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Year 2 BRS Neuro > Headache > Flashcards

Headache Flashcards

1
Q

Causes of dull headache

A

Overuse of medication (e.g. codeine)

Contraceptive pill, hormone replacement therapy

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2
Q

Causes acute single headache

Thunderclap (sudden onset), low pressure

A 
Febrile illness, sinusitis
 head injury
Subarachnoid haemorrhage
Meningitis,
 drugs,
 toxins, 
stroke
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3
Q 
What headache patterns are these? 
Cluster 
Migraine 
Episodic tension headache 
Trigeminal / post herpetic neuralgia
A

Recurrent

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4
Q

Triggered headache

A

Coughing, straining, exertion
Coitus
Food and drink

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5
Q

Red flags
onset?
presence of systemic symptoms?
what neuro symptoms?

better standing or lying down?

A

Onset : Thunderclap, acute, subacute

Meningism : Photophobia, phonophobia, stiff neck, vomiting

Systemic symptoms : Fever, rash, weight loss

neurological symptoms / focal signs : Visual loss, confusion, seizures, hemiparesis, double vision, 3rd nerve palsy, Horner syndrome, papilloedema,

Orthostatic-better lying down

Strictly unilateral

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6
Q

Horner syndrome?

A

decreased pupil size, a drooping eyelid and decreased sweating on the affected side of your face

inhibition of sympathetic nerve supply

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7
Q

3rd Nerve Palsy

A

CN III impacted so actions of CN IV/ VI

completely closed eyelid and deviation of the eye outward and downward

the eye cannot move inward or up, and the pupil is typically enlarged and does not react normally to light

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8
Q

Papilloedema

A

Papilledema or papilloedema is optic disc swelling that is caused by increased intracranial pressure due to any cause. The swelling is usually bilateral

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9
Q

Signs headache is due to Subarachnoid haemorrhage

A
  • blow to the head
  • stiff neck photophobia
  • ruptured aneurysm , arteriovenous
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10
Q

Subarachnoid Haemorrhage headache : Course of action

what drug? what needs monitoring

A
  • Vasospasm : stop leak
  • Nimodipine : calcium channel blocker used in preventing vasospasm secondary to subarachnoid hemorrhage
  • BP control needed
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11
Q

Markers of Subarachnoid Haemorrhage ?

A
  • CT brain
  • Lumbar Puncture : will show xanthochromia
  • MRA, Angiogram
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12
Q

what is xanthochromia ?

A

yellowish appearance of cerebrospinal fluid that occurs several hours after bleeding into the subarachnoid space
- sign of Subarachnoid Haemorrhage

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13
Q

How is an unruptured aneurysm dealt with ?

A
  • Clipped
  • Wrapped
  • Platinum coils
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14
Q

Optic disc swelling

A
  • due to raised intracranial pressure
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15
Q

Temporal Arteritis

characteristics

A

<55
3x more in women
Constant unilateral headache
Scalp tenderness and jaw claudication + present w polymyalgia rheumatica
Elevated ESR, CRP
Inflamed and tortuous
Biopsy inflammation and giant cells : disruption of internal elastic lamina

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16
Q

Polymyalgia Rheumatica

A

Proximal muscle tenderness

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17
Q

Temporal Arteritis

can cause blindness why?

A

inflamed temporal artery can get posterior ciliary arteries are involved

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18
Q

ESR and CRP what do they show?

A

signs of inflammation

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19
Q

Unusual amount of headache due to raised ICP

A
  • Cerebral Venous Thrombosis
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20
Q

Why does Cerebral Venous Thrombosis occur?

