Headaches 1 Flashcards
what is a headache
a symptom
could be due to structural, pharmacological e.g gtm and psychological cause
what can be some causes of acute single headache
febrile illness, sinusitis first attack of migraine following head injury subarachnoid haemorrhage meningitis, tumour, drugs, toxins, stroke thunderclap (sudden onset), low pressure
what are causes
of dull headache
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
what are some types of headaches
dull headache - unchanged over months
triggered headaches
recurrent headaches
describe a dull headache which is unchanged over months
not dangerous
chronic, tension headache
depressive, atypicial face pain
what is cause of triggered headache
coughing, straining, exertion
coitus
food/drink
what are types of recurrent headaches
migraine
cluster headache
episodic tension headache
trigeminal , post herpetic neuralgia
what are some red flags for headaches
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
what are some red flag focal signs you could see in someone with headaches
double vision
horners syndrome - enophthalmos
3rd nerve/oculomotor palsy - drooping eyelid
what type of headache do patients with a subarachnoid haemorrhage experience
sudden generalised ‘blow to the head’ - thunderclap
what are most subarachnoid haemorrhages caused by
ruptured aneurysms
dew are from arteriovenous malformations
some unexplained
what are some symptoms of subarachnoid haemorrhages
meningism - stiff neck and photophobia
what % of subarachnoid haemorrhages are instantly fatal
50%
what can stop leakage in subarachnoid haemorrhages
vasospasms
initial treatment for subarachnoid haemorrhage and first steps
nimodipine
bp control
early neurological assessment to confirm bleed and establish cause
brain ct, lumbar puncture(rbc and xanthochromia)
mra, angiogram
how to treat anueurysms
used to be clipped/wrapped
nowadays filled with platinum coil
what is coning
pressure and swelling i=of brain
causes herniation. - brain squeezed out skull
how can you see raised intracranial pressure in brain
papilloedema
optic disc swelling at back of eye
what is carotid and verterbral artery dissection
layers of blood vessels can split
blood collects in these splits and can lead to turbulent flow
can cause headache and neck pain
what can cause dissection
traumatic
spontaneous
or predisposed e.g ehlers danlos
how can you investigate for a carotid/vertebral dissection
mri/mri
doppler
angipgraphy
what is the treatment for dissection
aspirin
anticoagulants so turbulent flow doesnt lead to clots
prevents stokes
what is temporal arteritis
commoner in females over 55
pain in shoulder muscle
constant unilateral headache
temporal artery usually inflammed and tortuous
how can you detect temporal arteritis
elevated esr and crp
biopsy shows inflammation and giant cells
visual on ulrasound
treatment for t arteritis
steroids and aspirin
what is cerebral venous thrombosis
thrombosis in dural venous sinus/cerebral vein
why do you see unusual amount of headache in cvt
raised icp
veins are fragile and can haemorrhage
why do people have cvt
thrombophilia pregnancy dehydration long haul flight behcets
what is meningitis
infection in brain
can also be caused by carcinomas
what can cause infective meningitis
viral - coxsackie,echo,mumps,ebv
bacterial - meningococci, pneumococci, haemophilius Tuberculous
granulomatous -sarcoid, lyme,brucella, syphilis
what are the presenting features of meningitis
malaise headache fever neck stiffness photophobia alteration of consciousness confusion
what is herpes simplex encepalitis
haemorrhagic changes in temporal lobes
how to treat meningitis
treat then diagnose give antibiotics first blood and urine culture cti/mri then lumbar puncture
what is bacterial meningitis
cerebral oedema with effacement of ventricles and sulci
inflammed meninges
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
what is idiopathic intracranial hypertension
pseudotumour cerebri
presents often in young obese women
headaches, visual obscurations, diplopia, tinnitus
papilloedema +- visual field loss
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
what is the hallmark of low pressure headache
orthostatic headache
appears when standing
what causes low pressure headache
csf leak due to tear in dura
or traumatic post lumbar puncture/spontaneous
how to diagnose low pressure headache
mri - meningeal enhancement
contrast injection
treatment for low pressure headache
rehydration
caffeine
blood patch
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
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
what treatment can be given to those with obstructive sleep apneoa
noctural niv
surgery
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
what is treatment for trigeminal neuralgia
carbamazepine
lamotrigine
gabapentin
posterior fossa depression
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
how can you treat atypical facial pain
painkillers, opiates, nerve blocks
tricyclics e.g amytriptiline
how can you manage post traumatic headache
find explanation
prevent analgesic abuse
how can you treat post traumatic headache
non steroidal anti imflammatories - ibuprofen, naproxen
tricyclic antidepressants - amitriptyline
what is cervical spondylosis
degeneration of discs, joints
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
how to treat cervical spondylosis
rest deep heat massage anti inflammatory analgesics over manipulation can be harmful
what are the signs of migraine
tendency to repeated attacks triggers easily hungover visual vertigo motion sickness
what are the 3 attacks of migraines
pain
pain and focal symptoms
just focal symptoms
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
what is migraine with aura
positive and negative symptoms together
scintillations
blind spots
what is migraine cause by
spreading electrical depression across cerebral cortex
also patients usually have genetic predisposition
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
why is tms useful for migraine
interrupts complex networks that trigger and perpetuate migraine - which is caused by spreading electrical depression
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
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
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
what is erenumab
aimovig - injectable drug
monoclonal antibody - disables calcitonin gene related peptide/its receptor
used for episodic migraine, chronic migrain, cluster headache
what are tension headaches
tight uscles around head and neck bilaterally
thought as though head is in vice
treatment for nsaids
ibuprofen naproxen diclofenac paracetamol tricyclic antidepressants ssris - less effective massage hot bath
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
how to treat acute cluster headache
inhaled oxygen
oxygen inhibits neuronal activation in trigeminocervical complex
sc injection/ nasal sumatriptan
how to prevent cluster headaches
verapamil prednisolone lithium valporate gabapentin topiarmate
