Headaches Flashcards

(58 cards)

1
Q

what are the different patterns of headaches?

A

acute single headache

dull headache- increasing severity or unchanged over months

recurrent headaches

triggered headaches

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2
Q

what are the red flags for headaches?

A

onset

meningism

systemic symptoms

neurological symptoms or focal symptoms

orthostatic (better lying down)

strictly unilateral-same pain in same spot

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3
Q

what are the red flags for onset of headaches?

A

thunderclap

acute

subacute

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4
Q

what are the red flags for meningism headaches?

A

photophobia

phonophobia

stiff neck

vomiting

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5
Q

what are the red flags for neurological symptoms or focal symptoms for headaches?

A
  1. Visual loss
  2. Confusion
  3. Seizures
  4. Hemiparesis
  5. Double vision
  6. 3rd nerve palsy
  7. Horner syndrome
  8. Papilloedema
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6
Q

what are the signs of subarachnoid haemorrhage?

A

sudden generalised headaches (thunderclap)

meningism= stiff neck and photophobia

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7
Q

what are the cause of a subarachnoid haemorrhage?

A

most caused by ruptured aneurysm

few arteriovenous malformations and some unexplained

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8
Q

what are the risks of subarachnoid haemorrhage?

A

50% instantly fatal

high risk further bleeding

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9
Q

what may stop the leak from a subarachnoid haemorrhage?

A

vasospasm

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10
Q

what is the treatment for subarachnoid haemorrhage?

A

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

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11
Q

what is the cause of acute intracerebral bleed?

A

fatal haemorrhage due to coning

raised ICP causes brainstem death due to compression of brain

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12
Q

what is papilloedema?

A

optic disc swelling due to raised ICP

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13
Q

what can an issue with carotid and vertebral arteries cause?

A

headaches

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14
Q

what are the types of carotid and vertebral artery dissection?

A

traumatic and spontaneous

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15
Q

what are the common symptoms of carotid and vertebral artery dissection?

A

headache and neck pain

20% ischaemic strokes <45years (carotid>vertebral)

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16
Q

how are carotid and vertebral artery dissection detected?

A

MRI/MRA

doppler

angiography

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17
Q

what is the treatment for carotid and vertebral artery dissection?

A

aspirin/angicoagulant

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18
Q

what is seen on the scan of a chronic subdural haemorrhage?

A

areas of black (blood)- black due to clotting

destroyed ventricles and brain pushed onto other side

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19
Q

when is temporal arthritis more commonly seen?

A

over age 55

more common females

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20
Q

what are the signs of temporal arthritis?

A
  • 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
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21
Q

what is the treatment for temporal arthritis?

A

high dose steroid and aspirin

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22
Q

what is cerebral venous thrombosis?

A

thrombosis in dural venous sinus or cerebral vein

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23
Q

what are the signs of cerebral venous thrombosis?

A

unusual amount headach due to raised ICP

non-territorial ischemia ‘venous infarcts’

haemorrhage

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24
Q

what are the risk factors for cerebral venous thrombosis?

A

thrombophilia

pregnancy

dehydration

behcets

25
what are the causes of viral meningitis?
coxsackie ECHO mumps EBV
26
what are the bacterial causes of meningitis?
meningococci pneumococci TB
27
what are the fungal causes of meningitis?
cyptococci
28
what are the granulomatous causes of menigitis?
sarcoid lyme brucells behcets's
29
what are the general causes of meningitis?
viral bacterial fungal granulomatous carcinomatous
30
what are the presenting symptoms of meningitis?
malaise headache fever neck stiffness photophobia confusion alteration of consciousness
31
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
32
what are the signs of sinusitis?
* malaise * headache * fever * blocked nasal passages * loss vocal resonance * anosmia * local pain + tenderness which clears up during afternoon
33
what is the most common form of brain tumour?
glioblastoma multiforme
34
what is a cause of idiopathic intracranial hypertension?
pseudotumour cerebri
35
when is pseudotumor cerebri usually seen?
* young obese women * headache, visual obscurations, diplopia, tinnitus caused by hormones, steroids, antibiotics vitamin
36
what is the treatment of pseudotumor cerebri?
* treatment= weight loss, diuretics, optic nerve sheath decompression lumboperitoneal shunt, stenting of stenosed venous sinuses
37
what is a low pressure headache?
orthostatic headache
38
what is the cause of orthostatic headache?
* CSF leak due to tear in dura * Traumatic post lumbar puncture or spontaneous
39
what is the treatment of orthostatic headache?
rehydration caffeine blood patch
40
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
41
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
42
how is obstructive sleep apnoea diagnosed?
require sleep study
43
what is the treatment for obstructive sleep apnoea?
nocturnal NIV surgery
44
what is the sensation of trigeminal neuralgia?
electric shock like pain in distribution of sensory nerve can be symptoms of MS
45
what is trigeminal neuralgia triggered by?
innocuous stimuli
46
what branch of the trigeminal nerve is affected in trigeminal neuralgia?
any division- neurovascular conflict at point of entry of nerve into pons
47
what is the treatment for trigeminal neuralgia?
carbamazepine, lamotrigine, gabapentin, posterior fossa decompression
48
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
49
what must be done to diagnose atypical facial pain?
pathology of other areas must be excluded first
50
what is the management of atypical facial pain?
tricyclics
51
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
52
what are the mechanisms of post traumatic headache?
* Neck injury * Scale injury * Depression- often delayed * Vasodilation? Autonomic damage
53
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
54
what is the commonest cause of new headache in older patients?
cervical spondylosis
55
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
56
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
57
what is cervical spondylosis?
narrowing of joint space due to worn disc
58