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Neurology > Headaches > Flashcards

Headaches Flashcards

1
Q

What do these red flag headache signs indicate?

First and worst headache, thunderclap.

A

Subarachnoid haemorrhage

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2
Q

What do these red flag headache signs indicate?

Unilateral and eye pain.

A

Cluster headache or glaucoma

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3
Q

What do these red flag headache signs indicate?

Cough initiated headache, worse in the morning/bending forwards.

A

Raised ICP

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4
Q

What does this red flag headache sign indicate?

Scalp tenderness

A

Giant cell arteritis

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5
Q

What do these red flag headache signs indicate?

Fever, neck stiffness.

A

Meningitis

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6
Q

What are the types of primary headache (90%)?

A

Tension, migraine, cluster.

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7
Q

What are the causes of secondary headaches (10%)?

A

SAH, meningitis, glaucoma, raised ICP, sinusitis, GCA, extra-dural haematoma.

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8
Q

What should you focus on in an examination involving a headache?

A
  1. Systemically unwell? Tachycardia? BP? Fever? Rashes?
  2. Reduced GCS?
  3. Temporal artery pulsation/tenderness?
  4. Focal neurology?
  5. Fundoscopy - papilloedema?
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9
Q

What is this a presentation of?
Bilateral, dull, tight/pressing, gradual onset headache. Patient can continue with normal activities but it is made worse by stress.

A

Tension headache

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10
Q

What is this a presentation of?
Recurrent severe headaches lasting several hours to a few days, waxing and waning in nature, photophobia, phonophobia, nausea, vomiting, some focal neurology. Intense, throbbing, unilateral.

A

Migraine

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11
Q

What are some common triggers of migraines?

A

Chocolate, hangover, orgasm, cheese, OCP, lie-in, alcohol, travel, exercise, stress.

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12
Q

At what age do patients normally present with their first migraine?

A

<40 years old

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13
Q

What is this a presentation of?
Severe, unilateral, retro-orbital headache. Restlessness, agitation, ipsilateral lacrimation, nasal stuffiness, rhinorrhoea. 15-980 minute attacks, occur frequently and repeatedly.

A

Cluster headache

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14
Q

What is the ratio of men:women affected by cluster headaches?

A

5:1 (more common in men)

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15
Q

What is the treatment for a cluster headache?

A

High flow oxygen via non-rebreather mask for 15 minutes plus sumatriptan SC at onset.

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16
Q

What drug is used for the prevention of cluster headaches?

A

Verapamil

17
Q

What is this a presentation of?
Sudden onset headache, reaches maximal intensity within a few seconds, occipital, very severe. Distress and photophobia common. Neck stiffness within hours. Vomiting.

A

Subarachnoid haemorrhage

18
Q

What is the potential presentation of a large subarachnoid haemorrhage?

A

Drop in GCS, seizure, or focal neurological signs.

19
Q

What is this a presentation of?

Headache, fever, meningism. Onset over hours.

A

Meningitis

20
Q 
What is this a presentation of?
Localised headache (temporal/occipital), scalp tenderness, jaw claudication, visual loss, malaise, night sweats, fever, weight loss, amaurosis fugax. Eye is not painful.
A

Giant cell arteritis

21
Q

What is the treatment for giant cell arteritis?

A

ESR almost always raised, start prednisolone first then urgent referral for temporal artery biopsy.

22
Q

What is this a presentation of?
Overweight young woman, COCP. Headache, worse in the morning and on lying flat/coughing/straining, gradual and dull. Nausea, vomiting, papilloedema.

A

Raised ICP

23
Q

What is this a presentation of?

Long-sighted, middle-aged/elderly patient. Peri-orbital pain, nausea, vomiting, reduced vision, halos around lights.

A

Acute angle closure glaucoma

24
Q

What is this a presentation of?

Patient just started paracetamol/opiate/triptans, episodic headache becoming chronic daily headache.

A

Medication overuse headache

25
Q

What are the common medications causing a medication overuse headache?

A

Paracetamol, opiates, or triptans.

26
Q

What is this a presentation of?
Dull, throbbing headache associated with facial pain over sinuses. Worse on bending forwards. Nasal congestion/discharge.

A

Sinusitis

27
Q

What is this a presentation of?

Female, Asian. Intense, stabbing pain, lasting seconds. Unilateral headache affecting maxillary and mandibular regions.

A

Trigeminal neuralgia

28
Q

What are the common triggers of trigeminal neuralgia?

A

Washing area, shaving, eating, talking, dental prostheses, compression of CN V by inflammation/MS/zoster/tumour

29
Q

What are the findings of a neurological examination in trigeminal neuralgia?

A

Normal apart from tenderness

30
Q

What is the treatment for trigeminal neuralgia?

A
  1. Carbamazepine 100mg BD

2. Refer to neurology - MRI and further management

Neurology (51 decks)

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