciousness
Confusion
Personality Changes
Raised ICP
How would you investigate a suspected Subdural Haemorrhage?
Urgent non-contrast CT-Head - Banana Shape
How should you manage a Subdural Haemorrhage?
ABCDE & Neurosurgery referal
Admit, Observe and monitor
Follow-Up CT in 2-3 Weeks
Prophylactic Antiepileptics
If Large, Burr Hole/Craniotomy (10mm or more)
How do Sub-Arachnoid Haemorrhages present?
Sudden-Onset Worst ever headache
Thunderclap presentation
Meningism
Raised ICP
What are the main risk factors for SAH?
Polycystic Kidney Disease
Alcohol
Smoking
Hypertension
How would you investigate a suspected SAH?
Urgent Non-contrast CT Head
Within 12 Hours, sensitivity decreases with time
If CT is normal, Lumbar Puncture
Xanthochromia & Oxyhaemoglobin
How do CNS tumours generally present?
Headache - Bilateral, Gradual, Throbbing, Morning
FLAWS
Weakness
Focal Neurological Signs
How should you investigate a suspected Brain Tumour?
CT/MRI
CXR, CT Thorax, Abdo and Pelvis
Biopsy (Definitive)
