Headaches and Cerebral Bleeds Flashcards
What is a Tension Headache?
- Described as a band, vice or tightness
- Episodic or ‘attack-like’ symptoms
- Short lasting, no more than several hours
- Commonly spreads to the neck
- Commonly worse in the evening
- Treatment is with paracetamol or NSAIDs
What is a Migraine?
- Classic unilateral throbbing pain
- Phono/photo phobia
- Last 4 - 72hrs
- Aura 5-60 ins precedes headaches in 1/3 of suffers
- Visual blurring, spots
- Can have unilateral parathesis hand, arm, face
- LOC
- Treatment with paracetamol, high dose aspirin, NSAIDS and triptans
What is a cluster headache?
- Excruciating, unilateral pain
- Usually cheek, temple or around eye
- Blood shot eye or unilateral watering of the eye or nose
- Symptoms last >3hrs
- Bouts lasting >3 months, remission for months and years
- Verapamil (calcium channel blocker - works in hypothalamus) used a prophylaxis of cluster headaches
What are some sub-acute headaches?
Temporal arteritis
Raised intercranial pressure
Neuralgia’s
Infections/sinusitis
What happens when temporal arteritis?
- Sudden onset throbbing
- Consider for patients >55yrs
- Can lead to sudden blindness from occlusion of the ophthalmic artery
What happens when raised intracranial pressure?
- Poorly localised
- Coughing
- Defecating
- Worse in the morning
What happens when they have Neuralgia’s ?
- Knife-like or burning affect single nerves
- Paroxysms (outburst of emotion or energy) last seconds but reoccur over several minutes
What happens when infections/sinusitis?
- Frontal headache and facial pain
- Often viral, may be allergic
- Pain worse on bending down
What is Subarachnoid Haemorrhage?
- Thunderclap, described as like being hit with a baseball bat on back of head
- Usually bilateral
- Occipital region with nausea and vomiting
- Reduced or impaired consciousness
- Meningeal irritation can occur
- Confirm with CT
- Acute meningitis
What are the six points of the Ottawa SAH Rule?
- Symptoms of neck pain or stiffness
- Age > 40 years old
- Witnessed loss of consciousness
- Onset during exertion
- Thunder clapping headache (peak intensity immediately)
- Limited neck flexion on exam
What are red flags for headaches?
- New onset or change or headaches and age >50 years
- Sudden onset or thunderclap headache
- New focal in cognition or personality
- Impaired consciousness
- Neck stiffness
- Abnormal neuro examination
How do you work out Cerebral Perfusion Pressure (CPP)?
Mean Arterial Pressure - Intracranial Pressure
What happens when there is too much inflammation of the brain?
- Only enough room for small amount of inflammation or haematoma before starts to compress the brain known as SOL (space occupying lesion)
- SOL leads to raised ICP. ICP puts pressure on arteries supplying brain
What happens when there is >15mmHg?
Known as intracranial hypertension
What happens when there is >20mmHg?
Leads to focal problems
What happens when there is 40-50 mmHg?
Can decrease GCS lead to generalised weakness
What happens when someone has Increased Intracranial Pressure?
Eyes:
- Impaired eye movement
Posturing:
- Flaccid
- Decerebrate
Decreased Motor Function:
- Change in motor ability
- Posturing
Headache
Seizures:
- Impaired sensory and motor function
Change in Vital Signs:
- Cushings Triad
Vomitting
Changes in Speech
What is Cushing’s Triad?
+ systolic BP
- pulse
- respirations
What are some types of Posturing someone may have?
Decorticate (flexor):
- Arms are like ‘C’
- Moves towards the chest
Decerebrate (Extensor):
- Arms are like ‘E’
- Problems within midbrain or pons
What are some signs of Raised Intracranial Pressure?
Decreased LOC - pressure on brainstem/cerebrum
Headache - stretching or distortion of meninges or walls of large arteries
Vomiting - Pressure on emetic centre of medulla
Increased BP with increasing PP - Cushing’s Triad response to cerebral ischaemia cause systemic vasoconstriction
Slow Heart Rate - response to increasing blood pressure
Fixed, dilated pupils - Pressure on cranial nerve III (oculomotor)
What happens when someone has had a concussion?
- Brain jarred in the skull
- Caused by rapid acceleration-deceleration
- Causes transient cortex dysfunction
- Improves rapidly with no impairment
What are some signs and symptoms of concussion?
- Confusion
- LOC may/may not occur
- Amnesia may occur
What is an axonal injury?
- Similar forces as concussion
- More severe-poor outcome
- Stretching, tearing and shearing of nerve axons
Some signs and symptoms to diffuse axonal injury?
- LOC
- Amnesia
- Motor/Sensory impairment
- Persistent confusion
- Mood swings
- Posturing
- Vegetative state
- Death
