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3C week 3 - headaches and tingly toes > headache (see DM) > Flashcards

headache (see DM) Flashcards

1
Q

8 causes of secondary headache

A
  1. meningitis;
  2. subarachnoid haemorrhage;
  3. raised intracranial pressure;
  4. GCA;
  5. venous sinus thrombosis;
  6. pituritary apoplexy;
  7. carotid dissecton;
  8. acute closed angle glaucoma
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2
Q

4 primary headache disroders

A
  1. tension headache;
  2. migraine;
  3. cluster headache;
  4. trigeminal neuralgia
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3
Q

red flags for headache

A

new; “worst ever”; thunerclap (peak intensity reached in seconds-minutes); systemically unwell; symptoms of raised ICP; B symptoms (fever, night sweats, weight loss); meningism; focal signs

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4
Q

where does the pain in a secondary headache arise from

A

outside the brain (meninges in particular) - the brain itself has no sensory neurons to detect pain

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5
Q

what does a haemorrhage do to the meninges

A

causes inflammation

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6
Q

how to irritate the meninges (test for it)

A

slowly, gently, move the head forwards

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7
Q

what condition is motion sensitivity prominent in

A

migraine

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8
Q

what is a red flag for raised ICP

A

short onset of pain when lying down

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9
Q

why is raised ICP worse when lying down

A

when standing - excess CSF pools in the sacral area which is more lax and the meninges is less stretched;
when lying down - CSF is distributed more evenly in the CNS meaning that there is greater volume in the cranial region -> less flexible and so meninges is more irritates

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10
Q

signs of raised ICP (4)

A

headache worse on lying down, coughing, sneezing and straining

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11
Q

what is papilloedema

A

swelling of the optic disc due to elevated intracranial pressure (ICP)

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12
Q

what does venous pulsation in the retina indicate

A

ICP normal - this is a normal finding (however, absence of this does not necessariy mean there is raised ICP)

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13
Q

time frame for a lumbar puncture in a SAH pt

A

12hrs -2weeks (peak time for blood degredaton products)

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14
Q

what does an angiogram negative SAH indicate

A

cortical SAH rather than the usual basal

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15
Q

2 examples of causes of cortical based SAHs

A

reversible cerebrum vasoconstricton syndrome (seen in cocaine abuse and chronic nasal decongestion users);
amyloid angiopathy

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16
Q

what is amyloid angiopathy

A

a type of cerebrovascular disorder characterized by the accumulation of amyloid within the leptomeninges and small/medium-sized cerebral blood vessels

17
Q

SAH vs meningitis headache

A

SAH - sudden onset, thunderclap;
meningitits - acute onset but gradually gets worse (rather than thunderclap)

18
Q

pt comes in with neck + head pain after going on a rollercoaster, L pupil is constricted - what does this pt hv and what is the immediate mgx

A

carotid artery dissection causing horner’s syndrome (pressure on sympathtic chain) -> high risk of stroke;
give Aspirin (300mg)

19
Q

what is Horner’s syndrome

A

a condition that arises due to damage to the sympathetic supply to the eye, resulting in unilateral partial ptosis (drooping or falling of the upper eyelid), miosis (constricted pupil), and facial anhydrosis

20
Q

Horner’s syndrome ptosis vs CN III palsy

A

Horner’s - patial ptosis due to sympathetic stimulation only innervating the superior tarsal muscle (smooth muscle) which only contributes to 1/3 of the upper eyelid’s opening power;

CN III palsy - complete ptosis due to lack of motor stimulation to the levator palpebae superior (skeletal muscle) which contributes to 2/3 of the upper eyelid opening

21
Q

pt presents with thunderclap headache and Hx of galactorrhea and bitermptal hemianopia - what does this pt hv and what is the immediate mgx

A

Pituitary apoplexy (blockage in blood flow or hemorrhage in your pituitary gland) which may result in addisionian crisis; give steroids

22
Q

what kind of thrombosis does the pill increase the risk of

A

cerebral venous sinus thrombosis

23
Q

venous sinus thrombosis CT findings

A
  1. dense clot sign;
  2. empty delta sign ;
  3. hemorrhage in sinuses (not typical areas seen);
24
Q

venous sinus thrombosis Mgx

A

heparin

25
Q

what is the commonest cause of headache

A

tension

26
Q

tension headache presentation (4)

A
  1. band like distribution;
  2. Dull, aching head pain;
  3. Feeling of tightness or pressure bilaterally across the forehead or on the sides and back of the head;
  4. tenderness in the scalp, neck and shoulder muscles;
27
Q

tension headache mgx (3)

A

1.Over-the-counter analgesics (e.g., paracetamol, ibuprofen);
2. If over-the-counter treatments are ineffective, consider prescribing stronger analgesics;
3. amitriptyline

28
Q

migraine presentation (7)

A
  1. unilateral throbbing;
  2. gradual onset;
  3. photophobia/phonophobia;
  4. motion sensitivity;
  5. naursea/vomiting;
  6. prodrome/aura preceeding (flashing lights, silvery zigzags etc.);
  7. non responsive to painkillers
29
Q

what counts as analgesia overuse in headaches

A

opiates/triptans - 10 days per month;
other analgesisc - 15 days per month

30
Q

cluster headache presentation (6)

A
  1. unilateral periorbital pain;
  2. boring/dull pain;
  3. lacrimation;
  4. red eye;
  5. nasal stuffiness;
  6. restlessness (walks about);
31
Q

cluster headache epidemiology

A

men (5:1) in their 20/30s

32
Q

what overarching group of headaches does a cluster headache belong to

A

trigeminal autonomic cephalgia

33
Q

chronic cluster headache treatments (6)

A
  1. verapamil (needs ECG monitoring);
  2. topiramate;
  3. gabapentin;
  4. sodium valporate
  5. lithium (toxic, so only use if others don’t work);
  6. gammacore device (contraversial, targets vagus nerve);
34
Q

other examples of trigeminal autonomic cephalgia (not cluster headache)

A
  1. paroxysmal hemicrania (boring, orbital pain);
  2. short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (severe, stabbing pain, orbital);
35
Q

trigeminal neuralgia presentation (5)

A
  1. sudden onset;
  2. severe, stabbing pain (like an electric shock);
  3. lasts seconds-minutes but may leave a dull ache;
  4. occurs in bouts of pain throughout the day (sometimes multiple);
36
Q

what can trigger trigeminal neuralgia

A

wind, movement (e.g chewing), cold, touch etc.

37
Q

trigeminal neuralgia mgx (5)

A

pharma:
1. carbamazepine/oxcarbazepine;
2. gabapentin;
3. baclofen (muscle relaxant);
etc.
non pharma:
1. radiofrequency ablation of CN V;
2. neurovascular decompression (but significant complication rate so not usually done)

38
Q

trigeminal neuralgia pathophys

A

compression of trigeminal nerve by ectatic blood vessel (diffuse dilation of bv)

39
Q

increase in tenderness of what muscles is seen in tension headaches and how does this contribute to tension headaches occuring

A

pericranial and cerviacle muscles -> increased sensitisation -> hyperalgesia -> further sensitisation -> allodynia

3C week 3 - headaches and tingly toes (7 decks)

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