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Y3 MedEd > Headaches > Flashcards

Headaches Flashcards

1
Q

Primary headaches (4)

A

Migraine*
Tension*
Cluster
Trigeminal neuralgia

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2
Q

Secondary headaches (7)

A 
Meningitis*
Encephalitis
Haemorrhages
Extradural
Subdural*
Subarachnoid
CNS tumours
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3
Q

Age and gender of tension headaches

A

Young females more commonly

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4
Q

Site of tension headaches

A

Generalised, Bilateral

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5
Q

Onset of tension headaches

A

Gradual or acute onset

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6
Q

Character of tension headaches

A

Dull – “tight band”

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7
Q

Time it lasts of tension headaches

A

Lasts 3-4 hours

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8
Q

Alleviating factors of tension headaches

A

E: Analgesics help

§§

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9
Q

Radiation of tension headaches

A

Neck/shoulders

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10
Q

RF of tension headaches

A

Stress

Disturbed sleep

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11
Q

Mx of tension headaches

A

Conservative: Headache diaries (avoid triggers, relaxation) Medical: Simple analgesia (paracetamol, ibuprofen)

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12
Q

Epidemiology of migraine

A

Young adult females

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13
Q

Site of migraine

A

Unilateral

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14
Q

Onset of migraine

A

Paroxysmal, comes on gradually

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15
Q

Character of migraine

A

Pulsating/throbbing

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16
Q

Timing of migraine

A

4 – 72h

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17
Q

Exacerbating factors of migraine (3)

A

Physical activity/stress, noise, light

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18
Q

Alleviating factors of migraine

A

lying in a quiet, dark room

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19
Q

Associated symptoms of migraine (8)

A 
Aura: flashing lights, tingling
Photophobia, phonophobia
Nausea, vomiting
Visual changes
Tingling
Numbness
Migraine interferes with current activities
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20
Q

RF of migraine

A

FHx

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21
Q

How long does a migraine prodrome last

A

Can last for days

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22
Q

Migraine Mx (conservative, medical 4, preventative 3)

A

① Conservative: Headache diary, avoid triggers

②Acute Medical
Paracetamol, Ibuprofen, NSAIDs
Triptans

③ Preventative
Propranolol (BB) or topiramate (antiepileptic)
Amitriptyline (antidepressant)

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23
Q

Site of cluster headache

A

S: UNILATERAL, behind the eye

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24
Q

Onset of cluster headache

A

: Acute onset, CYCLICAL PATTERN,

Same time each day

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25
Q

Character of cluster headache

A

C: intense, sharp, penetrating

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26
Q

Timing of cluster headache

A

T: 15 minutes – 3 hours

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27
Q

Exacerbating factors of cluster headache

A

E: triggered by alcohol & strong smells

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28
Q

Severity of cluster headache

A

S: Severe – Can be disabling and cause suicidal thoughts

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29
Q

Associated symptoms of cluster headache (3)

A

Watery, red eye
Facial flushing
Nasal congestion

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30
Q

Examination of cluster headache

A

Partial Horners (ptosis, miosis)

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31
Q

What is trigeminal neuralgia associated with

A

MS

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32
Q

Site of trigeminal neuralgia

A

S: Unilateral, along the trigeminal division

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33
Q

Onset of trigeminal neuralgia

A

O: paroxysmal, lasting for seconds

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34
Q

Character of trigeminal neuralgia

A

C: stabbing, shooting

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35
Q

Exacerbating factors of trigeminal neuralgia

A

E: brushing teeth, speaking, shaving, talking

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36
Q

Associated symptoms of trigeminal neuralgia

A

Numbness

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37
Q

What is the common cause of meningitis in babies (2)

A

E. Coli, Group B Strep

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38
Q

What is the common cause of meningitis in children (2)

A

H. influenzae,

Strep. pneumoniae

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39
Q

What is the common cause of meningitis in adults

A

Neisseria meningitidis

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40
Q

What is the common cause of meningitis in elderly (2)

