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Neuro > Headaches - 2 > Flashcards

Headaches - 2 Flashcards

1
Q

Describe cranial neuralgias

A

An intense burning or stabbing pain - is usually brief and severe
Pain extends length of affected nerve
Caused by irritation or damage to nerve - trigeminal mainly

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1
Q

Describe trigeminal neuralgia

A

Unilateral maxillary or mandibular division pain more than ophthalmic
Triggered and spontaneous stabbing pain - 5-20sec duration
Triggers - cold, chewing, touch
Refractory period

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2
Q

What are the causes of trigeminal neuralgia?

A

Vascular compression of the trigeminal nerve
Multiple sclerosis, intracranial arteriovenous malformation, tumour and brainstem lesions

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3
Q

What is the treatment of trigeminal neuralgia?

A

Medical - Carbamazepine, Oxcarbazepine, Lamotrigine, Pregabalin, Phenytoin
Surgical - glycerol ganglion injection, stereotactic radiosurgery and microvascular decompression (best)

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4
Q

What are the 4 types of trigeminal autonomic cephalalgias?

A

Cluster headache, paroxysmal hemicrania, SUNCT/ SUNA and hemicrania continua

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5
Q

Describe trigeminal autonomic cephalalgias

A

Strictly unilateral head pain - V1
Very severe and excruciating pain
Cranial autonomic symptoms - lacrimation, eyelid oedema, forehead sweating, nasal congestion
Restless
Attack frequency and duration differs

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6
Q

Describe cluster headache - the attack

A

Pain is mainly orbital and temporal
Unilateral and rapid onset
15mins to 3 hrs
Rapid cessation of pain
Excruciating and restless
Prominent ipsilateral autonomic symptoms
Migraine symptoms often present

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7
Q

Describe the bout of cluster headache

A

Attacks in cluster into bouts lasting 1-3 months with periods of remission at least 1 month
1-8 a day
Striking circadian rhythm
Some have chronic cluster

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8
Q

What is the treatment for cluster headache?

A

Abortive
Transitional - abort cluster bout and allow time for preventative treatment to work
Preventative

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9
Q

What are some abortive treatments for cluster headache?

A

Triptans - Sumatriptan is treatment of choice, used 2 x daily, nasal zolmitriptan, oral is not effective
Oxygen - 10-15ltrs for 15-20 mins which may delay rather than abort attack

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10
Q

What is some transitional treatment for cluster headaches?

A

Oral prednisolone taper - introduce preventative at same time
Greater occipital nerve block - depomedrone and lidocaine

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11
Q

What is preventative treatment used in cluser headaches?

A

Verapamil
Lithium - chronic cluster headache
Topiramate - 2nd line
Gabapentin
Pregabalin
Sodium Valproate
Levetiracetam
Melatonin

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12
Q

Describe paroxysmal hemicrania

A

Pain is mainly orbital and temporal
Unilateral and rapid onset
2-30 mins and rapid cessation
Very severe pain
Can be restless
Prominent autonomic symptoms and migraine symptoms
Absolute response to indomethacin

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13
Q

Describe hemicrania continua

A

Strictly unilateral
Episodic or chronic
Moderate serve continuous background headache
Superimposed exacerbations of more severe pain lasting 20 mins
Mainly orbital and temporal

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14
Q

Describe SUNCT/ SUNA

A

Unilateral, supraorbital or temporal pain
Stabbing or pulsating pain
10-240 seconds
Triggers - cold, touch, chewing
Attack frequency is 3-200 a day and no refractory period
Conjunctival injection and lacrimation

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15
Q

What is the treatment for SUNCT/SUNA?

A

Medial - Lamotrigine, topiramate, oxcarbazepine, carbamazepine, duloxetine and pregabalin
Transitional - GON block
Surgical - occipital nerve and deep brain stimulation

16
Q

What are the main disorder presenting to A+E with headache?

A

Not just secondary headache - lots of range of disorders in secondary
Disabling primary headache
SAH and brain tumour
Sinister headache is infrequent

17
Q

What presentations are more likely to predict sinister headache?

A

Head injury, first or worst, sudden onset, new daily persistent headache, change in headache pattern and returning patient

18
Q

What features should make us consider secondary headache?

A

New onset headache, new or change in headache, change in frequency or characteristics, focal or non focal neuro symptoms, neck stiffness, high pressure, low pressure and GCA

19
Q

Describe a thunderclap headache

A

High intensity headache reaching max intensity in less than 1 min
Majority peak is instantaneous and is whole head
Must exclude subarachnoid haemorrhage

20
Q

Describe subarachnoid haemorrhage

A

Aneurysmal rupture and bleeding into subarachnoid space
There is a risk of re-bleeding and rupture
CT head as soon as possible and CT angiogram is SAH is confirmed

21
Q

What are some complications of subarachnoid haemorrhage?

A

Vasospasm, hydrocephalus, seizure, infection and re-bleeding

22
Q

What is the treatment for SAH?

A

Early treatment of aneurysm - coiling and clipping
Nimodipine - Ca channel blocker for vasospasm
Treat complications
HHH therapy - hydration, hyperoxia and hypertension

23
Q

Describe meningism and encephalitis

A

CNS infection
Presents with headache and fever
Meningism - nausea and vomiting, photophobia, phonophobia and stiff neck
Encephalitis - altered mental state, focal symptoms and seizures
Look for rash

24
Q

What can cause high pressure?

A

Intracranial pressure - change in volume of CSF and blood
Space occupying lesion
Brain swelling
Raised CSF pressure - hydrocephalus and intracranial hypertension

25
Q

What are the symptoms of a high pressure headache?

A

Headache wakens patient up, cough or other Valsalva headache, visual obscuration, seizures, progressive focal symptoms, cognitive change and LOC

26
Q

What should be considered if patient has headache and loss of consciousness?

A

3rd ventricle colloid cyst

27
Q

What are the signs of high pressure headache?

A

Papilledema
New abnormal neurological examination

28
Q

Describe intracranial hypertension

A

Elevated CSF opening pressure
Presentation - episodic or persistent headache, visual obscuration and papilledema

29
Q

What is the differential diagnosis of intracranial hypertension?

A

Idiopathic intracranial hypertension, drug induced, pregnancy, cerebral venous sinus thrombosis, meningitis and after SAH

30
Q

Describe intracranial hypotension

A

Spontaneous or post lumbar puncture
Postural headache so worst upright due to brain sink
MRI brain and spine show venous enlargement and subdural hygromas

31
Q

What is the treatment of intracranial hypotension?

A

Bed rest, fluids, analgesia and caffeine - IV
Epidural blood patch

32
Q

Describe giant cell areritis

A

Inflammation of large arteries
Headache is non specific
Scalp tenderness, jaw claudication and visual disturbance
Prominent, beaded and large temporal arteries present

33
Q

What investigations are used for giant cells arteritis?

A

ESR elevated
Raised CRP and platelet count

34
Q

What is the treatment for giant cell arteritis?

A

High dose prednisolone
If GCA is considered prednisolone should be started immediately and temporal artery biopsy arranged

Neuro (40 decks)

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