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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
Q

treatment for t arteritis

A

steroids and aspirin

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26
Q

what is cerebral venous thrombosis

A

thrombosis in dural venous sinus/cerebral vein

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27
Q

why do you see unusual amount of headache in cvt

A

raised icp

veins are fragile and can haemorrhage

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28
Q

why do people have cvt

A 
thrombophilia
pregnancy
dehydration
long haul flight
behcets
29
Q

what is meningitis

A

infection in brain

can also be caused by carcinomas

30
Q

what can cause infective meningitis

A

viral - coxsackie,echo,mumps,ebv
bacterial - meningococci, pneumococci, haemophilius Tuberculous
granulomatous -sarcoid, lyme,brucella, syphilis

31
Q

what are the presenting features of meningitis

A 
malaise
headache
fever
neck stiffness
photophobia
alteration of consciousness
confusion
32
Q

what is herpes simplex encepalitis

A

haemorrhagic changes in temporal lobes

33
Q

how to treat meningitis

A 
treat then diagnose
give antibiotics first
blood and urine culture
cti/mri
then lumbar puncture
34
Q

what is bacterial meningitis

A

cerebral oedema with effacement of ventricles and sulci

inflammed meninges

35
Q

what is sinusitis

A 
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
Q

what is idiopathic intracranial hypertension

A

pseudotumour cerebri
presents often in young obese women
headaches, visual obscurations, diplopia, tinnitus
papilloedema +- visual field loss

37
Q

what drugs can be given for iih

A

hormones, steroids, antibiotics,vit e

weightloss, diuretics, optic nerve sheath decompression, lumboperitoneal shunt, stenting of stenosed venous sinuses

38
Q

what is the hallmark of low pressure headache

A

orthostatic headache

appears when standing

39
Q

what causes low pressure headache

A

csf leak due to tear in dura

or traumatic post lumbar puncture/spontaneous

40
Q

how to diagnose low pressure headache

A

mri - meningeal enhancement

contrast injection

41
Q

treatment for low pressure headache

A

rehydration
caffeine
blood patch

42
Q

what is chiari malformation

A

brain sits very low in skull
but normal
cerebral tonsils come through foramen magnum
descends when patients cough and tugs on meninges

43
Q

what dies obstructive sleep apnoea cause

A

hypoxia
co2 retention - leads to headache as potent vasodilator
non refreshing sleep
can lead to depression, impotence, poor performance at work

44
Q

what treatment can be given to those with obstructive sleep apneoa

A

noctural niv

surgery

45
Q

what is trigeminal neuralgia

A

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
Q

what is treatment for trigeminal neuralgia

A

carbamazepine
lamotrigine
gabapentin
posterior fossa depression

47
Q

what is atypical facial pain

A

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
Q

how can you treat atypical facial pain

A

painkillers, opiates, nerve blocks

tricyclics e.g amytriptiline

49
Q

how can you manage post traumatic headache

A

find explanation

prevent analgesic abuse

50
Q

how can you treat post traumatic headache

A

non steroidal anti imflammatories - ibuprofen, naproxen

tricyclic antidepressants - amitriptyline

51
Q

what is cervical spondylosis

A

degeneration of discs, joints

52
Q

what type of headache can cervical spondylosis cause

A 
usually bilateral
occipital pain can radiate forwards to frontal region
steady pain
no nausea/vomiting
worsened by moving neck
53
Q

how to treat cervical spondylosis

A 
rest
deep heat
massage
anti inflammatory analgesics
over manipulation can be harmful
54
Q

what are the signs of migraine

A 
tendency to repeated attacks
triggers
easily hungover
visual vertigo
motion sickness
55
Q

what are the 3 attacks of migraines

A

pain
pain and focal symptoms
just focal symptoms

56
Q

what are the phases in migraine

A

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
Q

what is migraine with aura

A

positive and negative symptoms together
scintillations
blind spots

58
Q

what is migraine cause by

A

spreading electrical depression across cerebral cortex

also patients usually have genetic predisposition

59
Q

how can we treat acute attack of migraine

A

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
Q

why is tms useful for migraine

A

interrupts complex networks that trigger and perpetuate migraine - which is caused by spreading electrical depression

61
Q

what are some lifestyle issues in those with migraines

A

have sensitive heads even between attacks
over react to any sort of stimulation
world around them overstimulates their brains

62
Q

triggers to avoid in those with migraine

A 
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
Q

prophylaxis for chronic migraine

A 
over counter preparations 
tricyclic antidepressants
beta blockers
serotonin antagonists - 
calcium channel blockers
anticonvulsants - valproate
greater occipital nerve blocks 
botox - paralyses muscles
suppress ovulation
64
Q

what is erenumab

A

aimovig - injectable drug
monoclonal antibody - disables calcitonin gene related peptide/its receptor
used for episodic migraine, chronic migrain, cluster headache

65
Q

what are tension headaches

A

tight uscles around head and neck bilaterally

thought as though head is in vice

66
Q

treatment for nsaids

A 
ibuprofen
naproxen
diclofenac
paracetamol
tricyclic antidepressants
ssris - less effective
massage
hot bath
67
Q

what is a cluster headache

A 
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
Q

how to treat acute cluster headache

A

inhaled oxygen
oxygen inhibits neuronal activation in trigeminocervical complex
sc injection/ nasal sumatriptan

69
Q

how to prevent cluster headaches

A 
verapamil
prednisolone
lithium
valporate
gabapentin
topiarmate

brs2 (65 decks)

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