A

Strep pneumoniae,

Listeria monocytogenes

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41
Q

What does a non-blanching rash suggest

A

Meningococcal disease

42
Q

Associated symptoms of meningitis (6)

A 
Meningism 
Neck stiffness 
Photophobia
Fever
Rash
Vomiting
Seizures
43
Q

3 signs of meningitis on examination

A

Kernig’s Sign:
Brudzinski’ s sign
Petechial/purpuric Rash
(non-blanching)

44
Q

What is Kernigs sign

A

with the hips flexed, there is pain/resistance on passive knee extension - this is due to severe stiffness in the hasmstrings

45
Q

What is Brudzinskis sign

A
  • flexion of the hips and knees when the neck is flexed - this is due to severe neck stiffness
46
Q

Contraindications for lumbar puncture (3)

A

↑ ICP is a CONTRAINDICATION for LP

CT-head before LP if: neurological deficit or ↓ Consciousness

47
Q 
CSF bacterial:
Appearance
Cells
Glucose
Protein
A 
Bacterial
Turbid (Cloudy)
↑ neutrophils (polymorphs)
↓
↑
48
Q 
CSF viral:
Appearance
Cells (which type)
Glucose
Protein
A 
Clear
↑ lymphocytes
(mononuclear)
Normal
Normal or ↑
49
Q 
CSF TB:
Appearance
Cells (which type)
Glucose
Protein
A 
TB
Fibrin web
↑ lymphocytes
(mononuclear)
↓
↑
50
Q

Meningitis Mx at GP and then at A&E

A

at GP: benzylpenicillin IM & URGENT REFERAL TO THE HOSPITAL

at A & E: Broad spectrum antibiotics (ceftriaxone IV, benzylpenicillin IM, acyclovir if viral)

Targeted antibiotic Tx depending on sensitivities.
Consider IV dexamethasone

51
Q

Why use dexamethasone in meningitis

A

Prevent cerebral oedema

reduces complications such as cerebral oedema

52
Q

Complications of meningitis (3)

A

Hearing loss (most common)
Sepsis
Impaired mental status

53
Q

Usual causes of encephalitis (5)

A

Usually viral: HSV1-2, CMV, EBV, HIV, measles

54
Q

Non-usual causes of encephalitis (6)

A

bacterial meningitis, TB, malaria, listeria, Lyme disease, legionella

55
Q

Epidemiology of encephalitis

A

Affects mostly the extremes of age
<1
>65

56
Q

Symptoms of encephalitis (4)

A 
Viral prodrome
Fever
Headache
ALTERED MENTAL STATE
(Memory disturbances
Personality changes
Psychiatric manifestations
Impaired consciousness)
57
Q

Ix for encephalitis (4)

A

LP
Bloods
EEG
CT/MRI (oedema/hyperintense lesions

58
Q

Meningitis vs Encephalitis:
Location
Aetiology
Major symptomatic difference

A

MENINGITIS
Meninges
Bacterial, Viral, TB
Usually unimpaired

ENCEPHALITIS
Brain Parenchyma
Usually viral
Usually altered

59
Q

4 causes of raised ICP

A

SOL (tumour, abscess, haemorrhage)

Hydrocephalus

60
Q

Raised ICP headache (site onset character timing and exacerbating factors)

A 
S: Bilateral
O: Gradual
C: throbbing/bursting
T: worse in the morning
E: coughing, sneezing
61
Q

Associated symptoms of raised ICP (3)

A

Associated symptoms:
Vomiting
Altered GCS
Seizures

62
Q

What is Cushing’s triad and what is it seen in

A

Raised ICP
↑SBP
Irregular breathing
Bradycardia

63
Q

Signs of raised ICP (4)

A 
Focal neurological symptoms
Papilloedema
Cushing’s reflex → Cushing’s triad
↑SBP
Irregular breathing
Bradycardia
Cheyne-stokes respiration
64
Q

What is Cheynes Stokes respiration

A

: abnormal pattern of breathing characterised by progressively deeper and sometimes faster breathing followed by a gradual decrease that results in apnoea

