Headache TCD

Question 1

‘Worst ever headache’

Answer 1

Subarachnoid

Question 2

Neckstiffness and …. sign indicated meningeal irritation

Answer 2

Kernig’s sign

Question 3

Headache with generalised aches and pains in the elderly

Answer 3

Giant cell arteritis

Question 4

three causes of hydrocephalus in children

Answer 4

Congenital - Arnold-Chiari malformation
meningitis
Haemorrhage

Question 5

Causes of hydrocephalus in adults

Answer 5

Late presentation of congenital 
cerebral tumours in posterior fossa or brainstem 
Subarachnoid haemorrhage 
Head injury 
meningitis 
Third ventrical colloid cyst 
Normal pressure hydrocephalus

Question 6

Recurrent prostrating headaches with episodes of lower limb weakness

Answer 6

intermittent hydrocephalus due to a third ventricle colloid cyst

Question 7

Clinical features of hydrocephalus

Answer 7

headache, vomiting, papilloedema caused by raised intracranial pressure. Ataxia and bilateral pyramidal signs

Question 8

Indication of brain imaging in headache patient

Answer 8

Sudden onset
New headache in a patient over 50 
Abnormal neurological signs 
Headache changing with posture - ICP 
Headache made worse with coughing, bending ect - ICP 
Fever 
HIstory of HIV 
History of cancer

Question 9

Jaw claudication headache

Answer 9

giant cell arteritis

Question 10

What are most chronic daily and recurrent headaches?

Answer 10

Tension headaches

Question 11

Symptoms and treatment of tension headaches

Answer 11

pressure or tightness all around the head and scalp muscles, treat with reassurance, analgesic withdrawal and maybe TCAnti-D

Question 12

Age of onset and gender of migraines

Answer 12

usually before 40, more in females

Question 13

Which cranial nerve nucleus is most affected in migraines?

Answer 13

Trigeminal nerve

Question 14

Three types of migraines

Answer 14

Migraine with aura (classic) 
Migraine without aura (common) 
Migraine variants (Look scary, resemble strokes)

Question 15

Describe the headache in migraine

Answer 15

Unilateral, throbbing, builds up.

Question 16

Symptoms in migraine

Answer 16

Photophobia, phonophobia, nausia, vomiting.

Question 17

Do auras come on before or after the headache in migraines

Answer 17

Before

Question 18

Differetial diagnosis in migraines

Answer 18

Meningitis, SAH, thrombotic TIAs (TIA maximum deficit is immediate and visual symptoms are negative - negative visual symptoms not positive)

Question 19

Oral contraseptive and migraines

Answer 19

contraindicated with migraine with focal aura

Question 20

Management of mild migraine

Answer 20

paracetamol, NSAIDs, aspirin and anti emetic such as metoclopramide

Question 21

Management of moderate/ severe attacks

Answer 21

Triptans, CGRP antagonists e.g telcagepant for acute

Question 22

What are triptans and when are they contraindicated?

Answer 22

Examples: sumatriptan, almotriptan, eletriptan.
Mechanism: serotonin agonists
Contraindicated when there is vascular disease and in migraine variants

Question 23

When is migraine prophylaxis indicated?

Answer 23

frequent attacks more than two per month, or poor responce o acute attack treatment

Question 24

Types of prophylaxis for migraines

Answer 24

valporate, b-blockers, amitriptyline, botulinum toxin.

Question 25

Which cranial nerve could be the causes of facial pain?

Answer 25

Trigeminal nerve - trigeminal nerve lesions, trigeminal neuralgia.

Question 26

What sort of headache classification are cluster headaches?

Answer 26

Trigeminal autonomic cephalgias

Question 27

Describe cluster headaches

Answer 27

Rapid onset, severe and short. Come in clusters - over weeks and then a long time of none. More often in men. Start around the eyes or temple. Autonomic features - lacrimation and redness of eye. Horner's syndrome. Medication - acute - 100 oxygen, nasal triptans

Question 28

Giant cell arteritis type of arteritis

Answer 28

Granulomatous arteritis

Question 29

What arteries are mainly effected in GCA

Answer 29

extradural arteries

Question 30

GCA is closely related to

Answer 30

Polymyalga rheumatica

Question 31

Symptoms of GCA

Answer 31

Headache, scalp tenderness, on combing hair. pain in jaw and mouth which is worse on eating . SUPERFICIAL TEMPORAL ARTERY MAY BECOME TENDER AND PULSELESS.

Question 32

Optic consiquence of untreated GCA

Answer 32

inflammation and occlusion of the ciliary and or central retinal artery, can cause blindness

Question 33

Investigations in GCA

Answer 33

ESR elivated about 50 mm/H Liver enzymes elivated too Normochromic, normocytic anaemia Temporal artery biopsy - granulomatous changes

Question 34

Management of GCA

Answer 34

Prednisolone initially 60-100mg daily ASAP. reduced guided by ESR

Question 35

Cluster headache prophylaxis

Answer 35

verampamil

Question 36

CSF appearance, glucose, protein and white cell in bacterial meningitis

Answer 36

Cloudy, low glucose, High protein, highest white cells 10-5000 polymorphs.

Question 37

CSF appearance, glucose, protein and white cells in viral meningitis

Answer 37

clear/cloudy, 60-80% of plasma glucose, normal/raised protein, 15-1000 lymphocytes

Question 38

CSF appearance, glucose, protein and white cells in TB meningitis

Answer 38

Slightly cloudy with fibrin web, Low glucose, high protein, 10-1000 lymphocytes.

Question 39

Meningitis in elderly and immunosuppressed

Answer 39

Listeria monocytogenes

Question 40

Alpha haemolytic streptococci that can cause meningitis

Answer 40

Streptococcus pneumoniae

Question 41

Triad of symptoms for normal pressure hydrocephalus

Answer 41

The classic triad of symptoms is dementia, incontinence and disturbed gait.

Question 42

What is obstructive hydrocephalus and what are the causes?

Answer 42

Blockage of flow of CSF, causes dilatation of ventricles superior to block Causes: tumours, acute haemorrhage (e.g. subarachnoid haemorrhage or intraventricular haemorrhage) and developmental abnormalities

Question 43

What is non-obstructive hydrocephalus and what are the causes?

Answer 43

Abnormal production (Choroid plexus tumour) or abnormal re-absorption of CSF (meningitis or post-haemorrhagic)

Question 44

First line investigation of hydrocephalus

Answer 44

CT head, followed by MRI

Question 45

In what type of hydrocephalus is lumbar puncture contraindicated?

Answer 45

obstructive