Headache and Non-traumatic Brain Bleeding Flashcards
List red flag symptoms/signs related to headache
New onset in over 55 yr old Known/previous cancer Immunosuppressed Early morning onset Exacerbated by valsalva
What is the difference between migraine with and without aura? Which is more common?
Migraine with aura: warning signs before migraine begins, e.g. flashing lights
Migraine without aura is more common
How long do auras typically last in migraine?
20-60 mins
List triggers of migraine
Sleep Diet Stress Physical exertion Hormones
List non-pharmacological treatment for migraine
Trigger diary
Education
Stress management
List pharmacological management of migraine
NSAID + anti-emetic if vomiting
Triptans (rizatriptan)
When should prophylaxis be considered for migraine?
More than 3 attacks in a month or very severe
List prophylactic therapy for migraine
Propranolol Topiramate Amitryptilline Gabapentin Sodium valproate
List the 4 main types of trigeminal cephalgias
Cluster headache
Paroxysmal hemicranias continua
Hemicrania continua
SUNCT
Who gets cluster headaches more - men or women?
Men
Typically 30-40 yr olds
When do cluster headaches typically come on?
Around sleep time
Describe a cluster headache
Severe unilateral headache lasting 20mins-3hrs
1 to 8 episodes a day
Who gets paroxysmal hemicranias continua more - men or women?
Women
Typically 50-60 yr olds
How would you distinguish paroxysmal hemicranias continua from cluster headache?
Shorter duration, more frequent
2-45 minutes 1-40 times a day
Which drug provides absolute response to paroxysmal hemicranias continua?
Indomethicin
What is a SUNCT trigeminal cephalgia?
Short Unilateral Neuralgia Conjunctival injections Tearing
What is the treatment for SUNCT?
Gabapentin / lamotrigine
Who gets trigeminal neuralgia more - men or women?
Women
Typically elderly
What typically triggers trigeminal neuralgia?
Touch in V2/V3 region
How long does an episode of trigeminal neuralgia usually last?
1-90 seconds
10-100 episodes a day
List treatment for trigeminal neuralgia
Carbamazepine Gabapentin Phenytoin Baclofen Surgical decompression
What is the most common underlying pathology in a subarachnoid haemorrhage?
Berry aneurysm (polycystic kidney disease)
Subarachnoid haemorrhage can occur whilst having sex. True/False?
True
Which cranial nerve can be particularly affected in subarachnoid haemorrhage?
CN III
What may be seen on fundoscopy in someone who has had a subarachnoid haemorrhage?
Retinal or vitreous haemorrhage
CT scan of a brain may be normal in subarachnoid haemorrhage. True/False?
True
If a CT scan of a person with suspected subarachnoid haemorrhage is normal, what is the next best investigation?
Lumbar puncture
Describe CSF appearance on lumbar puncture in subarachnoid haemorrhage
Xanthochromatic or bloodstained
What investigation is gold-standard for identifying bleeding location of a subarachnoid haemorrhage?
Cerebral angiography with/without CT
List some complications of subarachnoid haemorrhage
Re-bleeding often fatal Hydrocephalus Hyponatraemia Seizure Delayed ischaemia - 3-14 days following haemorrhage
Why should you not fluid restrict someone with hyponatraemia as a complication of subarachnoid haemorrhage?
Will cause hypovolaemia, predisposing to vasospasm and cerebral ischaemia
What is the most common aetiology/risk factor for intracerebral haemorrhage?
Hypertension leading to microaneurysm
Typically where does a hypertensive intracerebral haemorrhage affect anatomically?
Basal ganglia (haematoma)
List the main investigations for intracerebral haemorrhage
CT scan (urgent if decreased consciousness) Angiography
Arteriovenous malformations (AVMs) are typically clinically silent. True or false?
True - they are clinically silent until haemorrhage
Where is the bleeding in a subarachnoid haemorrhage?
Bleeding in the subarachnoid space between the pia and arachnoid membrane
If a subarachnoid haemorrhage shows up on CT is shows up as a ____ signal in the subarachnoid space?
Hyperdense
Which well circumscribed benign vascular lesion shows up as a focal lesion with a “popcorn-like” appearance surrounded by a ring of hypo-intensity consistent with hemosiderin deposition on MRI?
Cavernous malformation
Most aneurysms arise in the posterior circulation. True or false?
False - 90% arise from the anterior circulation
Intracerebral haemorrhage always causes focal neurological deficits. True or false?
True
Idiopathic intercranial hypertension typically affects what type of patient?
Young, obese females