65
Q

Aetiology of extradural haemorrhage

A

Head trauma

66
Q

Epidemiology of extradural haemorrhage

A

Young males

67
Q

Extradural haemorrhage onset

A

Acute following a lucid interval

68
Q

Associated symptoms of extradural haemorrhage (5)

A

N & V, confusion, seizure, paresis, brainstem herniation

69
Q

Ix for extradural haemorrhage

A

Urgent Non-contrast CT head-scan (lemon shape)

MRI

70
Q

Massive sign of extradural haemorrhage from trauma

A

Continued bleeding causes ipsilateral pupil dilatation due to haemorrhage compressing parasympathetic nerve fibres

71
Q

Aetiology of subdural haemorrhage

A

Rupture of the bridging veins (susceptible in elderly and alcoholics, due to brain atrophy)

72
Q

What is a subdural haemorrhage bleeding between

A

Dura and arachnoid mater

73
Q

RF of subdural haemorrhage (4)

A

Head trauma & falls (often following minor trauma up to 9 weeks before which patients have forgotten)
Old age
Alcoholics
Anticoagulation

74
Q

Onset of subdural haemorrhage

A

Gradual

75
Q

Timing of subdural haemorrhage

A

Continuing

76
Q

Classifications of subdural haemorrhages (3)

A

Acute: Within 72 hours (younger patients, trauma)
Subacute: 3-20 days (worsening headache, elderly)
Chronic: After 3 weeks (headache, confusion)

77
Q

Associated symptoms of a subdural haemorrhage (4)

A

Fluctuating consciousness
Confusion
Personality changes
Symptoms of ↑ ICP

78
Q

Shape of lesion in a extradural haemorrhage

A

Lemon

79
Q

Shape of lesion in a subdural haemorrhage

A

Banana

80
Q

Mx of subdural haemorrhage

A

ABCDE & NEUROSURGERY REFERAL
Depends on size & presentation
If small (<10mm) and no significant neurological dysfunction: observe
If large or significant neurological dysfunction: Burr hole or craniotomy

81
Q

SAH aetiology

A

Most commonly due to rupture of a saccular aneurysm

82
Q

SAH site

A

Occipital or diffuse

83
Q

SAH onset

A

Sudden “thunderclap”

84
Q

SAH character

A

Like being hit with a ball

Worst headache ever

85
Q

SAH timing

A

Continuous

86
Q

SAH severity

A

Very severe, maximum intensity in minutes

87
Q

Associated symptoms with SAH (2)

A

Meningism

Symptoms of ↑ ICP

88
Q

RF of SAH (4)

A

Polycystic kidney disease

Alcohol, smoking, HTN

89
Q

Ix for SAH

A

Urgent CT head within 12 hours

LP after 12 hours

90
Q

What cells do most brain tumours arise from

A

Glial cells

91
Q

Site of headache from brain tumour

A

Bilateral

92
Q

Onset of headache from brain tumour

A

Gradual

93
Q

Character of headache from brain tumour

A

Throbbing bursting

94
Q

Timing of headache from brain tumour

A

Worse in morning

95
Q

Exacerbating factors of headache from brain tumour

A

Coughing sneezing

96
Q

Associated symptoms of brain tumours (6)

A 
FLAWS
Focal neurological signs
Weakness
Difficulty walking
Seizures
Personality changes
97
Q

RF of brain tumours (2)

A

History of cancer

FHx of cancer

98
Q

Symptoms of vestibular schwannoma

A

Progressive deafness

99
Q

Symptoms of right parietal lobe tumour (3)

A

L homonymous
Hemianopia, L sided hemiparesis and sensory
loss

100
Q

Symptoms of frontal lobe tumour (3)

A

personality disturbance,

apathy, impaired intellect

101
Q

Ix for brain tumour (4)

A

CT (quicker)
MRI (better resolution)
CXR, CT thorax, abdo & pelvis to check for metastases
Biopsy (definitive)

Y3 MedEd (34 decks)

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