Headaches Flashcards
what are the different patterns of headaches?
acute single headache
dull headache- increasing severity or unchanged over months
recurrent headaches
triggered headaches
what are the red flags for headaches?
onset
meningism
systemic symptoms
neurological symptoms or focal symptoms
orthostatic (better lying down)
strictly unilateral-same pain in same spot
what are the red flags for onset of headaches?
thunderclap
acute
subacute
what are the red flags for meningism headaches?
photophobia
phonophobia
stiff neck
vomiting
what are the red flags for neurological symptoms or focal symptoms for headaches?
- Visual loss
- Confusion
- Seizures
- Hemiparesis
- Double vision
- 3rd nerve palsy
- Horner syndrome
- Papilloedema
what are the signs of subarachnoid haemorrhage?
sudden generalised headaches (thunderclap)
meningism= stiff neck and photophobia
what are the cause of a subarachnoid haemorrhage?
most caused by ruptured aneurysm
few arteriovenous malformations and some unexplained
what are the risks of subarachnoid haemorrhage?
50% instantly fatal
high risk further bleeding
what may stop the leak from a subarachnoid haemorrhage?
vasospasm
what is the treatment for subarachnoid haemorrhage?
nimodipine and BP control
early neurological assessment to confirm bleed and establish cause
CT scan, lumbar puncture (RBC and xanthochromia). MRA angiogram
used to clip or wrap aneurysm, now filled with platinum coils using catheter in groin
what is the cause of acute intracerebral bleed?
fatal haemorrhage due to coning
raised ICP causes brainstem death due to compression of brain
what is papilloedema?
optic disc swelling due to raised ICP
what can an issue with carotid and vertebral arteries cause?
headaches
what are the types of carotid and vertebral artery dissection?
traumatic and spontaneous
what are the common symptoms of carotid and vertebral artery dissection?
headache and neck pain
20% ischaemic strokes <45years (carotid>vertebral)
how are carotid and vertebral artery dissection detected?
MRI/MRA
doppler
angiography
what is the treatment for carotid and vertebral artery dissection?
aspirin/angicoagulant
what is seen on the scan of a chronic subdural haemorrhage?
areas of black (blood)- black due to clotting
destroyed ventricles and brain pushed onto other side
when is temporal arthritis more commonly seen?
over age 55
more common females
what are the signs of temporal arthritis?
- Constant unilateral headache, scalp tenderness, jaw claudication
- 25% polymyalgia rheumatica- proximal muscle tenderness
- involvement of posterior ciliary arteries= blindness
- elevated ESR and CRP
- temporal arteries inflamed and tortuous
- visible on ultrasound
- biopsy shows inflammation and giant cells
what is the treatment for temporal arthritis?
high dose steroid and aspirin
what is cerebral venous thrombosis?
thrombosis in dural venous sinus or cerebral vein
what are the signs of cerebral venous thrombosis?
unusual amount headach due to raised ICP
non-territorial ischemia ‘venous infarcts’
haemorrhage
what are the risk factors for cerebral venous thrombosis?
thrombophilia
pregnancy
dehydration
behcets
what are the causes of viral meningitis?
coxsackie
ECHO
mumps
EBV
what are the bacterial causes of meningitis?
meningococci
pneumococci
TB
what are the fungal causes of meningitis?
cyptococci
what are the granulomatous causes of menigitis?
sarcoid
lyme
brucells
behcets’s
what are the general causes of meningitis?
viral
bacterial
fungal
granulomatous
carcinomatous
what are the presenting symptoms of meningitis?
malaise
headache
fever
neck stiffness
photophobia
confusion
alteration of consciousness
what is the treatment for meningitis?
treat first then diagnose
- antibiotics
- blood and urine culture
- CT/MRI scan
- lumbar puncture- check for cerebral oedema first on MRI
what are the signs of sinusitis?
- malaise
- headache
- fever
- blocked nasal passages
- loss vocal resonance
- anosmia
- local pain + tenderness which clears up during afternoon
what is the most common form of brain tumour?
glioblastoma multiforme
what is a cause of idiopathic intracranial hypertension?
pseudotumour cerebri
when is pseudotumor cerebri usually seen?
- young obese women
- headache, visual obscurations, diplopia, tinnitus
caused by hormones, steroids, antibiotics vitamin
what is the treatment of pseudotumor cerebri?
- treatment= weight loss, diuretics, optic nerve sheath decompression lumboperitoneal shunt, stenting of stenosed venous sinuses
what is a low pressure headache?
orthostatic headache
what is the cause of orthostatic headache?
- CSF leak due to tear in dura
- Traumatic post lumbar puncture or spontaneous
what is the treatment of orthostatic headache?
rehydration
caffeine
blood patch
what is chiari malformation?
- Normal brain that sits very low
- Cerebellar tonsils descending through foramen magnum
- Descending further when patient cough can tug on meninges causing cough headache
- Can remodel base skill
what is obstructive sleep apnoea characteried by?
body habitus
history loud snoring
apnoeic spells
hypoxia
CO2 retention
non refreshing sleep
depression
impotence
poor performance at work
how is obstructive sleep apnoea diagnosed?
require sleep study
what is the treatment for obstructive sleep apnoea?
nocturnal NIV
surgery
what is the sensation of trigeminal neuralgia?
electric shock like pain in distribution of sensory nerve
can be symptoms of MS
what is trigeminal neuralgia triggered by?
innocuous stimuli
what branch of the trigeminal nerve is affected in trigeminal neuralgia?
any division- neurovascular conflict at point of entry of nerve into pons
what is the treatment for trigeminal neuralgia?
carbamazepine, lamotrigine, gabapentin, posterior fossa decompression
what is atypical facial pain?
- Most common middle aged women, depression or anxious
- Daily, constant, poorly localised deep aching or burning
- Facial or jaw bones but may extend neck, ear or throat
- Not lancinating
- Not conforming to strict anatomical distribution of any nerve
- No sensory loss
- Unresponsive to conventional analgesics, opiates and nerve blocks
what must be done to diagnose atypical facial pain?
pathology of other areas must be excluded first
what is the management of atypical facial pain?
tricyclics
when is post-traumatic headache seen?
- Depends on nature of head injury
- High in victims of car accident
- Low in sports injuries/ perpetrators of car accidents
- Corelates with previous history of headache
- Unrelated to duration of post-traumatic amnesia
what are the mechanisms of post traumatic headache?
- Neck injury
- Scale injury
- Depression- often delayed
- Vasodilation? Autonomic damage
what is the management of post traumatic headaches?
- Explanation no damage
- Prevent analgesic abuse
- Treatment
- NSAID
- Tricyclic antidepressants- amitriptaline
- Be patient- 3-4 yrs to get better
what is the commonest cause of new headache in older patients?
cervical spondylosis
what are the signs of cervical spondylosis?
- Usually bilateral
- Occipital pain can radiate forward to frontal region
- Steady pain
- No nausea or vomiting
- Worsened by moving neck
what is the management of cervical spondylosis?
- Rest, deep heat, massage
- Anti-inflammatory analgesics
- Over- manipulation may be harmful
- Gets better over course day usually
what is cervical spondylosis?
narrowing of joint space due to worn disc
