Headaches and CNS Infections Flashcards
List some red flag symptoms of headaches:
- severity/sudden onset
- features of raised intracranial pressure: sore when coughing, worse on positional change/strain, present on waking, nausea and vomiting
- focal neurology e.g. face, speech, vision, legs, sensation
- visual changes
- impaired consciousness/confusion
- meningism, fever, rash
- associated history i.e. cancer/HIV
List some primary headache disorders:
- tension headache
- migraine
- cluster headache
- medication overuse headache
- trigeminal neuralgia
List some features of tension headaches:
How are they treated?
Tension:
- stress related
- '’tight band’’
- symmetrical
- chronic, gradual onset
- worse towards end of day
Treatment:
- conventional analgesia
- tricyclic antidepressants for prophylaxis
What causes migraines?
List some triggers:
Classical features:
Treatment:
Migraine: prolonged reduction in cerebral blood flow following a brief spell of increased flow
Triggers: often none, wine, cheese, chocolate, premenstrual, anxiety, exercise, sleep deprivation, fasting
Classical features: pre-headache (aura - 15 mins) flashing lights, wavy lines, dots, spots, distorted vision, focal symptoms
Headache within 1 hour: 1 sided, throbbing, nausea, vomiting, photophobia
Treatment:
- conventional analgesia
- metoclopramide (nausea)
- serotonin agonists e.g. sumatriptan, zolmitriptan
Characteristic features of cluster headaches:
Treatment:
Severe pain around eye, watery, blood shot, lid swelling, runny nose
- more common in males and smokers
Treatment: sumatriptan, oxygen
List some facts concerning medication overuse headaches:
How is this managed?
- chronic headaches
- users of opiates and triptans most at risk but can occur with paracetamol
Management: medication withdrawal
Signs of trigeminal neuralgia:
Management?
- intense stabbing pain 10/10 severity
- evoked by light touch
- also paroxysmal i.e. spontaneous
Management: carbamazepine and rule out other causes
List some secondary headache disorders:
- head injury
- CNS tumours
- CNS infections
- Intracerebral or subarachnoid bleeds
- giant cell arteritis
- glaucoma
List some clinical features of giant cell arteritis (temporal arteritis/polymyalgia rheumatica):
Why is it important?
Clinical features:
- headache, scalp tenderness, loss of temporal artery pulse
- jaw claudication (pain on chewing)
- visual disturbance
- shoulder and pelvic girdle pain and stiffness
Importance:
- risk of blindness –> refer to GP
What are clinical features of glaucoma?
Treatment?
Clinical features:
- constant ache around eye
- reduced vision
- nausea and vomiting
- red, congested eye
- cornea may be cloudy
Treatment: urgent opthalmology referral
List some micro-organisms involved in bacterial meningitis and which group of patients they are most common in:
- neisseria meningitidis: infants, adolescents, young adults - contact spread
- streptococcus pneumoniae: babies, elderly
- haemophilus influenzae: babies, infants
Hence targets for immunisation
List some features of bacterial meningitis:
- headache
- photophobia
- neck stiffness and pain
- impaired consciousness
- fever/low BP, tachycardia, sepsis
- nausea and vomiting
- with or w/out rash
What is meningism?
Meningism = clinical features of meningeal irritation
May not be associated with bacterial meningitis e.g. may be secondary to viral meningitis or subarachnoid bleed
Symptoms:
- photophobia
- neck stiffness
- headache/neckache
How is bacterial meningitis diagnosed?
Treated?
Diagnosis:
- lumbar puncture
- blood cultures
- CT or MRI of brain
Treatment
- empirical antibiotics
- urgent hospitalisation
- prophylaxis for contacts
What is encephalitis?
List its associated features:
Diagnosis:
Management:
Encephalitis: inflammation of the brain parenchyma
Viral infection: herpes simplex, varicella zoster
Associated features:
- impaired consciousness
- headache
- change in personality
- meningism
- seizures
Diagnosis:
- lumbar puncture, EEG, MRI
Management:
- hospitalisation, anti-viral therapy
