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neurology > headaches > Flashcards

headaches Flashcards

1
Q

name some red flags for headaches

A

new onset > 50
known/previous malignancy
immunosuppressed
early morning headache
exacerbation by valsalva

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2
Q

what may a new onset headache in patients over 50 suggest

A

temporal arteritis
space occupying lesion

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3
Q

what may a headache exacerbated by valsalva suggest

A

chiari malformation type 1
space occupying lesions

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4
Q

what is a chiari malformation type 1

A

a herniation of the cerebellar tonsils

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5
Q

what might a headache worsened on standing suggest

A

CSF leak

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6
Q

what should we rule out as a cause for a headache in an immunosuppressed patient

A

CNS infection and malignancy

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7
Q

what is the most common cause of an episodic headache

A

migraine

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8
Q

who is more likely to get a migraine

A

females

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9
Q

what can trigger a migraine

A

stress, diet, sleep, hormonal imbalance, physical exertion

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10
Q

how frequent are migraine attacks usually

A

once a month

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11
Q

what are tension headaches associated with

A

stress, depression, alcohol, skipping meals and dehydration

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12
Q

clinical presentation of a tension headache

A

bilateral, non-pulsatile pain
tightness sensation
scalp muscle tenderness
NO N+V, photophobia or phonophobia

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13
Q

management of a tension headache

A

paracetamol + NSAIDs
stress management
massages and muscle relaxation exercises

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14
Q

what is used to manage severe chronic tension-type headaches

A

trial amitriptyline or dothiepin for 3 months

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15
Q

what is trigeminal neuralgia

A

long-term pain disorder that affects the trigeminal nerve

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16
Q

who is usually affected by trigeminal neuralgia

A

women >60

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17
Q

what may trigger an attack of trigeminal neuralgia

A

washing, shaving, cold wind, chewing

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18
Q

what is the suggested cause of trigeminal neuralgia

A

compression of the trigeminal nerve

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19
Q

clinical presentation of trigeminal neuralgia

A

severe stabbing unilateral facial pain, lasting 1-90s, occurs many times a day

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20
Q

investigation for trigeminal neuralgia

A

usually a clinical diagnosis, but MRI can be used to exclude secondary causes

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21
Q

first line management of trigeminal neuralgia

A

carbamazepine

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22
Q

secondary management of trigeminal neuralgia

A

phenytoin, lamotrigine, gabapentin
microvascular decompression, ablation

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23
Q

what is venous sinus thrombosis

A

occlusion of venous vessels in sinuses of the cerebral veins

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24
Q

risk factors for venous sinus thrombosis

A

oral contraceptives, dehydration, clotting disorders

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25
who is more likely to get venous sinus thrombosis
young females
26
clinical presentation of venous sinus thrombosis
progressive headache - worsens when lying down or bending over visual changes seizures focal neurological deficits
27
investigations for venous sinus thrombosis
non-contrast CT shows hyper density in affected sinus CT venogram looks for a filling defect
28
empty delta sign on CT venogram
venous sinus thrombosis
29
where is most commonly affected in dural venous thrombosis
superior sagittal sinus
30
management of venous sinus thrombosis
anticoagulation with low molecular weight heparin monitoring for neurological deterioration
31
what are trigeminal autonomic cephalgias
primary headache syndromes that are associated with paroxysmal facial autonomic symptoms
32
what are some autonomic features associated with trigeminal autonomic cephalgias
ptosis, miosis, nasal stuffiness, N+V, tearing, eye lid oedema
33
what is ptosis
droopy eyelids
34
what is miosis
excessive constriction of the pupil
35
who usually presents with a cluster headache
men aged 20-50, often smokers
36
how are cluster headaches described
alarm clock headaches
37
clinical presentation of a cluster headache
severe, unilateral headache felt in or behind the eye - with watery, bloodshot eyes patients become agitated during attacks facial swelling, nasal congestion
38
acute management of cluster headache
high flow oxygen for 20 mins + subcutaneous or nasal triptans
39
prophylaxis of a cluster headache
verapamil
40
how does paroxysmal hemicrania different to a cluster headache
shorter in duration (10-30 mins) and occur more frequently
41
how long do cluster headaches usually last
20 mins - 3 hrs
42
who usually presents with paroxysmal hemicrania
women aged 50-60s
43
clinical presentation of paroxysmal hemicrania
