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BRS Y2 > Headache > Flashcards

Headache Flashcards

1
Q

Is a headache a symptom or a sign

A

A symptom

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2
Q

What are some reasons people get headaches?

A

Structural, pharmacological and psychological

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3
Q

What diagnosis could result after an acute single headache?

A 
Febrile illness, sinusitis
First attack of migraine
Following a head injury
Subarachnoid haemorrhage
Meningitis, tumour, drugs, toxins, stroke
Thunderclap (sudden onset), low pressure
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4
Q

What diagnosis could result after an dull headache that increases in severity?

A 
Usually benign
Overuse of medication (e.g. codeine)
Contraceptive pill, hormone replacement therapy
Neck disease
Temporal arteritis
Benign intracranial hypertension
Cerebral tumour
Cerebral venous sinus thrombosis
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5
Q

What diagnosis could result after an dull headache that is unchanged?

A

Chronic tension headache

Depressive

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6
Q

What diagnosis could result after recurrent headaches?

A

Migraine
Cluster headache
Episodic tension headache
Trigeminal or post-herpetic neuralgia

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7
Q

What diagnosis could result after triggered headaches?

A

Coughing, straining, exertion
Coitus
Food and drink

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8
Q

What are some red flags in headaches?

A 
Acute onset
Meningism
Systemic symptoms (fever/rash)
Neurological symptoms
If its better lying down (orthostatic)
Strictly unilateral
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9
Q

What are some red flag neurological syptoms?

A

Visual loss, confusion, seizures, hemiparesis, double vision, 3rd nerve palsy, Horner syndrome, papilloedema

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10
Q

When do patients get double vision?

A

If any eye muscle isnt working (or any associated nerve

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11
Q

What is 3rd nerve palsy? How does it present

A

When the patient has a droopy eyelid or a dilated pupil and eye points out

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12
Q

What is Horner syndrome? How does it present

A

When the sympathetic supply to the eye is affected. Eye is slightly droppy, inopthalmos

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13
Q

How does headache occur with subarachnoid haemorrhage?

A

Sudden and generalised

They have meningism (stiff neck and dont like light)

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14
Q

How are subarachnoid haemorrhages caused?

A

Aneurysm ruptre

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15
Q

How fatal are subarachnoid haemorrhages?

A

50% are fatal

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16
Q

How are subarachnoid haemorrhages treated?

A

Nimodipine and BP control.
Early neurosurgical assessment to confirm the bleed and establish the cause.
CT brain, lumbar puncture and MRA, angiogram.

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17
Q

How are aneurysms treated?

A

They used to be clipped or coiled, now they are filled with platinum coils

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18
Q

What is an acute intracerebral bleed? Why does it happen?

A

A fatal haemorrhage due to coning

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19
Q

What is herniation and coning?

A

When vol in the brain increases and starts to increase intracranial pressure so that the brain starts to be squeezed out of the skull and starts weeping

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20
Q

What is papilloedema?

A

When pressure in the brain rises and you can see the retina being pushed outwards

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21
Q

What is a carotid or vertebral artery dissection? How can it cause a stroke?

A

When the blood vessel tears and the false lumen becomes large causing turbulent flow in the actual lumen. This can cause clotting and stroke so aspirin or anticoag is given

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22
Q

What is temporal arteritis? How does it present?

A

Constant unilateral headache, scalp tenderness and jaw claudication

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23
Q

How is temporal arteritis diagnosed?

A

Elevated ESR and CRP

Temporal artery are inflamed and tortuous visible on ultrasound

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24
Q

How is temporal arteritis treated?

A

High dose steroids and aspirin

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25
Q

What is cerebral venous thrombosis?

A

Thrombosis in dural venous sinus or cerebral vein causing raised ICP

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26
Q

What are risk factors for cerebral venous thrombosis?

A

Thrombophilia, pregnancy, dehydration

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27
Q

What are presenting symptoms of meningitis?

A 
Malaise
Headache 
Fever
Neck stiffness
Photophobia
Confusion
Alteration of consciousness
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28
Q

What cause of meningitis is most concering?

A

Bacteria (low now due to vaccination)

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29
Q

What is herpes simplex encephalitis?

A

Classic haemorrhagic changes in the temporal lobes

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30
Q

Is meningitis treated or diagnosed first?

A

Treat

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31
Q

How are meningitis patients treated?

A

Antibiotics

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32
Q

How is meningitis diagnosed?

A

Blood and urine culture
Lumbar puncture
Increased White Cell Count, decreased glucose, Antigens, Cytology, Bacterial Culture
CT or MRI Scan

33
Q

How does sinusitis present?

A 
Malaise, headache, fever.
Blocked nasal passages. 
Loss of  vocal resonance.
Anosmia.
Nasal or postnasal catarrh.
Local pain and tenderness.
34
Q

How does headache present in sinusitis?

A

With frontal pain 1-2 hrs after waking up and clears in the afternoon

35
Q

What are brain tumors called?

A

Glioblastoma

36
Q

What is Idiopathic Intracranial Hypertension? How does it present?

