Headaches

Question 1

what are the different patterns of headaches?

Answer 1

acute single headache

dull headache- increasing severity or unchanged over months

recurrent headaches

triggered headaches

Question 2

what are the red flags for headaches?

Answer 2

onset

meningism

systemic symptoms

neurological symptoms or focal symptoms

orthostatic (better lying down)

strictly unilateral-same pain in same spot

Question 3

what are the red flags for onset of headaches?

Answer 3

thunderclap

acute

subacute

Question 4

what are the red flags for meningism headaches?

Answer 4

photophobia

phonophobia

stiff neck

vomiting

Question 5

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

Answer 5

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

Question 6

what are the signs of subarachnoid haemorrhage?

Answer 6

sudden generalised headaches (thunderclap)

meningism= stiff neck and photophobia

Question 7

what are the cause of a subarachnoid haemorrhage?

Answer 7

most caused by ruptured aneurysm

few arteriovenous malformations and some unexplained

Question 8

what are the risks of subarachnoid haemorrhage?

Answer 8

50% instantly fatal

high risk further bleeding

Question 9

what may stop the leak from a subarachnoid haemorrhage?

Answer 9

vasospasm

Question 10

what is the treatment for subarachnoid haemorrhage?

Answer 10

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

Question 11

what is the cause of acute intracerebral bleed?

Answer 11

fatal haemorrhage due to coning

raised ICP causes brainstem death due to compression of brain

Question 12

what is papilloedema?

Answer 12

optic disc swelling due to raised ICP

Question 13

what can an issue with carotid and vertebral arteries cause?

Answer 13

headaches

Question 14

what are the types of carotid and vertebral artery dissection?

Answer 14

traumatic and spontaneous

Question 15

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

Answer 15

headache and neck pain

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

Question 16

how are carotid and vertebral artery dissection detected?

Answer 16

MRI/MRA

doppler

angiography

Question 17

what is the treatment for carotid and vertebral artery dissection?

Answer 17

aspirin/angicoagulant

Question 18

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

Answer 18

areas of black (blood)- black due to clotting

destroyed ventricles and brain pushed onto other side

Question 19

when is temporal arthritis more commonly seen?

Answer 19

over age 55

more common females

Question 20

what are the signs of temporal arthritis?

Answer 20

• 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

Question 21

what is the treatment for temporal arthritis?

Answer 21

high dose steroid and aspirin

Question 22

what is cerebral venous thrombosis?

Answer 22

thrombosis in dural venous sinus or cerebral vein

Question 23

what are the signs of cerebral venous thrombosis?

Answer 23

unusual amount headach due to raised ICP

non-territorial ischemia ‘venous infarcts’

haemorrhage

Question 24

what are the risk factors for cerebral venous thrombosis?

Answer 24

thrombophilia

pregnancy

dehydration

behcets

Question 25

what are the causes of viral meningitis?

Answer 25

coxsackie ECHO mumps EBV

Question 26

what are the bacterial causes of meningitis?

Answer 26

meningococci pneumococci TB

Question 27

what are the fungal causes of meningitis?

Answer 27

cyptococci

Question 28

what are the granulomatous causes of menigitis?

Answer 28

sarcoid lyme brucells behcets's

Question 29

what are the general causes of meningitis?

Answer 29

viral bacterial fungal granulomatous carcinomatous

Question 30

what are the presenting symptoms of meningitis?

Answer 30

malaise headache fever neck stiffness photophobia confusion alteration of consciousness

Question 31

what is the treatment for meningitis?

Answer 31

treat first then diagnose * antibiotics * blood and urine culture * CT/MRI scan * lumbar puncture- check for cerebral oedema first on MRI

Question 32

what are the signs of sinusitis?

Answer 32

* malaise * headache * fever * blocked nasal passages * loss vocal resonance * anosmia * local pain + tenderness which clears up during afternoon

Question 33

what is the most common form of brain tumour?

Answer 33

glioblastoma multiforme

Question 34

what is a cause of idiopathic intracranial hypertension?

Answer 34

pseudotumour cerebri

Question 35

when is pseudotumor cerebri usually seen?

Answer 35

* young obese women * headache, visual obscurations, diplopia, tinnitus caused by hormones, steroids, antibiotics vitamin

Question 36

what is the treatment of pseudotumor cerebri?

Answer 36

* treatment= weight loss, diuretics, optic nerve sheath decompression lumboperitoneal shunt, stenting of stenosed venous sinuses

Question 37

what is a low pressure headache?

Answer 37

orthostatic headache

Question 38

what is the cause of orthostatic headache?

Answer 38

* CSF leak due to tear in dura * Traumatic post lumbar puncture or spontaneous

Question 39

what is the treatment of orthostatic headache?

Answer 39

rehydration caffeine blood patch

Question 40

what is chiari malformation?

Answer 40

* 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

Question 41

what is obstructive sleep apnoea characteried by?

Answer 41

body habitus history loud snoring apnoeic spells hypoxia CO2 retention non refreshing sleep depression impotence poor performance at work

Question 42

how is obstructive sleep apnoea diagnosed?

Answer 42

require sleep study

Question 43

what is the treatment for obstructive sleep apnoea?

Answer 43

nocturnal NIV surgery

Question 44

what is the sensation of trigeminal neuralgia?

Answer 44

electric shock like pain in distribution of sensory nerve can be symptoms of MS

Question 45

what is trigeminal neuralgia triggered by?

Answer 45

innocuous stimuli

Question 46

what branch of the trigeminal nerve is affected in trigeminal neuralgia?

Answer 46

any division- neurovascular conflict at point of entry of nerve into pons

Question 47

what is the treatment for trigeminal neuralgia?

Answer 47

carbamazepine, lamotrigine, gabapentin, posterior fossa decompression

Question 48

what is atypical facial pain?

Answer 48

* 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

Question 49

what must be done to diagnose atypical facial pain?

Answer 49

pathology of other areas must be excluded first

Question 50

what is the management of atypical facial pain?

Answer 50

tricyclics

Question 51

when is post-traumatic headache seen?

Answer 51

* 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

Question 52

what are the mechanisms of post traumatic headache?

Answer 52

* Neck injury * Scale injury * Depression- often delayed * Vasodilation? Autonomic damage

Question 53

what is the management of post traumatic headaches?

Answer 53

* Explanation no damage * Prevent analgesic abuse * Treatment * NSAID * Tricyclic antidepressants- amitriptaline * Be patient- 3-4 yrs to get better

Question 54

what is the commonest cause of new headache in older patients?

Answer 54

cervical spondylosis

Question 55

what are the signs of cervical spondylosis?

Answer 55

* Usually bilateral * Occipital pain can radiate forward to frontal region * Steady pain * No nausea or vomiting * Worsened by moving neck

Question 56

what is the management of cervical spondylosis?

Answer 56

* Rest, deep heat, massage * Anti-inflammatory analgesics * Over- manipulation may be harmful * Gets better over course day usually

Question 57

what is cervical spondylosis?

Answer 57

narrowing of joint space due to worn disc