Headaches

Question 1

Give 2 risk factors for tension headache

What is concern for patient taking medication for tension headache?

Answer 1

• Stress, disturbed sleep

- Beware of medication over-use headaches.

Question 2

Give 5 triggers of migraine

Answer 2

• Bright lights
• Stress
• Diet: wine, cheese, chocolate, hangover
• Lack of sleep, lie-ins
• Hormonal changes

Question 3

Give the soc(r)ates of migraine

Answer 3

• Unilateral
• Gradual onset, paroxysmal
• Pulsating/ throbbing character
• Associated with aura, photophobia, N&V, vision changes.
• 4-72 hours
• Physical activity/ stress, noise, light
• Moderate to severe.

Question 4

What are two steps in acute medical management of migraine?

What are two steps in preventative management of migraine?

Answer 4

Acute: Paracetamol/ NSAID. Triptans if not effective.e
Preventative:
- BB (propanolol) or antieplipetic (topiramate)
- Amitriptyline (antidepressant) if not effective

Question 5

Give 3 associated symptoms of cluster headaches.

Give an examination finding of cluster headaches

Answer 5

• Watery/ red eye, facial flushing, nasal congestion

Examination: partial Horner’s- ptosis and miosis.

Question 6

What is pathophysiology of trigeminal neuralgia?
Which condition is trigeminal neuralgia associated with?
Give 4 exacerbating factors of trigeminal neuralgia.

Answer 6

Caused by compression of trigeminal nerve by a loop of artery or vein.

• MS
• Exacerbated by brushing teeth, chewing, talking, shaving.

Question 7

Which bacterial causes of meningitis affect the following age groups:

• neonates
• Young children
• Teenagers and young adults
• older adults, elderly.

Answer 7

Neonate: E. Coli, Group B Strep.
Kids: H. Influenzae, Strep. pneumoniae
Young people: Neisserial meningitidis
Older: Strep pneumoniae, listeria monocytogenes.

Question 8

What is Kernig’s sign?

What is Brudzinski’s sign

Answer 8

Kernig: lifting leg to 90 degrees
Brudzinski: tilting head forward causes hip and knee flexion.

Question 9

Give a contraindication for LP in investigation of meningitis.
What type of white cells are seen in CSF in bacterial vs viral meningitis.
What is seen in CSF in TB?

Answer 9

Raised intracranial pressure.

• Bacterial has increased neutrophils, polymorphs. Viral has increased lymphocytes, mononuclear.
• TB has fibrin web in CSF.

Question 10

What should be immediately administered in community setting if bacterial meningitis suspected
What should be administered in A&E if bacterial meningitis suspected.
Why may Dexamethasone be considered?

Answer 10

• GP land: give benzylpenicillin IM. Urgent referral to hospital.
• A&E: broad spectrum antibiotics.
• Dexamethasone may be used to reduce cerebral oedema.

Question 11

What is most common complication of meningitis?

Answer 11

• hearing loss.

Question 12

Give SOCTE (from socrates) of raised ICP headache.
Give 3 associated symptoms of raised ICP headache.

Answer 12

S: bilateral
O: Gradual
C: throbbing/ bursting
T: worse in the morning- raise in ICP during night, less CSF absorption.
E: Coughing/ sneezing

• Vomiting, altered GCS, seizures.

Question 13

Give 3 signs of raised ICP.

Answer 13

• Papilloedema
• Cushing’s reflex: cushing’s triad: raised SBP, irregular breathing, bradycardia.
• Cheyne-stokes respiration: abnormal breathing pattern- increase and decrease in resp. rate up to apnoea.

Question 14

What is urgent investigation for raised ICP?

Answer 14

CT head

Question 15

What is common cause of extradural haemorrhage?
What age group?
What is onset of the headache?
What shape is seen on non-contrast CT?

Answer 15

• Trauma
• Young males
• Acute following lucid interval.
• Lemon shape

Question 16

What is pathophysiology of subdural haemorrhage?
Which two groups of people are susceptible to subdural haemorrhage.
What is the onset of subdural haemorrhage?
Give 4 risk factors for subdural.

Answer 16

• Rupture of bridging veins in brain atrophy.
• Alcoholics and elderly are susceptible.
• Gradual onset.
• Head trauma and falls, old age, alcoholism, anticoagulation.

Question 17

Give 4 associated symptoms of subdural haemorrhage.

Answer 17

• Fluctuating consciousness
• Confusion
• Personality changes
• Symptoms of raised ICP.

Question 18

What is immediate management of subdural haemorrhage?

Answer 18

• ABCDE and Neurosurgery referral.

- If greater than 10mm or significant neurological dysfunction, Burr hole or craniotomy.

Question 19

Give SOCTS of subarachnoid haemorrhage.

Answer 19

• Occipital or diffuse
• Thunderclap
• hit by brick, worst headache ever
• Continuous
• very severe, maximum intensity in minutes.

Question 20

What is first investigation for subarachnoid haemorrhage and within what time?
What is next investigation and what is being looked for?

Answer 20

• CT head in less than 12 hours.

- LP if normal CT. Look for xanthochromia and oxyhemoglobin.

Question 21

Which cells do most brain tumours arise from?

Which brain tumours are more common in children?

Answer 21

• Most tumours from glial cells (supportive CNS cells)

- medulloblastomas

Question 22

What symptoms do the following types of tumour produce:

• Frontal lobe tumour
• R parietal lobe tumour
• Vestibular schwannoma

Answer 22

Frontal: personality disturbance

• R parietal: L homonymous hemianopia, L sided hemiparesis and sensory loss
• Vest. Schwann: progressive deafness. Benign tumour.

Question 23

Give the red flags in headache according to acronym SNOOP.

Answer 23

• Systemic signs: FLAWS, HIV, meningismus, pregnancy
• Neurologic signs: papilloedema, hemiparesis, hemisensory loss, diplopia, dysarthria.
• Onset: worst headache of life
• Older: new headache >50
• Progression of existing disorder: change in quality, frequency, location.