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Headaches 1 Flashcards

1
Q

what is a headache

A

a symptom

could be due to structural, pharmacological e.g gtm and psychological cause

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2
Q

what can be some causes of acute single headache

A 
febrile illness, sinusitis
first attack of migraine
following head injury
subarachnoid haemorrhage
meningitis, tumour, drugs, toxins, stroke
thunderclap (sudden onset), low pressure
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3
Q

what are causes

of dull headache

A 
usually benign
overuse of meds e.g codeine
ocp, hormone replacement therapy
neck disease
temporal arteritis
benign intracranial hypertension
cerebral tumour
cerebral venous sinus thrombosis
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4
Q

what are some types of headaches

A

dull headache - unchanged over months
triggered headaches
recurrent headaches

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5
Q

describe a dull headache which is unchanged over months

not dangerous

A

chronic, tension headache

depressive, atypicial face pain

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6
Q

what is cause of triggered headache

A

coughing, straining, exertion
coitus
food/drink

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7
Q

what are types of recurrent headaches

A

migraine
cluster headache
episodic tension headache
trigeminal , post herpetic neuralgia

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8
Q

what are some red flags for headaches

A

onset - thunderclap, acute, subacute
meningism - photophobia,phonophobia, stiff neck, vomiting
systemic symptoms - fever, rash,weightloss
neurological symptoms/focal signs - visual loss, confusion, double vision
orthostatic
strictly unilateral

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9
Q

what are some red flag focal signs you could see in someone with headaches

A

double vision
horners syndrome - enophthalmos
3rd nerve/oculomotor palsy - drooping eyelid

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10
Q

what type of headache do patients with a subarachnoid haemorrhage experience

A

sudden generalised ‘blow to the head’ - thunderclap

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11
Q

what are most subarachnoid haemorrhages caused by

A

ruptured aneurysms
dew are from arteriovenous malformations
some unexplained

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12
Q

what are some symptoms of subarachnoid haemorrhages

A

meningism - stiff neck and photophobia

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13
Q

what % of subarachnoid haemorrhages are instantly fatal

A

50%

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14
Q

what can stop leakage in subarachnoid haemorrhages

A

vasospasms

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15
Q

initial treatment for subarachnoid haemorrhage and first steps

A

nimodipine
bp control
early neurological assessment to confirm bleed and establish cause
brain ct, lumbar puncture(rbc and xanthochromia)
mra, angiogram

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16
Q

how to treat anueurysms

A

used to be clipped/wrapped

nowadays filled with platinum coil

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17
Q

what is coning

A

pressure and swelling i=of brain

causes herniation. - brain squeezed out skull

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18
Q

how can you see raised intracranial pressure in brain

A

papilloedema

optic disc swelling at back of eye

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19
Q

what is carotid and verterbral artery dissection

A

layers of blood vessels can split
blood collects in these splits and can lead to turbulent flow
can cause headache and neck pain

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20
Q

what can cause dissection

A

traumatic
spontaneous
or predisposed e.g ehlers danlos

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21
Q

how can you investigate for a carotid/vertebral dissection

A

mri/mri
doppler
angipgraphy

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22
Q

what is the treatment for dissection

A

aspirin
anticoagulants so turbulent flow doesnt lead to clots
prevents stokes

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23
Q

what is temporal arteritis

A

commoner in females over 55
pain in shoulder muscle
constant unilateral headache
temporal artery usually inflammed and tortuous

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24
Q

how can you detect temporal arteritis

A

elevated esr and crp
biopsy shows inflammation and giant cells
visual on ulrasound