very similar to cluster headaches severe unilateral headache
44
investigation for paroxysmal hemicrania
MRI brain and MR angiogram in new onset unilateral cranial autonomic features
45
management of paroxysmal hemicrania
absolute response to indomethacin
46
how does paroxysmal hemicrania differ to hemicrania continua
constant duration in hemicrania continua
47
what is SUNCT syndrome
short-lasting unilateral neuralgiform headache with conjunctival injection and tearing
48
what are the main 4 trigeminal autonomic cephalgias
cluster headache paroxysmal hemicrania hemicrania continua SUNCT syndrome
49
how does SUNCT syndrome present
severe unilateral headache + autonomic symptoms very brief (15-120 seconds) and occur very frequently
50
management of SUNCT syndrome
lamotrigine or gabapentin
51
what is ICP
intracranial pressure the pressure exerted by the cranium onto brain tissue, CSF and intracranial circulating blood volume
52
what can cause a raised ICP
SOL brain swelling increased central venous pressure (venous sinus thrombosis) problems with CSF flow
53
what are the 3 main problems you can have which disrupt CSF flow
obstruction increased production decreased absorption
54
what can cause obstructive hydrocephalus
masses, Chiari syndrome
55
what can cause increased production of CSF
choroid plexus papilloma
56
what can cause decreased absorption of CSF (communicating hydrocephalus)
subarachnoid haemorrhage meningitis malignant meningeal disease
57
what is the normal range for ICP at rest
7-15 mmHg
58
where is CSF secreted from
choroid plexus
59
how does CSF move through the brain (4)
choroid plexus - ventricular system - subarachnoid space - venous system (arachnoid granulations)
60
how do we calculate cerebral perfusion pressure
mean arterial pressure - intracranial pressure
61
name some early signs of raised ICP
decreased level of consciousness, headache, pupil dysfunction +/- papilledema, changes in vision, N+V
62
name some late signs of raised ICP
coma, fixed dilated pupils, bradycardia, hyperthermia, increased urinary output
63
who usually gets normal pressure hydrocephalus and why
elderly, due to decreased brain elastance
64
hakim's triad indicates what condition
normal pressure hydrocephalus
65
what is hakim's triad
abnormal (magnetic) gait, urinary incontinence, dementia
66
what does a magnetic gait look like
feet appear to be stuck to the floor
67
mnemonic to remember symptoms of normal pressure hydrocephalus
wet, wacky and wobbly
68
investigations for normal pressure hydrocephalus
lumbar puncture CT/MR imaging can show enlarged lateral ventricles
69
management of normal pressure hydrocephalus
therapeutic lumbar puncture then ventriculoperitoneal shunt if responsive
70
who usually presents with idiopathic intracranial hypertension
young, overweight female patients (possibly PCOS)
71
clinical presentation of idiopathic intracranial hypertension
headache, double vision, tinnitus, radicular pain, morning N+V, papilledema
72
what is radicular pain
pain along a dermatome due to a pinched nerve
73
investigation for idiopathic intracranial pressure
elevated pressure on lumbar puncture normal CT
74
management of idiopathic intracranial hypertension
wight loss, carboanhydrase inhibitor
75
give some examples of carboanhydrase inhibitors
acetazolamide, topiramate
76
medical management of raised ICP
hypertonic saline, barbiturate coma or antiepileptics
77
surgical management of raised ICP
surgical decompression
78
what triad of symptoms suggest raised inctracranial pressure
cushings triad hypertension, bradycardia and irregular breathing
79
what is an aura
sensory disturbance that occurs before or during a headache
80
what is the most common type of aura
visual
81
clinical presentation of a migraine
unilateral, throbbing headache causes avoidance of routine activities of daily life
82
how long do migraines usually last
4-72 hours
83
name some symptoms associated with a migraine
N+V, photophobia, phonophobia
84
name some examples of aura
unilateral numbness, dysphasia, teichopsia
85
what is teichopsia
zigzags in vision
86
how long does aura usually last
5-60 mins and can present up to an hour before headache
87
name some red flags for atypical aura
motor weakness, double vision, visual symptoms only affecting one eye, poor balance, decreased level of consciousness
88
name some prodromal symptoms of a migraine
fatigue, poor concentration, neck stiffness and yawning
89
name some postdromal symptoms of a migraine
fatigue, elated or depressed mood
90
how do we differentiate between diagnosing episodic and chronic migraine
episodic: less than 15 days per month chronic: at least 15 days per month, for more than 3 months
91
what can be done when investigating migraines
headache diary to identify triggers
92
acute pharmacological management of migraines
NSAIDs or paracetamol in combination with triptans (at the start of the headache)
93
special consideration around female patients with migraine with aura
should avoid the combined oral contraceptive due to increased risk of ischaemic stroke
94
who is considered for prophylactic management of migraines
if the patient is experiencing > 3 attacks per month or they are very severe
95
what can be added on to acute pharmacological management of a migraine
anti-emetic
96
what are the 3 main drugs that can be offered for migraine prophylaxis
propanolol topiramate amitryptilline
97
when is topiramate contraindicated
in pregnancy - girls and women would need to be on highly effective contraception prior to initiation
98
when is propanolol contraindicated
patients with asthma

neurology (19 decks)

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