A

Non-territorial ischaemia “venous infarcts”
Haemorrhage
Thrombophilia, pregnancy, dehydration,
- Behcets :blood vessel inflammation throughout your body

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21
Q

Cause of Headache

A

Viral- Coxsackie, ECHO, Mumps, EBV
Bacterial - Meningococci, Pneumococci, Haemophilus
Tuberculous
Fungal - Cryptococci
Granulomatous- Sarcoid, Lyme, Brucella, Behçet’s, Syphilis
Carcinomatous

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22
Q

Meningitis

Presenting symptoms

A 
Malaise
Headache 
Fever
Neck stiffness
Photophobia
Confusion
Alteration of consciousness
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23
Q

Herpes Simplex Encephalitis

A

Classic haemorrhagic changes in the temporal lobes

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24
Q

Meningitis

Treat then diagnose

A 
Antibiotics
Blood and urine culture
Lumbar puncture
		Increased White Cell Count, decreased glucose
		Antigens
		Cytology
		Bacterial Culture
CT or MRI Scan
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25
Q

Bacterial Meningitis

characterisitic

A

Cerebral oedema with effacement of ventricles and sulci and inflamed meninges

26
Q

Sinusitis

characteristic

A

Malaise
Headache
Fever
Blocked nasal passages
loss of vocal resonance (increased air present)
build of mucus in nasal / postnasal : Catarrh
Anosmia: loss of smell

27
Q

Idiopathic Intracranial Hypertension

A

Pseudotumor Cerebri

  • young , obese women
  • headache, diplopia, tinnitus
28
Q

What can cause? idiopathic intracranial hypertension?

Treatment?

A

Hormones, steroids, antibiotics, Vit E

-weight loss, diuretics, optic nerve sheath decompression, lumboperitoneal shunt, stenting of stenosed venous sinuses

29
Q

Low Pressure Headache

A

CSF leak due to tear in Dura

30
Q

What can cause L-Pessure Headcache

A

Traumatic post lumbar puncture or spontaneous

31
Q

Treatment for LPH

A

Treatment rehydration, caffeine, blood patch

32
Q

Chiari Malformation

A

Normal brain sits low within skull

33
Q

Why in Chiari Malformation does a cough trigger a headache?

A

Cerebellar tonsils descending through the foramen magnum. Descend further when patient cough and tug on the meninges causing cough headache.

34
Q

Cause of headache : Obstructive sleep apnoea
causes of headache is due to?

treatment?

A
  • loud snoring
  • apnoeic spell

Hypoxia, CO2 retention, non refreshing sleep

Nocturnal NIV
Surgery

35
Q

Cause of headache : Trigeminal Neuralgia

why?

Drug treatments?

A

Electric shock like pain in the distribution of a sensory nerve

Neurovascular conflict at point of entry of nerve into pons
Can be symptom of MS

Carbamazepine [ inhibts sodium channels] , lamotrigine [ binds sodium channels, inhibits glutamate], gabapentin [ mimic GABA? inhibits calcium channels not sure hot it works]

36
Q

Cause of headache : Trigeminal Neuralgia

Drug treatments? [3]

sodium channel inhibitor?
calcium channel blocker

A

Carbamazepine, lamotrigine, gabapentin.

37
Q

Atypical facial pain

A

Middle aged women

  • Depressed or anxious
  • Daily, constant, poorly localised deep aching or burning.
  • Not piercing pain [ exclude any nerve pain]
  • No sensory loss
  • Pathology in teeth, temporomandibular joints, eye, nasopharynx and sinuses must be excluded.
38
Q

treatment for :

Atypical facial pain

A

Unresponsive to conventional analgesics, opiates and nerve blocks.

  • Mainstay of management tricyclics.
39
Q

Post traumatic headache
who?

mechanims?

A

High in victims of car accidents

Low in perpetrators of car accidents

Low in sports injuries

  • Neck, Scalp, Vasodilation, depression
40
Q

What is the most common cause of new headache in older patients?

A

Cervical Spondylosis

41
Q

Cervical Spondylosis

A
  • Bilateral
  • Occipital pain radiates forwards to the frontal region
  • steady pain
  • worsened by neck movements
  • steady pain
42
Q

management of

Cervical Spondylosis

A

Rest, deep heat, massage

Anti-inflammatory analgesics

43
Q

Vascular and Circulatory causes of headaches:

A
  • Subarachnoid Haemorrhage [circle of willis]
  • Acute intracerebral haemorrhage
  • Raised Intracranial Pressure (ICP) > - Cerebral Venous Thrombosis
  • Chronic subdural haemorrhage [venous]
  • Temporal Arteritis [temporal artery]
44
Q

3 most common types of Primary headaches?

