Headaches Flashcards
2
Fever, photophobia and neck stiffness associated with headache could indicate?
Meningitis, encephalitis or brain abscess
Sudden onset occipital headache- worse headache they’ve ever had suggests?
Subarachnoid haemorrhage
Headache that is worse on coughing or straining suggests?
That there is raised intracranial pressure
Tension headache- presentation and management?
Mild ache or pressure in a band like pattern around the head
Develop and resolve gradually and do not produce visual changes
Associated with:
* Stress
* Depression
* Alcohol
* Skipping meals
* Dehydration
Management:
* Reassurance
* Ibuprofen or paracetamol
* Amitriptyline is 1st line for frequent tension headaches
What is sinusitis?
Inflammation of the paranasal sinuses due to viral infection
What causes a hormonal headache? Presentation?
Low oestrogen
Unilateral pulsatile headache associated with nausea
A condition that usually presents as a headache with neck pain that is worse on movement?
Cervical spondylosis- degenerative changes in the cervical spine
Trigeminal neuralgia- presentation and treatment?
Intense facial pain- in distribution of the trigeminal nerve branches- V1, V2 and V3
* Shooting, electricty like stabbing/burning pain
Over 90% of cases are unilateral
Treatment- carbamazepine
Investigations and management for subarachnoid haemorrhage
Non contrast CT head-1st line
* If CT head is done within 6 hours of symptom onset and is normal- do not do a lumbar puncture- consider alternative diagnosis
* If CT head is done more than 6 hours after symptomonset do lumbar puncture
* Lumbar puncture findings- xanthochromia- result of red blood cell breakdown- diagnoses heamorrhage
Management:
* Bed rest
* Analgesia
* Venous thromboembolism
* Nimodipine- prevents vasospasm
* Surgery with coil to prevent rebleeding from aneurysm
A headache that is recurrent, severe, throbbing and unilateral in nature. Also associated with nausea and photosensitivity?
Migraine
Headache described as an intense pain around 1 eye. Attacks occurs one a day, each episode lasting 15 mins-2 hours for the past 8 weeks. Associated with a red and watery eye and constricted pupil?
Cluster headache
More common in men and smoker
Patient >60 years old presents with rapid onset unilateral headache associated with pain on chewing and brushing her hair?
Temporal arteritis:
Jaw claudication
Tender, palpable temporal artery
Raised ESR
What is the normal intracranial pressure in adults in the supine position?
7-15mmHg
What is invasive ICP monitoring?
Catheter placed into the lateral ventricles of the brain to monitor the pressure
Management of raised ICP?
- 1st step- head elevation to 30 degrees
- IV mannitol- osmotic diuretic
- Controlled hyperventilation- reduce co2= vasoconstriction of the cerebral arteries= reduced ICP
Typical 5 stages of a migraine?
- Premonitory or prodromal stage (can begin several days before the headache)- may have subtle symps e.g. yawning or mood change)
- Aura (lasting up to 60 mins)
- Headache stage (lasts 4 to 72 hours)
- Resolution stage (the headache may fade away or be relieved abruptly by vomiting or sleeping)
- Postdromal or recovery phase
Typical features of a migraine headache?
- Usually unilateral
- Moderate-severe intensity
- Pounding or throbbing in nature
- Photophobia (discomfort with lights)
- Phonophobia (discomfort with loud noise)
- Osmophobia (discomfort with strong smells)
- Aura (visual changes)
- Nausea and vomiting
Hemiplegic migraine?
- Main feature- hemiplegia- unilateral limb weakness
- Other symps– ataxia and impaired consciousness
Can mimic a stroke or TIA
Acute managment of a migraine?
Medical:
* 1st line- combo of oral triptan and an NSAID or paracetamol
Triptans- 5-HT agonists e.g. sumatriptan
* Cause cranial vasoconstriction, inhibit pain signals, inhibit release of inflammatory neuropeptides
Antiemtics e.g. metoclopramide or prochlorperazine
Prophylaxis of a migraine?
5-HT antagonists
Meds to reduce the frequency and severity of attacks are:- should only be given if having a sig impact on quality of life e.g. occur more than once a week
* Propanolol
* Amitriptyline
* Topiramate- avoid in women of childbearing age
Other therapies:
* CBT
* Mindfulness
* Vit B2 (riboflavin)
