Headaches and cerebral bleeds Flashcards
What are the 4 different types of headaches?
Sinus, cluster, tension, migraine
What is a tension headache?
Described as a band, vice or tightness at the front of the head. Attack like episodes. Short lasting. Commonly spreads to or from neck. Treated with paracetamol or NSAIDS
What is a migraine?
Throbbing pain on 1 side of head. Lasts 4-72 hours. Can have visual blurring. Treat with paracetamol, high dose aspirin, NSAIDS and triptans (these stimulate serotonin)
What is a cluster headache?
Excruciating pain one one side - usually cheek, temple or around eye. Lasts more than 3 hours
What is temporal arteritis?
Where arteries in the temple become inflamed
What are symptoms of temporal arteritis?
Sudden onset throbbing, unilateral pain
what are symptoms of raised intracranial pressure?
Coughing, poorly localised, aggravated with postural changes, worse in morning, changes in LOC, headache, changes in speech, decreased motor function
What are symptoms of neuralgia?
Unilateral knife like or burning affect
What are symptoms of infections/sinusitis?
Frontal headache and facial pain, pain worse on bending down
What is a subarachnoid haemorrhage?
Thunderclap - described as being hit by a baseball bat. Usually bilateral. Nausea and vomiting. Reduced or impaired consciousness
What is the Ottawa SAH Rule?
Used for alert patients over 15 years with new severe non traumatic headache reaching maximum intensity within 1 hour
When would a patient need investigating under the Ottawa SAH Rule?
if 1 of the following findings are present:
1. symptoms of neck pain or stiffness
2.aged over 40
3. witnessed loss of consciousness
4. onset during exertion
5. thunderclap headache (peak intensity immediately)
6. limited neck flexion on exam
What are some red flags for headaches?
Impaired consciousness
Neck stiffness
Abnormal neurological examination
What is the formula for mean arterial pressure?
systolic + 2(diastolic) / 3
What is cerebral perfusion pressure?
Meana arterial pressure - inter cranial pressure
What is Cushing’s triad?
3 primary signs that often indicate an increase in inter cranial pressure: Increased BP, Lowered pulse, Lowered reps
What are the 2 types of posturing?
Dectorticate (flexor) and Decerebate (extensor)
What is the flexor posture?
Arms are like Cs - move in towards the cord. Problems with cervical spinal tract or cerebral hemisphere
What is the extensor posture?
Arms are like e’s. Problems within midbrain or pons
What is concussion?
Brain jarred in the skull, caused by rapid acceleration and deceleration. Causes transient cortex dysfunction
What are the signs and symptoms of concussion?
Confusion, LOC may or may not occur, Amnesia may occur
What is a diffuse axonal injury?
Similar forces as concussion. Has more severe tearing of nerve axons
What are symptoms of a diffuse axonal injury?
LOC, amnesia, motor/sensory impairment, persistant confusion, mood swings, posturing, death, vegetative state
What is epidural haematoma?
0.5-1% of all head injuries often from a blow to the head causing fracture of the temporal bone
