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Yr2 Lily BRS Neuro > headaches > Flashcards

headaches Flashcards

1
Q

what is a headache?

A

a symptom

half to three quarters of adults age 18-65 in the world have had a headache in the past year

among those 30% or more have reported a migraine

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2
Q

what are the general bases of generation of headaches?

A

some structural
some perhaps pharmacological (eg. GTN used to treat angina)
some psychological

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3
Q

what are the main patterns of headache?

A

acute single headache

dull headache, increasing in severity

dull headache, unchanged over months

recurrent headaches

triggered headaches

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4
Q

what are causes of an acute single headache?

A

much more serious than other headaches

febrile illness, sinusitis, first attack of migraine, following a head injury, subarachnoid haemorrhage, meningitis, tumour, drugs, toxins, stroke, thunderclap, low pressure

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5
Q

what are causes of a dull headache that worsens in severity?

A

usually benign, but may be worrying

overuse of medication (eg. codeine), OCP, HRT, neck disease, temporal arteries, benign intercranial hypertension, cerebral tumour, cerebral venous sinus thrombosis

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6
Q

what are causes of a dull headache, unchanging over months?

A

people complain most about these

chronic tension headache

depressive, atypical face pain

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7
Q

what are causes of recurrent headaches?

A

lots of complaining about these

migraine, cluster headache, episodic tension headache, trigeminal or post herpetic neuralgia

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8
Q

what are causes of triggered headaches?

A

coughing, straining, exertion, sex, food and drink

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9
Q

what are headache red flags?

A

onset:
thunderclap, acute, subacute

meningism:
photophobia, phonophobia, stiff neck, vomiting

systemic symptoms:
fever, rash, weight loss

neurological symptoms or focal signs:
visual loss, confusion, seizures, hemiparesis, double vision, 3rd nerve palsy, horner syndrome, papilloedema

orthostatic:
better lying down

strictly unilateral

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10
Q

what are focal signs of headaches that are red flags?

A

double vision

3rd nerve (occulomotor) palsy

horner syndrome

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11
Q

what is 3rd nerve palsy?

A

palsy of the occulomotor nerve , it doesn’t work

symptoms:

one eye has a ptosis - levator palpabrae innervated by CN III

dilated pupil - as CNIII constricts pupil

eye points down and out - as lateral rectus and superior oblique are only extraoccular muscles not supplied by CNIII

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12
Q

what is horner syndrome?

A

when sympathetic nerve supply to an eye is affected, doesnt work

sympathetic dilates the pupil and opens it

so in horners, one eye is smaller, constricted, looks pushed in (enopthalmos)

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13
Q

what is the headache caused by a subarachnoid haemorrhage like?

A

sudden generalised headache “blow to the head”, thunderclap
often occipital

causes meningism - stiff neck and photophobia
blood irritates the meninges

most are caused by a ruptured aneurism, a few from arterovenous malformations and some are unexplained

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14
Q

what are the risks and treatments of subarachnoid haemorrhages?

A

50% are fatal
high risk of further bleed

may be automatic vasospasm which may stop the leak

we give nimodipine and BP control

early neurological assessment. will confirm the bleed and assess the cause
CT brain, lumbar puncture (for RBC and Xanthochromia) (if cant tell if there is a bleed from CT), MRA and angiogram

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15
Q

how are aneurisms treated?

A

used to be clipped or wrapped physically

now they are filled with platinum coils. doesnt require opening of the head. instead you use a catheter.
the platinum causes the aneurism to sclerose and seal

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16
Q

what is an intracerebral bleed?

A

fatal haemorrhage due to coning

it increases ICP.
brain can tolerate a certain amount of bleeding into the brain due to compliance, but then it gets past this point and a small increase in volume highly increases the pressure

coning is when the brain creeps around the falx, or the tentorium, or the skull (worst coz this is the area that controls respiration)

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17
Q

what is papilloedema?

A

optic disc swelling

due to raised ICP

visible when you look at the eye

18
Q

what are carotid and vertebral artery dissections?

A

the arteries leading up to the neck can split, blood collects in the split between layers, and causes turbulent flow

causes headache and neck pain

cause 20% of ischaemic strokes <45 yrs (young stroke)

mean age is 40, Carotid>vertebral

can be traumatic/spontaneous

diagnosed with MRI,MRA, doppler, angiography

19
Q

how are carotid and vertebral artery dissections treated?

A

aspirin or anticoagulation

as turbulent flow causes sticky blood prone to clotting

20
Q

what are symptoms of a vertebral vs carotid artery dissection?

A

vertebral - occipital and back of neck pain

carotid - phantom of the opera mask pain distribution

21
Q

what is chronic subdural haemorrhage?

A

SDH

due to a venous bleed. so slow.
causes blood to accumulate under the dura
can cause compression of the ventricles and the brain

common in old people who are on anticoagulants and fall

causes headache, unsteadiness and weakness on the (ipsilateral?) side

may be solved by just draining the blood

22
Q

what is temporal arteritis?

A

inflammation of the arteries in the temporal lobe

occurs in people over the age of 55.
three times more common in females

disruption of the internal elastic lamina is the main sign of vasculitis

23
Q

what are symptoms of temporal arteritis?

A

constant unilateral headache
scalp tenderness
jaw claudication

25% also get polymyalgia rheumatica - proximal muscle tenderness

involvement of the posterior ciliary arteries can cause blindness

24
Q

how is temporal arteritis diagnosed and treated?

A

may be seen on ultrasound. the arteries

biopsy shows inflammation and giant cells

elevates ESR and CRP (inflammatory markers)

treatment:
high dose steroids and aspirin

25
Q

what is cerebral venous thrombosis?