A

Looks like they have a tumor but they dont
Presents with Headache, visual obscurations, diplopia, tinnitus
Papilloedema, +/- visual field loss
Headache, visual obscurations, diplopia, tinnitus
Papilloedema, +/- visual field loss

37
Q

How is Idiopathic Intracranial Hypertension treated?

A

Drugs: hormones, steroids, antibiotics, vitamin E
Treatment: weight loss, diuretics, optic nerve sheath decompression, lumboperitoneal shunt, stenting of stenosed venous sinuses.

38
Q

What can indicate ICP in a MRI?

A

Ventricles arent visible as they are squashed

39
Q

What pressures can cause headaches?

A

Usually high but also low

40
Q

How does low pressure headache occour?

A

CSF leak due to tear in dura, pressure falls when they get up

41
Q

How is low pressure headache treated?

A

rehydration, caffeine, blood patch

42
Q

How does low pressure headache show up on a scan?

A

There is meningeal enhancement

43
Q

What is Chiari malformation?

A

The brain is normal but it sits very low in the skull

44
Q

What happens to cerebellar tonsils in chiari malformation?

A

They go through the foramen magnum

45
Q

What is the sign of chiari malformation?

A

Coughing headache as when the patient coughs the cerebellar tonsils snag on the meninges

46
Q

What is obstructive sleep apnoea?

A

Headache with history of loud snoring and apnoeic spells

47
Q

Why do those with obstructive sleep apnoea have headache?

A

They have co2 retention

48
Q

What can obstructive sleep apnoea cause?

A

Trouble with sleep, depression, always falling asleep, poor performance at work

49
Q

What is trigeminal neuralgia?

A

Electric shock like pain in the distribution of a sensory nerve, have a headache

50
Q

How is trigeminal neuralgia treated?

A

Carbamazepine, lamotrigine, gabapentin.

Posterior fossa decompression.

51
Q

How is pain in trigeminal neuralgia triggered?

A

By anything sensory eg touching the face, wind, chewing

52
Q

What is atypical facial pain?

A

Daily, constant, poorly localised deep aching or burning

53
Q

How is atypical face pain treated?

A

Painkillers, opiates, nerve blocks, tricylics

54
Q

What is post traumatic headache?

A

Headache after physical trauma, depends on the nature of the injury eg victim of a car accident is more likely than person who caused it. Has many causes

55
Q

How are post traumatic headaches treated?

A

Non-steroidal anti-inflammatories - ibuprofen, naproxen
Tricyclic antidepressants - Amitriptyline
Explain to them that they can overcome this

56
Q

What is cervical spondylosis?

A

Narrowing of joint space in spine causing discs to be worn

57
Q

How does cervical spondylosis present?

A 
Usually bilateral
Occipital pain can radiate forwards to the frontal region
Steady pain
No nausea or vomiting
Worsened by moving the neck
58
Q

How is cervical spondylosis treated?

A

Rest, deep heat, massage.

Anti-inflammatory analgesics

59
Q

What are the main primary headaches?

A

Migraine, cluster and tension

60
Q

How many attacks occur in someone who experiences migraines?

A

1-8 monthly

61
Q

How long can a migraine last?

A

48 hrs

62
Q

What are the main symptoms of a migraine?

A

Vertigo, motion sickness, headache, aura

63
Q

What is aura in relation to migraines?

A

Visual symptoms eg seeing expanding ā€˜Cā€™s, scintillations, blind spot

64
Q

What is prodrome?

A

The first phase of a migraine where there are changes in mood, urination, food cravings and yawning

65
Q

What are the treatments for migraine?

A 
Aspirin/ibuprofen/paracetamol
Triptans
Opiates
Naps
Avoid triggers
66
Q

How do migraines start?

A

Spontaneously or brought on via triggers eg light, dehydration, caffeine, skipping meals

67
Q

Describe the pain in a tension type headache

A

Tight muscles around the head and neck

68
Q

How are tension type headaches treated?

A

NSAIDs
Paracetamol
Tricyclic antidepressants
SSRIs (but less effective)

69
Q

Describe the pain in a cluster headache

A

Severe unilateral pain

70
Q

How long do cluster headaches last

A

15-180 mins

71
Q

What symptoms does a cluster headache present with

A

At least one of the following ipsilaterally
Conjunctival redness and/or lacrimation
Nasal congestion and/or rhinorrhea
Eyelid oedema

72
Q

How often do cluster headaches occur

A

One or alternate days up to 8 a day

73
Q

Describe how migraines and cluster headaches differ in terms of duration

A

Migraine: 3-12 hrs

Cluster headache: 45 mins-3hrs

74
Q

Describe how migraines and cluster headaches differ in terms of frequency

A

Migraine: 1-8 attacks monthly
Cluster: 1-3 attacks daily

75
Q

Describe how migraines and cluster headaches differ in terms of remission

A

Migraine: Long remissions unusual
Cluster: Long remissions common

76
Q

Describe how migraines and cluster headaches differ in terms of nausea

A

Migraine: nausea and vom frequent
Cluster: nausea rare

77
Q

Describe how migraines and cluster headaches differ in terms of pain

A

Migraine: Pulsating hemicranial pain
Cluster: Steady, exceptionally severe, well localised, unilateral

78
Q

With which type of headaches are auras seen as a symptom?

A

Migraines

BRS Y2 (85 decks)

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