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25
treatment for t arteritis
steroids and aspirin
26
what is cerebral venous thrombosis
thrombosis in dural venous sinus/cerebral vein
27
why do you see unusual amount of headache in cvt
raised icp | veins are fragile and can haemorrhage
28
why do people have cvt
``` thrombophilia pregnancy dehydration long haul flight behcets ```
29
what is meningitis
infection in brain | can also be caused by carcinomas
30
what can cause infective meningitis
viral - coxsackie,echo,mumps,ebv bacterial - meningococci, pneumococci, haemophilius Tuberculous granulomatous -sarcoid, lyme,brucella, syphilis
31
what are the presenting features of meningitis
``` malaise headache fever neck stiffness photophobia alteration of consciousness confusion ```
32
what is herpes simplex encepalitis
haemorrhagic changes in temporal lobes
33
how to treat meningitis
``` treat then diagnose give antibiotics first blood and urine culture cti/mri then lumbar puncture ```
34
what is bacterial meningitis
cerebral oedema with effacement of ventricles and sulci | inflammed meninges
35
what is sinusitis
``` another infection that causes malaise headache fever blocked nasal passages anosmia nasal/post nasal catarrh local pain + tenderness frontal pain starts 1-2 hrs before getting up in morning ```
36
what is idiopathic intracranial hypertension
pseudotumour cerebri presents often in young obese women headaches, visual obscurations, diplopia, tinnitus papilloedema +- visual field loss
37
what drugs can be given for iih
hormones, steroids, antibiotics,vit e | weightloss, diuretics, optic nerve sheath decompression, lumboperitoneal shunt, stenting of stenosed venous sinuses
38
what is the hallmark of low pressure headache
orthostatic headache | appears when standing
39
what causes low pressure headache
csf leak due to tear in dura | or traumatic post lumbar puncture/spontaneous
40
how to diagnose low pressure headache
mri - meningeal enhancement | contrast injection
41
treatment for low pressure headache
rehydration caffeine blood patch
42
what is chiari malformation
brain sits very low in skull but normal cerebral tonsils come through foramen magnum descends when patients cough and tugs on meninges
43
what dies obstructive sleep apnoea cause
hypoxia co2 retention - leads to headache as potent vasodilator non refreshing sleep can lead to depression, impotence, poor performance at work
44
what treatment can be given to those with obstructive sleep apneoa
noctural niv | surgery
45
what is trigeminal neuralgia
electric shock like pain in distribution of a sensory nerves often triggered by innocuous stimuli e.g chewing any division of trigeminal nerve can be affected neurovascular conflict at point of entry of nerve into pons can be symptom of ms
46
what is treatment for trigeminal neuralgia
carbamazepine lamotrigine gabapentin posterior fossa depression
47
what is atypical facial pain
most common in middle aged woman who are usually depressed/anxious usually around face/jaw but can extend to neck,ear,throat no sensory loss
48
how can you treat atypical facial pain
painkillers, opiates, nerve blocks | tricyclics e.g amytriptiline
49
how can you manage post traumatic headache
find explanation | prevent analgesic abuse
50
how can you treat post traumatic headache
non steroidal anti imflammatories - ibuprofen, naproxen | tricyclic antidepressants - amitriptyline
51
what is cervical spondylosis
degeneration of discs, joints
52
what type of headache can cervical spondylosis cause
``` usually bilateral occipital pain can radiate forwards to frontal region steady pain no nausea/vomiting worsened by moving neck ```
53
how to treat cervical spondylosis
``` rest deep heat massage anti inflammatory analgesics over manipulation can be harmful ```
54
what are the signs of migraine
``` tendency to repeated attacks triggers easily hungover visual vertigo motion sickness ```
55
what are the 3 attacks of migraines
pain pain and focal symptoms just focal symptoms
56
what are the phases in migraine
prodrome - changes in mood, urination, fluid retention, food craving, yawning aura - visual, sensory, weakness, speech arrest headache - head body pain and photophobia resolution recovery
57
what is migraine with aura
positive and negative symptoms together scintillations blind spots
58
what is migraine cause by
spreading electrical depression across cerebral cortex | also patients usually have genetic predisposition
59
how can we treat acute attack of migraine
aspirin/ ibuprofen (non steroidals) and paracetamol metoclopramide - anti emetic triptans - tablets,nasal sprays, sc injections. synergise with nsaids short nap use opiates with caution as there is analgesic abuse potential tms
60
why is tms useful for migraine
interrupts complex networks that trigger and perpetuate migraine - which is caused by spreading electrical depression
61
what are some lifestyle issues in those with migraines
have sensitive heads even between attacks over react to any sort of stimulation world around them overstimulates their brains
62
triggers to avoid in those with migraine
``` environmental, dehydration, stress, dietary drink 2l a day avoid caffeinated drinks dont skip meals and eat fresh food dont oversleep/late nights analgesic abuse ```
63
prophylaxis for chronic migraine
``` over counter preparations tricyclic antidepressants beta blockers serotonin antagonists - calcium channel blockers anticonvulsants - valproate greater occipital nerve blocks botox - paralyses muscles suppress ovulation ```
64
what is erenumab
aimovig - injectable drug monoclonal antibody - disables calcitonin gene related peptide/its receptor used for episodic migraine, chronic migrain, cluster headache
65
what are tension headaches
tight uscles around head and neck bilaterally | thought as though head is in vice
66
treatment for nsaids
``` ibuprofen naproxen diclofenac paracetamol tricyclic antidepressants ssris - less effective massage hot bath ```
67
what is a cluster headache
``` unilateral not hemicranial - trigeminal autonomic cephalgia conjunctival redness +/ lacrimation nasal congestion and rhinorrhoea eyelid oedema ``` ``` forehead/facial sweating miosis and or ptosis sense of restlessness/agitation frequent and can be on alternate days not associated with brain lesion ```
68
how to treat acute cluster headache
inhaled oxygen oxygen inhibits neuronal activation in trigeminocervical complex sc injection/ nasal sumatriptan
69
how to prevent cluster headaches
``` verapamil prednisolone lithium valporate gabapentin topiarmate ```

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