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BRS Year 2 > Headaches > Flashcards

Headaches Flashcards

1
Q

what are all the causes of acute single headaches?

A 
febrile illness, sinusitis
first migraine attack
post trauma headache
subarachnoid haemorrhage
meningitis
tumour
drugs
toxins
stroke
thunderclap
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2
Q

what are all the causes of dull headaches increasing in severity?

A 
overuse of medication
contraceptive pill
neck disease
temporal arteritis
benign intracranial hypertension
cerebral tumour
cerebral venous sinus thrombosis
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3
Q

what are all the causes of a dull headache, unchanging over months

A

chronic tension headache

depressive, atypical facial pain

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4
Q

what are all the causes of a triggered headache?

A

coughing, straining, exertion
sexual intercourse
food and drink

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5
Q

what are all the causes of recurrent headaches?

A

migraine
cluster headache
episodic tension headache
trigeminal or post hepatic neuralgia

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6
Q

what are the red flag signs of headaches?

A

acute/subacute and thunderclap headaches
photophobia, phonophobia, stiff neck, vomiting
fever, rash, weight loss
vision loss, confusion, seizures, hemiparesis, double vision, 3rd nerve palsy, Horner syndrome, papilloedema
orthostatic
unilateral

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7
Q

what is horners syndrome?

A

sympathetic supply to eyes disrupted

eye looks pushed in, pupil smaller, eyelid droopy

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8
Q

how fatal are subarachnoid haemorrhages?

A

~50% instantly fatal

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9
Q

how do you assess for the possibility of a subarachnoid haemorrhage?

A 
neurological assessment
CT brain
lumbar puncture (pink/red colour - RBC and xanthochromia)
MRA
angiogram
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10
Q

how do you treat a burst aneurysm?

A

filled with platinum coils via catheter

used to be clipped or wrapped

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11
Q

what is the cause of death following an acute intracerebral bleed?

A

coning - raised intracranial pressure forcing the brain out of weak areas e.g tentorium/falsine herniation

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12
Q

what is papilloedema?

A

optic disk swelling due to raised ICP

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13
Q

what is the mechanism of coning?

A

the brain can handle a small increase of fluid volume without increasing pressure until it hits a limit, pressure increases exponentially, causing herniation

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14
Q

what are the investigations for a carotid or vertebral dissection?

A

MRI/MRA
doppler ultrasonography
angiography

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15
Q

what is the pain distribution for a carotid dissection?

A

headache and neck pain - phantom of opera

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16
Q

what is more likely, carotid or vertebral dissection?

A

carotid

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17
Q

how should you treat carotid or vertebral dissection?

A

aspirin or anticoagulation x 6/12

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18
Q

how does a chronic subdural haemorrhage present?

A

long standing one sided headache, limb weakness on one side

commonly elderly patients

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19
Q

how do you treat a subdural haemorrhage?

A

drill a hole to release blood buildup

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20
Q

what is temporal arteritis

A

inflammation of the temporal arteries, often with presence of giant cells

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21
Q

what is the typical patient for temporal arteritis?

A

females over 55

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22
Q

what is the presentation of temporal arteritis?

A

constant unilateral headache, scalp tenderness, jaw claudication
possible shoulder pain
visual disturbances acutely

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23
Q

what investigations can be done for suspected temporal arteritis?

A

elevated ESR and CRP
temporal artery visibly inflamed on ultrasound
biopsy showing giant cells

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24
Q

how can temporal arteritis cause blindness?

A

involvement of posterior ciliary arteries

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25
Q

how should temporal arteritis be treated?

A

high dose steroids and aspirin

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26
Q

what is cerebral venous thrombosis?

A

thrombosis in dural venous sinus or cerebral vein causes lack of venous drainage and therefore raised ICP

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27
Q

what are the causes of cerebral venous thrombosis?

A 
non-territorial ischaemia
haemorrhage
thrombophilia
pregnancy
dehydration
Behcets
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28
Q

what are all the types of meningitis?

A 
viral
bacterial - pneumococci most common
tuberculosis
fungal
granulomatous
syphilis
carcinomatous
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29
Q

what are the presenting symptoms of meningitis?