A

Migraine , Cluster , Tension

45
Q

Migraine

common characteristic

A 
repeat attacks 
has triggers
unilateral
pulsating
visual vertigo
motion sickness
46
Q

Migraine phases

5

A

Prodrome : Changes in mood, urination, fluid retention, food craving, yawning

Aura (can occur wo) : Visual, sensory, weakness, speech arrest

Headache: pain , nausea, photophobia

Resolution : rest / sleep

Recovery :mood disturbed, food intolerance, feeling hungover - 48 hours or so

47
Q

Define visual aura

Migraine

A

Scintillations and blindspots

48
Q

Treatment for

Acute Migraine attack

A

NSAIDS: aspirin / ibuprofen
Anti-emetic: metoclopramide [anti nausea]
Vasoconstrictors synergise with NSAIDS

Triptans : ssragonist : triptans work by stimulating serotonin, a neurotransmitter found in the brain, to reduce inflammation and constrict blood vessels, thereby stopping the headache or migraine

Nap

49
Q

Migraine

long term treatment

A

dietary, environmental, hormonal, weather, dehydration, stress
Drink 2 litres water/day
Avoid caffeinated drinks
Don’t skip meals. Fresh food. Avoid ready meals & take-aways
Don’t oversleep or have late nights. Electronics downstairs.
Analgesic abuse

50
Q

Migraine
prophylaxis
over the counter

A 
feverfew
coenzyme Q10
riboflavin
magnesium
 EPO
nicotinamide
51
Q

MIgraine treatments prophylaxis

A 
TCA's
Beta blockers
Serotonin antagonists
calcium channel blockers
anticonvulsants 
Suppress ovulation (progesterone only pill or implant/injection
greater occipital nerve blocks
52
Q

Migraine wonder drug?

also for episodic migraine, chronic migraine or cluster headache

A

Erenumab
CGRP mAbs: targets calcitonin gene related peptide or its receptor

8 a month to 4/5 a month

injectable

53
Q

Tension type headache

A

Bilateral
‘Head in a vice’

Nsaids : naproxen , diclofenac

Paracetamol
TCAs
SSRIs - less effective

54
Q

Cluster

A

Severe unilateral
15-180 mins
Trigeminal autonomic cephalgia

ipsilateral : Conjunctival redness and/or lacrimation
Nasal congestion and/or rhinorrhoea
Eyelid oedema

restlessness
miosis / ptosis

site of pain most common : EYE , FOREHEAD , TEMPLE

55
Q

Cluster : headache

Acute

A

Acute : Inhaled oxygen. Oxygen inhibits neuronal activation in the trigeminocervical complex

S/C or Nasal Sumatriptan

56
Q

Prophylactic treatment Cluster
what type of drugs is Verapamil?
: steroid example?

drug which inhibits glutamate[nmda downregulations] and upregulates inhibitory NT GABA
increases GABA
blocks voltage-dependent sodium and calcium channels

A 
calcium channel blocker
Prednisolone : steroid
Lithium 
Valproate
Gabapentin
Topiramate
Pizotifen
57
Q

how does erenumab work?

what is it used for?

A

migraines

monoclonal antibody which blocks calcitonin gene-related peptide

58
Q 
Neck disease
Temporal arteritis
Benign intracranial hypertension
Cerebral tumour
Cerebral venous sinus thrombosis

these present as what type of headache?

A

Dull

59
Q

temporal arteritis pathophysiology, imaging and treatment?

A

temporal artery is inflamed
serious and needs clinical attention

straight away ultrasound : see inflamed temporal artery
give HIGH dose steroids [anti-inflammatory]

and aspirin [antiplatelets /avoid clot]
impact posterior ciliary arteries
= causing blindness

60
Q

migraine drug which
‘blocks serotonin (or 5HT) receptors in the brain. Blocking these receptors stops blood vessels in the brain from dilating and contracting. Pizotifen also blocks histamine receptors in the brain. Histamine is responsible for causing inflammation and widening of blood vessels’

A

Pizotifen

for cluster headaches

Year 2 BRS Neuro (8 decks)

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