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Year 3 - GP Block > Headaches > Flashcards

Headaches Flashcards

1
Q

Is a rapid onset headache typically concerning?

A

Yes

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2
Q

What can cause a rapid onset headache?

A

Sub-arachnoid haemorrhage

Meningitis

Encephalitis

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3
Q

How is a sub-arachnoid haemorrhage often described?

A

‘Worst ever headache’

‘Thunderclap headache’

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4
Q

Where in the head does a headache caused by a sub-arachnoid haemorrhage typically occur?

A

Occipital region

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5
Q

How does a sub-arachnoid haemorrhage affect consciousness?

A

Decreased consciousness

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6
Q

What can a sub-arachnoid haemorrhage cause within the cranium?

A

Raised ICP

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7
Q

What are some signs of raised ICP that can be seen in GP?

A

Papilloedema on fundoscopy

History of nausea and vomiting

Double vision (diplopia)

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8
Q

Why does raised ICP cause double vision?

A

Raised ICP disproportionately affects the VI cranial nerve

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9
Q

Why does ICP disproportionately affect the VI cranial nerve?

A

Because it has the longest intracranial course

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10
Q

What is the name of the VI cranial nerve?

A

Abducens

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11
Q

What muscle is innervated by the abducens?

A

Lateral rectus

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12
Q

What other symptoms accompany meningitis?

A

Fever

Photophobia

Purpuric, non-blanching rash

Neck stiffness

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13
Q

What other symptoms accompany encephalitis?

A

Odd behaviour

Fits

Fever

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14
Q

How should suspected encephalitis be investigated?

A

Urgent CT scan

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15
Q

What can cause a gradual onset headache?

A

Sinusitis

Tropical infections

Venous sinus thrombosis

Intra-cranial hypotension

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16
Q

What sign may suggest venous sinus thrombosis?

A

Papilloedema

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17
Q

What can make sinusitis pain worse?

A

Bending over

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18
Q

How is a headache caused by sinusitis described?

A

Dull, constant headache in the distribution of the nasal sinuses

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19
Q

What does palpation of the area over inflamed sinuses elicit?

A

Tenderness

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20
Q

Why might a tropical infection be a suspected cause of a headache?

A

A travel history with accompanying flu-like symptoms

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21
Q

What tropical infection can cause headaches?

22
Q

What can cause intra-cranial hypotension?

A

CSF leakage (possibly due to lumbar puncture)

23
Q

When is a headache due to intracranial hypotension worse?

A

When standing up

24
Q

What do recurrent (not ongoing) headaches typically suggest?

A

Usually benign

25
Q

What can cause recurrent headaches?

A

Migraines

Cluster headaches

Trigeminal neuralgia

26
Q

How does a cluster headache present?

A

The most disabling of primary headaches

Pain around the eye

Watery/bloodshot eye

Unilateral

27
Q

What can be used to treat cluster headaches?

A

100% O₂ for ~15 mins through non-rebreath mask

Sumatriptan

29
Q

How does trigeminal neuralgia present?

A

Unilateral

Stabbing pain

Typically affects maxillary and mandibular divisions

30
Q

How do migraines typically present?

A

Preceded by an aura

Followed within 1 hr by unilateral throbbing headache

31
Q

What types of aura can precede a migraine?

A

Visual - melting or jumbling of lines or dots, or hemianopia

Somatosensory - parasthesia from fingers to face

Motor - dysarthria, ataxia, or dysphasia

32
Q

What percentage of the population do migraines affect?

34
Q

What mnemonic can be used to remember migraine triggers?

35
Q

What does C stand for in the CHOCOLATE mnemonic?

A

Chocolate/Cheese/Caffiene

36
Q

What does H stand for in the CHOCOLATE mnemonic?

37
Q

What does O stand for in the CHOCOLATE mnemonic?

A

Orgasms/oral contraceptives

38
Q

What does C stand for in the CHOCOLATE mnemonic?

A

Chocolate/Cheese/Caffiene

39
Q

What does O stand for in the CHOCOLATE mnemonic?

A

Orgasms/Oral contraceptives

40
Q

What does L stand for in the CHOCOLATE mnemonic?

41
Q

What does A stand for in the CHOCOLATE mnemonic?

42
Q

What does T stand for in the CHOCOLATE mnemonic?

43
Q

What does E stand for in the CHOCOLATE mnemonic?

44
Q

What are migraines associated with?

A

Obesity

Family history

45
Q

How are migraines diagnosed?

A

Clinical diagnosis based on history:

If no aura: ≥5 headaches lasting 4-72 hours + N&V + any 2 of:

Pulsating
Unilateral
Impairs (or worsened by) regular activity

46
Q

What is a chronic progressive headache suggestive of?

A

Raised ICP due to:

Haemorrhage

Tumour

Aneurysm

47
Q

A head ache with eye pain +/- visual loss may suggest what?

A

Acute glaucoma

48
Q

How should acute glaucoma be handled?

A

Immediate referral

49
Q

What can cause headaches?

A

Food

Sex

Analgesia

Trauma

50
Q

What part of a social history is it important to identify when thinking about headaches?

A

Possible stressors

51
Q

What part of a drug history is it important to identify when thinking about headaches?

A

Medication overuse

52
Q

How can migraines be treated?

A

Avoid triggers

Prophylactic treatment - 1st line = propranalol

During attack - oral triptan + NSAID or paracetamol

Non-pharmacological therapies

53
Q

What percentage of migraines can the CHOCOLATE mnemonic be applied to?

Year 3 - GP Block (5 decks)

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