A 
malaise
headache
fever
neck stiffness
photophobia
confusion
alteration of consciousness
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30
Q

what is the main thing to remember with meningitis?

A

treat then diagnose

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31
Q

what are the investigations for suspected meningitis?

A

CT or MRI
lumbar puncture
blood and urine culture

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32
Q

what would a lumbar puncture in someone with meningitis show?

A 
increased white cell count
decreased glucose
antigens
cytology
bacterial culture possible
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33
Q

what are the first line treatments for suspected meningitis?

A

IV antibiotics
sometimes corticosteroids
fluids and oxygen

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34
Q

what are the presenting symptoms for sinusitis?

A 
malaise
headache
fever
blocked nasal passages, anosmia
loss of vocal resonance
local pain/tenderness
frontal pain in morning, resolves slowly
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35
Q

how do you investigate brain tumours?

A

head CT or MRI

36
Q

what is idiopathic intracranial hypertension?

A

buildup of pressure around the brain for no apparent cause

pseudotumour cerebri

37
Q

who is most affected by idiopathic intracranial hypertension?

A

young obese women

38
Q

what are the symptoms of idiopathic intracranial hypertension?

A 
headache,
visual obscurations,
diplopia, 
tinnitus, 
papilloedema, 
possible visual field loss especially upon standing
39
Q

how can you treat idiopathic intracranial hypertension?

A

hormones, steroids, antibiotics, vitamin E

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

40
Q

how does raised ICP appear on a head CT?

A

cerebral oedema with ventricle and sulci effacement with no mass lesion

41
Q

what are low pressure headaches?

A

rupture of meninges (usually dura) causes CSF to leak

42
Q

how do low pressure headaches typically occur?

A

traumatic post lumbar puncture or spontaneously

43
Q

how do you treat low pressure headaches?

A

rehydration by fluids, caffeine, blood patch

44
Q

what is chiari malformation?

A

normal brain but sits low in the skull from birth

45
Q

how does chiari malformation cause headaches?

A

cerebellar tonsils descend through the foramen magnum, descend further upon coughing causing tugging of the meninges

46
Q

how do you manage chiari malformation?

A

treat any underlying cough/sneeze

can do surgery to remodel the skull base

47
Q

what is obstructive sleep apnoea?

A

walls of the throat relax during sleep interrupting normal breathing

48
Q

what is a typical presentation of obstructive sleep apnoea?

A

high BMI, history of loud snoring and apnoeic spells

49
Q

what are the symptoms of obstructive sleep apnoea?

A

hypoxia, co2 retention, non-refreshing sleep, depression, impotence, work difficulties, morning headaches

50
Q

why does obstructive sleep apnoea cause morning headaches?

A

buildup of CO2 causes vasodilation of brain vessels

51
Q

how do you diagnose obstructive sleep apnoea?

A

requires sleep study

52
Q

what are the treatments for obstructive sleep apnoea?

A

nocturnal NIV, surgery

53
Q

what is trigeminal neuralgia?

A

facial/neck pain (electric shock-like) in distribution of sensory nerve due to irritation of trigeminal

54
Q

how is trigeminal neuralgia triggered?

A

by innocuous stimuli e.g chewing, something touching teeth

55
Q

how is trigeminal neuralgia caused?

A

neurovascular conflict at point of entry of nerve to pons (nerve touches/is pinched by vessel)
can be a symptom of MS

56
Q

what is the treatment for trigeminal neuralgia?

A

carbamazepine, lamotrigine, gabapentin (anti-convulsants)

posterior fossa decompression

57
Q

what is atypical facial pain?

A

daily, constant, poorly localised deep aching or burning in facial or jaw bones (may extend to neck ear or throat)
no numbness or sensory loss

58
Q

what is the typical presentation of atypical facial pain?

A

middle aged woman who is depressed or anxious, with daily constant poorly localised pain

59
Q

how should you diagnose atypical facial pain?

A

exclude pathology in teeth, TMJ, eye, nasopharynx, sinuses

60
Q

how do you manage atypical facial pain?

A

tricyclics

61
Q

what is a post traumatic headache?

