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taz year 3 gp > Headaches > Flashcards

Headaches Flashcards

1
Q

How do tension headaches present?

A

Bilateral pain/ tightness/ pressure in halo distribution/ forehead. Can be mild mod or severe lasting a few hrs to days. Do not usually disturb sleep, mildest in the morning and may have tenderness around muscles of head.

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2
Q

What could exacerbate/ cause tension headaches?

A

tightness in neck and head muscles, exacerbated by tiredness, anxiety, eye strain, working/ reading in low light, dehydration, sunlight, cold, noise etc

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3
Q

How are tension headaches treated (4)

A
  • paracetamol and NSAIDs
  • reducing stress
  • exercise
  • amytriptyline (start low dose and increase, stop when no headaches for 4-6 months)
  • if chronic: keep diary to find triggers
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4
Q

How do migranes typically present?

A

Usually unilateral, throbbing/ pulsating pain at front or side, may start in one place and spread. Often preceeded by aura. lasts 2-12 hrs. Associated N+V, photophobia, noise intolerance, blurred vision, sweating

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5
Q

List 6 triggers of a migraine

A
  • diet: caffeine, cheese, choco, alcohol
  • smoking
  • bright light
  • depression/ anxiety/ stress
  • loud noises
  • strong smells
  • medications (HRT, COCP)
  • mensturation
  • shift work
  • lack of sleep
  • strenuous exercise
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6
Q

How are migraines managed?

A
  • Try and identify triggers
  • 1st: aspirin or ibuprofen w/ prochlorperazine to stop N+V
  • 2nd: diclofenac suppository w/ domperidone (for n+v)
  • 3rd: 5-HT receptor agonists (triptans: sumatriptan, almotriptan)
  • beta blockers, amitriptyline, sodium valproate, pizotifen and botulinum toxin type A as prophylaxis for chronic migraines
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7
Q

How frequent should migraines be for the pt to be offered prophylaxis?

A

> 2 per month

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8
Q

How does a retinal/ ocular migraine present?

A

Partial or total loss of vision in one eye lasts 10 to 20 mins before vision returns. Headache before during or after after vision attack. caused by vasospasm of blood vessels in eye

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9
Q

How are retinal migraines treated?

A

aspirin, b blocker or ccb, TCA

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10
Q

What is a hemiplegic headache?

A

Temporary paralysis of one half of body with severe headache. lasts hrs- days often confused with stroke.

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11
Q

How does a cluster headache present?

A

one sided burning/ throbbing headache, mainly around on eye or temple which can spread to other parts of the head. They come on quickly with no warning, last 15mins- 3hrs and happen everyday for weeks- months before improving. may be triggered by alcohol, heat or strong smells. may have redness and watering of eye, runn or buged nose, facial sweating, eyelid dropping. often occur at night and can wake from sleep

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12
Q

What is thought to be happening during a cluster headache?

A

hypothalamic overdrive causing neurotransmitters to be released that stimulates pain and other symptoms. Nerve overactivity thought to cause vasodilation of blood vessels of one side of brain causing pain and pressure on nearby tissue.

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13
Q

How are cluster headaches treated? (3)

A
  • SC sumatriptan injection releives them within 15 mins
  • zolmitriptan nasal spray doesnt work as fast
  • high flow oxygen works within 15 mins (3rd line)
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14
Q

How can cluster headaches be prevented? (3)

A
  • verapamil (action not clear)
  • lithium (action not clear)
  • corticosteroids can help break the cycle
  • others eg methysergide, ergotamine, topiramate
  • take them till headache free for 14 weeks but may need them indefinatly
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15
Q

How do medication overuse headaches present

A

constant or dull headache most days, often worse in morning and after exercise on background of paracetamol, aspirin or nsaid use for 15 days or opaite or triptan use for 10 days or more.

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16
Q

How are medicine overuse headaches treated?

A

Stop pain relief and switch to another if its still needed, usually returns to normal after 7-10 days

17
Q

How do exertion/ sexual headaches tend to present?

A

severe, usually posterior head or behind eyes, but can be all over, quick onset and last roughly 20 mins, bought on by exercise or sex, worse with coughing, straining

18
Q

What type of headache presents with stabbing pain around ears which are very intense but only last 5-30 seconds, often in people with PMH migraines

A

primary stabbing headaches (ice pick headaches)

19
Q

What is hemicrania continua

A

a primary chronic daily headache, usually one sided which is continious but fluctuating and often associated with eye watering, red eye, runny or blocked nose, eyelid drooping, photophobia, N+V

20
Q

How is hemicrania continua treated?

A

indometacin (an NSAID)

21
Q

How does trigeminal neuralgia present?

A

electric shock type pain in distribution of one of the 3 trigeminal nerve branches. comes in short bursts can be sudden onset and be very frequent or only occasionally. May be triggered by brushing teeth, talking, breeze, swallowing etc. most common in 60-70 y/os

22
Q

How is trigeminal neuralgia treated?

A
  • carbemazepine

- deep brain simultation and decompression surgery only if severe and not respond to medical management

23
Q

How does a subarachnoid haemorrhage present?

A

All over rapid onset thunderclap headache usually w/ LOC/ drowsiness rapidly/ some have warning signs: dizziness, eye pain, double vision, loss of sensation

24
Q

How are SAH treated?

A

stabilise pt, prevent further bleeding, surgery to stop bleeding and improve blood supply to affected part of brain

25
Q

How does meningitis present?

A

Severe diasbiling headache, vomiting, photophobia, fever, neck stiffness, tachypnoea, pupuric rash

26
Q

How is meningitis treated?

A

Ceftriaxone, if 60+, pregnant or immunocompromised (inc diabetes and alcohol abuse) give IV amoxicillin as well
Supportive with fluids, o2, steroids

27
Q

What are possible complications of meningitis?

A

hearing loss, learning problems, epilepsy, renal problems, joint or bone problems

28
Q

How does encephalitis present?

A

fever, headache, muscle ache, tiredness, n+v, reduced consciousness, confusion, stiff neck, photophobia, seizure

29
Q

What is most common cause of encephalitis and what is the treatment?

A

usually herpes simplex virus

treat with aciclovir + fluids, medication to control seizures, fever, pain and oxygen

30
Q

How is encephalitis investigated?

A

CT/ MRI, lumbar puncture, EEG, bloods (FBC, U&E, CRP, virology)

31
Q

How does giant cell arteritis present

A

Temporal headache, tenderness over temples (uni or bilat), feels unwell, jaw pain on eating, visual loss/ distubances, pain on brushing hair, history of PMR common

32
Q

How is giant cell arteritis treated?

A

High dose oral prednisolone (60mg), needs refferal for temporal artery biopsy

33
Q

Give 4 redflags for brain tumours?

A
  • early morning headaches
  • worse on sitting up
  • worse throughout day
  • never easing or dissapearing
  • worse on coughing and sneezing
  • age >50 and <10

taz year 3 gp (12 decks)

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