A

thrombosis in dural venous sinus or cerebral vein. blood cant leave the brain

unusual high amount of headache due to raised ICP

non territorial ischaemia “venous infarcts”
haemorrhage

may be caused by thrombophilia (sticky blood), pregnancy, dehydration, behcets

26
Q

what are causes of minigitis?

A

viral - Caxsackie, ECHO, mumps, EBV

bacterial - menincococci, pneumococci, haemophilus, tubrculosis. (bacterial is more worrying)

fungal - cryptococci

granulomatous - sarcoid, lyme, brucella, syphilis

carcinomatous

27
Q

what are the symptoms of meningitis?

A

very similar to that of a subarachnoid haemorrhage

malaise, headache, fever, neck stiffness, photophobia, confusion, alteration to consciousness

but the main one is fever

they may look septic if they have been left untreated

28
Q

what is herpes simplex encephalitis?

A

infection that effects the brain tissue

commonly effects the temporal lobe

(meningitis affects the meninges, encephalitis affects the brain)

29
Q

how is meningitis treated and diagnosed?

A

treat first then think about diagnosis (because it kills fast)

antibiotics

diagnosis:
blood and urine culture
CT, MRI
lumbar puncture (increased white cell count, decreased glucose, antigens, cytology, bacterial culture)

CT, MRI must come before lumbar puncture.
as meningitis causes cerebral oedema with effacement of ventricles and sulci and inflamed meninges. so LP will decompress this, and the brain might hurtle through the foramen magnum

30
Q

what are the symptoms of sinusitis?

A

causes a really bad headache but wont kill you

malaise, headache, fever.
blocked nasal passages, loss of vocal resonance, anosmia. nasal or postnasal catarrh.
local pain and tenderness (sinuses, either side of nose, or above eyes)

frontal pain starts 1-2 hours after waking up then clears up during the afternoon

31
Q

what is idiopathic intracranial hypertension?

A

people may think they have a brain tumour but they have this instead
causes raised ICP

aka pseudotumour cerebri

often seen in overweight people and women

may be caused by drugs:
hormones, steroids, antibiotics, vitamin E

32
Q

what are symptoms of idiopathic intracranial hypertension?

A

headache, visual obscurations, diplopia, tinnitus, papilloedema +/- visual field loss

33
Q

how is idiopathic intracranial hypertension treated?

A

weight loss (maybe even bariatric surgery), diuretics, optic nerve sheath decompression, lumboperitoneal shunt, stenting of stenosed venous sinuses

34
Q

what is a low pressure headache?

A

headaches caused caused low ICP

orthostatic headaches are a hallmark of these. (when they stand up)

possible causes:
CSF leak due to tear in dura.
traumatic post lumbar puncture
may be no apparent cause

diagnosis:
MRI with gadrolinium contrast. shows intense meningeal enhancement

35
Q

how are low pressure headaches treated?

A

rehydration, caffeine (seals the hole), blood patch (remove blood then inject it straight into the dura. it will find and seal the hole)

36
Q

what is chiari malformation?

A

normal brain, but it just sits very low down in the cranium

cerebellar tonsils descend through the foramen magnum. they descend further when the patient coughs (as the pressure in the head goes up a bit). when this happens they tug on the meninges which causes a sudden, short lived horrible headache.

treat the cold or the cough. or do an operation to remodel the base of the skull

37
Q

what is obstructive sleep apnoea (related to headache)?

A

cant breathe at night due to obstruction. may go with obesity. history of loud snoring and apnoeic spells

causes hypoxia, CO2 retention, non refreshing sleep, depression, poor performance at work

headaches - due to retained CO2. it is a potent vasodilator. vasodilates blood vessels in the brain. headache decreases over the course of the morning ass they breathe normally

requires a sleep study.

treatment: nocturnal NIV, surgery

38
Q

what is trigeminal neuralgia?

A

not necessarily a headache cause

but causes really bad pain on the face.

trigeminal: 3 branches

electric shock like pain in the distribution of a sensory nerve

often triggered by innocuous stimuli

any division of the trigeminal can be effected

cause:
neurovascular conflict at the point of entry of the nerve into the pons
can be a symptom of MS

treatment: carbamazepine, lamotrigine, gabapentin, posterior fossa decompression

39
Q

what is atypical facial pain?

A

daily, constant, ill defined, poorly localised deep aching or burning.
in facial or jaw bones, but may extend to neck ear or throat.
not lancinating

commonly occurs in middle aged women who are depressed or anxious

doesn’t conform to strict anatomical distribution of ay nerve
no sensory loss

unresponsive to conventional analgesics
opiates and nerve blocs may be used
also antidepressants

40
Q

what is post traumatic headache?

A

of people admitted with head injury, headaches are present in:
36% at discharge
24% at 6 months
16% at 1 year

it correlates with a previous history of headache
but unrelated to duration of post traumatic amnesia

it depends on the nature of the head injury:
high in victims of car accidents
low in perpetrators 
low in sports injuries
(so psychological element)
multiple mechanisms:
neck injury
scalp injury
vasodilation?
autonomic damage?
depression - often delayed
41
Q

how is post traumatic headache treated?

A 
give them an explanation
stop them from abusing analgesics
patience
non steroidal anti inflammatories - ibuprofen, naproxen
tricyclic antidepressants
42
Q

what is cervical spondylosis?

A

common cause of new headaches in old patients, due to arthritis

pain:
bilateral
normally occipital
constant
no nausea or vomiting
worsened by moving the neck

management:
rest, deep heat, massage
anti inflammatory analgesics

Yr2 Lily BRS Neuro (14 decks)

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