A

no previous history of headaches, dependent upon nature of head injury

62
Q

what is the prevalence of post traumatic headaches?

A

high in victims of car accidents
low in perps of car accidents
low in sports injuries
(psychological aspect?)

63
Q

how do you manage post traumatic headaches?

A

explain the cause of headache
prevent analgesic abuse
NSAIDs
tricyclic antidepressants (amitriptyline)

64
Q

what is cervical spondylosis?

A

bilateral steady pain worsened by moving the neck, caused by narrowing of the joint space due to worn discs

65
Q

what is the most common cause of new onset headaches in elderly?

A

cervical spondylitis

66
Q

how do you manage cervical spondylitis?

A

rest, deep heat, massage, antiinflammatory analgesics

chiropraction not recommended

67
Q

typical SOCRATES for a migraine

A

S- unilateral
O- sudden recurrence/intensification of symptoms
C - pulsating/throbbing
R- none
A- nausea/vom, aura (lights, halluc), tingling, tinitis, paralysis, photophobia, phonophobia
T - 4-72 hrs
E - physical activity, foods, bad sleep, hormones
S - moderate/severe

68
Q

treatment for acute migraine

A

aspirin
nasal sprays
short naps
TMS

69
Q

lifestyle recommendations for migraines

A 
dietary - fresh foods, avoid MSG takeaways
hormonal - OCP
drink plenty of water
dont have late nights or oversleep
avoid caffeine
70
Q

prophylaxis for migraines

A 
OTC - magnesium etc
TCAs - amitriptyline 
beta blockers - propanolol
serotonin agonists - PIZOTIFEN (very effective)
anticonvulsants
botox 
suppress ovulation - OCP
ERENUMAB injections monthly
71
Q

how is erenumab used in treating headaches?

A

prophylactic injections for migraines 2x month

monoclonal antibody

72
Q

what are the phases of a migraine?

A 
prodromal
aura
headache
resolution
recovery
73
Q

what is the prodromal phase of a migraine

A 
changes in mood
inc urination
fluid retention
food craving
yawning
74
Q

what is the aura phase of migraine

A 
visual or sensory
numbness/tingling
weakness
speech arrest
hallucinations
75
Q

what is the headache phase of migraine

A

head and body pain
nausea
photophobia
phonophobia

76
Q

what is the recovery like from a migraine

A

mood disturbed
food intolerance
feeling hungover
for about 48hrs

77
Q

what are positive and negative auras

A

positive - flashes, zigzags

negative - blindspots

78
Q

what is the SOCRATES of a tension headache

A 
S - generalised, bilateral
O - gradual onset usually
C - dull, tight band-like
R - neck/shoulders
A- pericranial muscle tenderness, NO NAUSEA/vomiting/photophobia etc
T - 3-4hrs
E - analgesics, rest
S - moderate
79
Q

treatments for tension headache

A

analgesics - NSAIDs preferred, paracet

if chronic, TCAs and SSRIs

80
Q

when should TCAs/SSRIs be considered for tension headaches?

A

if chronic - 7-9 headache days/month

81
Q

SOCRATES for cluster headaches

A

S - strictly unilateral, behind eye common, usually same side each time
O- acute onset, same time of day
C - excruciating, steady pain
R - none
A - eye watering, nose blocked, ptosis, eye redness, sweating, restlessness (autonomic features), photophobia, phonophobia
T - 15min-3hr, same length each time, often nocturnal, come in clusters with long remissions
E -
S - worst pain ever experienced

82
Q

acute management of cluster headaches

A

high flow O2

serotonin agonist - Sumatriptan (subcut or nasal)

83
Q

what autonomic disorder is associated with cluster headaches

A

horners syndrome

84
Q

prophylaxis of cluster headaches

A 
verapramil
prednisolone
lithium
valproate
gabapentin
topiramate
pizotifen
85
Q

differences between cluster and migraine

A

women migraine, men cluster
migraine longer duration but cluster have long remissions and daily attacks
nausea in migraine not cluster
pain in migraine is pulsating, cluster is steady
migraine has aura, cluster has ptosis etc
migraine patients lie in dark, cluster patients pace around

BRS Year 2 (67 decks)

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