Headaches Flashcards
Primary headache types?
Migraine, tension, cluster, trigeminal neuralgia
Secondary headache types?
Meningitis, encephalitis, haemorrhages (SAH, Subdural and extradural), CNS lesions
Features of tension headache?
Generalised, bilateral, gradual or acute onset. Dul ‘tight band’.
Last 3-4 hours, anaglesics help and moderate severity
RFs for tension headache?
Stree and disturbed sleep
Management for tension headache?
Conservative: headache diaries to avoid triggers and relax.
Medical: simple analgesia (paracetamol, ibuprofen)
MOST COMMON medication-overuse headache (rebund headache)
Migraine definition and potential aetiology?
Chronic condition that causes attacks of headaches potentially via inflammation of the trigeminal nerve changes the way that the brain processes stimuli
Epidemiology of migraines?
RFs?
More common in young adults and 3x more likely female
FHx
Triggers of migraines?
CHOCOLATE Chocolate Hangivers Orgasms Cheese/caffeine OCP Lie-ins Alcohol Travel Exercise
Bright lights, lack of sleep, wine, hormonal changes and stress
Describe migraine headache?
Unilateral, paroxysmal, gradual, pulsating, 4-72hrs, physical activity stress, noise and light exacerbate.
Relieving = lying in dark room and quiet
Associated symptoms of migraine?
Photophobia and phonophobia, Aura: flashing lights. N+V, visual changes and tingling, numbness
Migraine management?
1) Conservative: headache + avoid triggers
2) Acute medical: Paracetamol, ibuprofen and NSAIDs first. if not working then go to triptans
Whats preventative migraine management?
A) propabolol or topiramate.
B) Amitriptyline (antidepressant)
Definition and epidemiology of cluster headache?
RFs?
A neurological disorder characterized by recurrent, severe headaches on one side of head which occur cyclically.
Men and femal 20-40YO
Smoking and alcohol
Pathophysiology of cluster headaches?
Not clear but meant to be hypothalamic activity with secondary trigeminal and autonomic activation.
Presentation of cluster headaches?
UNILATERAL, behind the EYE. Acute onset with CYCLICAL pattern (same time each day). Intense, sharp penetrating pain. 15mins to 3hours and can be triggered by alcohol or strong smells. Can be very severe and disabling
Associated symptoms of cluster headache?
ANS e.g. watery, red eye. Facial flushing and nasal congestion.
Examination: Partial horners (ptosis, miosis).
Pathophysiology of of trigeminal neuralgia?
Facial pain syndrome in the distribution of >1 divisions of trigeminal nerve by compression of nerve by loop of artery or vein.
Associated with MS
Triggers of trigeminal neuralgia?
Touching face, shaving, brushing teeth, eating, talking
Presentation of trigeminal neuralgia?
Unilateral, paroxysmal, lasting for seconds, stabbing or shooting. Numbness is associated and no investigations
What is meningitis and causative organisms?
Inflammation of the meninges.
Bacterial, viruses and TB.
Bacterial: E.coli, group B strep for babies.
Neisseria meningitidis for yound adults.
H.Influenzae, strep pneumoniae for children
Old people = strep pneumoniae, listeria monocytogenes
Viruses: enteroviruses, HSV, VSV, HIV
Meningitis Hx?
Acute and severe.
RFs: Closed communities and crowding. Age <5, >65
Associated symptoms:
Meningism e.g. neck stiffness and photophbia, fever, rash, vomiting and seizures
Examination for Meningitis?
Kernigs sign and Brudzinskis sign. Petechial Rash (non-blanching)
Investigations for meningitis?
CSF is most importatn but ICP is contraindication.
If bacterial: Turbid (cloudy), increased neutrophils (polymorphs), decreased glucose and increased protein
Viral: Clear, increased lymphocytes (mononuclear), normal glucose, normal or increased protein
TB: fibrin web, increased lymphocytes (mononuclear), decreased glucose and increased protein