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Neurology finals > Headache > Flashcards

Headache Flashcards

1
Q

What is the most common form of headache?

A

Tension

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2
Q

Describe the presentation of a subarachnoid haemorrhage

A 
Sudden onset - thunderclap 
Worst ever pain 
Occipital stiff neck 
Focal signs 
Decreasing consciousness
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3
Q

Describe the presentation of meningitis

A 
Rapid onset headache 
Fever
Photophobia 
Stiff neck 
Purpuric rash 
Coma 
Neck stiffness - meningeal irritation
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4
Q

Describe the initial management of meningitis

A

LP and start antibiotics

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5
Q

Describe the presentation of encephalitis

A 
Rapid onset headache
Fever
Odd behaviour
Fits
Reduced consciousness
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6
Q

Describe the initial management of encephalitis

A

Urgent CT head

LP - look for infection

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7
Q

Describe the presentation of venous sinus thrombosis

A

Subacute headache

Papilloedema

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8
Q

Describe the presentation of sinusitis

A

Dull constant ache over frontal or maxillary
sinuses with tenderness +/- post nasal drip
Pain is worse on bending down
Ethmoid or sphenoid sinus pain is felt deep in the midline at the front of the root of the nose
Common with coryza
Pain lasts 1-2 weeks

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9
Q

Describe the presentation of intracranial hypotension

A

Subacute/gradual onset
CSF leakage
Headache worse on standing

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10
Q

Describe tension headache

A

Tight band
Bilateral
Non pulsatile headache
Scalp muscle tenderness

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11
Q

What can chronic progressive headaches indicate?

A

Raised ICP

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12
Q

Describe raised ICP presentation

A 
Chronic progressive headache
Worse on waking, coughing, lying and bending forward 
Vomiting
Papilloedema
Seizures
False localising signs 
Odd behaviour
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13
Q

What may cause raised ICP

A

Space occupying lesion

Idiopathic intracranial hypertension

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14
Q

Describe the symptoms of a cluster headache

A 
Rapid onset
Excruciating pain around one eye that may become watery and bloodshot with lid swelling, lacrimation, facial flushing, rhinorrhoea, miosis, ptosis
Unilateral pain 
Affects the same side 
Lasts 15-180 mins
Occurs once or twice a day 
Nocturnal 
Clusters last 4-12weeks and are followed by pain free periods of months or years between next cluster 
Sometimes chronic and not episodic
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15
Q

How do you treat an acute cluster headache attack

A

Give O2 100% for 15mins via non-rebreathable mask

Sumatriptan SC 6mg at onset

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16
Q

How can cluster headaches be prevented

A

Avoid triggers
Corticosteroids short term only
Verapamil 360mg
Lithium 900mg

17
Q

Describe the presentation of trigeminal neuralgia

A

Paroxysms of intense stabbing pain lasting seconds in the trigeminal nerve distribution
Unilateral
Affects mandibular or maxillary divisions
Face screws up with pain

18
Q

What can trigger trigeminal neuralgia

A

Shaving
Eating
Talking
Dental prostheses

19
Q

What is a typical trigeminal neuralgia patient

A

Asian
>50yo
Male

20
Q

List the secondary causes of trigeminal neuralgia

A

Compression of the trigeminal root by anomalous or aneurysmal intracranial vessels or a tumour, chronic meningeal inflammation, MS, zoster, skull base malformation

21
Q

How do you treat trigeminal neuralgia

A 
Carbamazepine (start at 100mg/12h PO)
Lamotrigine 
Phenytoin 200-400mg/24h PO
Gabapentin
Microvascular decompression
22
Q

Describe medication overuse headache

A

Mixed analgesics - paracetamol plus codeine/opiates, ergotamine and triptans
Common reason for episodic headache becoming chronic daily headache

23
Q

How is medication overuse headache treated

A

Withdraw analgesia - aspirin and naproxen may modify the rebound headache

24
Q

Describe the presentation of acute glaucoma

A

Eye pain
Reduced vision
Elderly, long sighted people
Constant pain develops round one eye radiating to the forehead with markedly reduced vision, visual haloes and a red, congested eye

25
Q

Describe giant cell arteritis

A

Subacute onset headache
ESR >40mm/h
Exclude in >50yos with a headache that lasted a few weeks: prompt diagnosis and steroids avoid

Neurology finals (32 decks)

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