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Nervous system > Headaches > Flashcards

Headaches Flashcards

1
Q

what are Acute Vascular causes fora headaches ?

A

Haemorrhage- SAH, IC, SDH, EDH

Thrombosis - Venous sinus

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2
Q

what are acute infective causes of headaches ?

A

Meningitis
Encephalitis
Abscess
temporal arteritis

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3
Q

what is an acute ophthalmic cause of headaches ?

A

Glaucoma

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4
Q

What are situational causes of headaches ?

A

cough, exertion and coitus

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5
Q

What are chronic causes of headaches ?

A

Migraine , cluster headaches
Drug side effects
tension headaches
Trigeminal Neuralgia

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6
Q

what are chronic causes of headaches that require immediate attention ?

A

Raised ICP from SoLs
Temporal / Giant cell arteritis
Systemic - HTN, Pre-eclampsia and pharmochromocytoma

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7
Q

what is difference between primary and secondary headaches ?

A

primary - due to the headache condition itself

secondary - present due to another condition

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8
Q

what do you consider to do next when someone comes in with headaches ?

A

Investigations
treatment
send to specialist or A and E

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9
Q

What must you consider in HPC of a patient with headaches ?

A 
the cause / trigger 
PMH
DH - Analgesics, side effects 
FH
Stress- eating , water
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10
Q

what must you consider in examinations and why ?

A

vital sign/obvs - Bradycardia, hypotension from raised ICP
Neuro - peripheral and CN exam
any other exams dependant on history

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11
Q

what are red flag features of headaches ?

A

SNOOP
Systemic signs - of meningitis, HTN
Neurological symptoms - SoLs, Glaucoma
Onset new or changed and patient >50 years old - malignancy
Onset in thunderclap presentation - vascular (SAH)
Papilloedema - raised ICP

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12
Q

What SoL symptoms from a headache presentation ?

A 
Gradual onset ,Progressive
Associated neurological features- vision
features of Increased ICP:
Early morning headache
nausea and vomiting 
worse on coughing or bending
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13
Q

what is the HPC of migraines ? think SQITARS

A

S= Unilateral , frontal
Quality - gradual or sudden, throbbing and pulsating
Intensity - moderate
Timing- Lasts 4-72 hours, cyclical
A- photo/Phonophobia, food , stress and lack of sleep
R- sleep , medications (Triptans)
S- aura with N+V

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14
Q

what is a theory for patholgy of margarine’s ?

A

vasodilation = spreading depression to cortex with FH linked

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15
Q

what is the HPC of tension headches ? think SQITARS

A 
site - bilateral , frontal, radiate to neck
Quality - squeezing, non pulsatile 
Intensity - less sever (mild/mod)
timing - worse at end of day
Chronic if > 15 times per month
Episodic if <15 times per month
Aggravating factors - stress, poor posture lack of sleep 
Relieving factors - analgesics
S - Mild nausea
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16
Q

what is the pathology of tension headaches ?

A

Maybe tension in muscles of head and neck (e.g. occipitofrontalis)
 Usually no family history

17
Q

what is the epidemiology of tension headaches ?
Sex ?
age ?
onset ?

A

Most common type of headache
Females > males
Young > old
First onset in over 50s unusual (thing possibility of malignancy)

18
Q

what is the epidemiology of migraines ?

A

2% of general population
Twice as many females as males
Most have had first attack when young (<30)
Severity decreases as age increases

19
Q

what is the epidemiology of meds over use headache?

A 
3rd most common type of headache
1-2% of UK population
20% of headaches are due to medication overuse
30-40 yrs
 Females > males
OTC responsive
20
Q

what is the definition of meds over use headache?

A

Present on at least 15 days per month
 No improvement after OTC medication
may get worse before better

21
Q

What is the DH of these patients ?

A

patients who get this headache are using
analgesics on at least 10 days per month
triptan or opioids at least 10/month
Paracetamol , NSAIDs at least 15/month

22
Q

what are some features of patients with Over use headaches ?

A 
seems to come about in people who are
taking analgesia for headache
mixed symptoms
difficult to manage 
Co-exist with depression and sleep disturbances
23
Q

What is the management of over use headaches ?

A

discontinuation of meds

may get withdrawal

24
Q

what is the pathology of over use headaches ?

A

upregulation of pain receptors in meninges

25
Q

what is the epidemiology of cluster headaches ?

A

1/1000 people
Males > females
Usual onset 20-40 years old

26
Q

what is the HPC of cluster headaches ?

A

S- Around / behind one eye ,No radiation
q- Sharp and penetrating
I-Very severe and constant intensity
T- Rapid onset , 15-3hrs 1-2x/day, nocturnal , lasts 2-12 wks, remission can be 3mo-3yrs
A- head injury, Alcohol, Smoking
R- Simple analgesics
S- Decreased sympathetics = red /watery eye , nasal congestion and ptosis

27
Q

what are some triggers for cluster headaches ?

A 
Alcohol
Histamine (hayfever)
 GTN
Heat
 Exercise
 Solvent inhalation
 Lack of sleep
28
Q

what is the epidemiology of trigeminal nerve ?

A

Peak incidence 50-60, increasing with age
25/100 000 UK population
Females > males

29
Q

What is the HPC of Trigeminal neuralgia ?

A

S- Unilateral , over one eye, radiates to eyes, lips , nose
Q- Sharp and stabbing
I - Severe
T- sudden onset , few secs - 2mins
A- Light touch to face Eating Cold wind, Vibrations
R- difficult to alleviate
S- numbness and tingling preceding an attack
history of chronic pain

30
Q

what is the pathophysiology of TN headaches ?

A

caused by compression of trigeminal nerve by a
vascular malformation few cases can be found to be caused by tumours, MS or skull
base anomalies

31
Q

how can you treat migraines

A

triptans

32
Q

how can you treat cluster headaches?

A

high flow oxygen

33
Q

when do you refer to specialists ?

A 
Suspicion of a tumour
Suspicion of raised ICP
Recent onset seizures
Previous cancer
Unexplained focal deficit
 Unexplained cognitive/personality changes

Nervous system (20 decks)

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