Headaches - sangita Mcq Teaching Flashcards
Treatment for migraine in acute phase
Aspirin 900mg
How does sumitriptan work?
It vasoconstricts
Side effects of sumitriptan
Chest pain and stroke like symptoms
Chronic treatment for migraine
First line treatment - ToPiramate
What is contraindicated if someone has migraines and why?
Combined oral contraceptive pill due to increase in risk of stroke
60yo man with sudden unilateral vision loss,
Contra lateral headache
Pain worse on eating
Shoulder ache
What is the one investigation you’d do to confirm diagnosis?
Temporal artery biopsy to confirm polymyalgia rheumatica and GCA
Severe headache, photophobia, vomiting, reduced GCS + non blanching Pete hail rash - what’s the organism causing the headache?
Meningococcal meningitis
How would you differentiate between bacteria, viral, fungal and TB on CSF?
Viral if over the mm
Lymphocytes
Normal glucose
Normal to elevated protein
Bacterial if Ober 1000 mainly neutrophils
Mild to marked elevation of proteins
Normal to marked decrease in Csf To glucose ratio
Fungal and tubercular - lymphocytes and high protein and low csf to glucose ratio
Headache with lacrimation + rhinorrhiea but no change to vision + restless/moving around fuming
Cluster
Tension vs cluster vs migraine
Tension - band around back of head
Cluster headache - mainly around eye + lacrimation
Migraine diffuse unilateral, behind eye, photo phobia, pounding
Vision change after cinema
Sudden pain
Conjunctival injections
Dilated pupil
What’s the diagnosis?
Glaucoma -
Acute angle glaucoma - precipitated by darkness as dilation of pupil causes opening up
Key red flag for headaches raised ICP
Bilateral papilaoedema
Relief of symptoms when standing up / early morning headache
Confusion
Worse on straining / coughing / leaning forward
Focal neurology e.g. stroke like symptoms or bilateral papilloedema
Two key signs of meningitis and explain
Kernig - extending knee causes pain
Brudzinski— lifting head causes knee to flex
Bilateral papillodema but no mri findings
Benign intracranial hypertension
Who do you see benign intracranial HTN in?
Young obese people
What do you connect the LP tube to?
Manometer
Csf goes up the tube then stops
Normal Csf opening pressure
10
What test is done to confirm acromegaly causing headache?
Prolonged glucose tolerance test
Rash when getting out of hot bath plus headache - diagnosis and complications
Polycythemia rubravera
Pain on eye movement
Cerebral venous sinus thrombosis
What kind of headache presents with delayed confusion? Why? What’s the presentation
Extradural haemorrhage - middle meningeal artery hit
Trauma
Extradural haemorrhage on CT SIGNS
Lens shaped on CT
Loss of ventricles
Defacement of sulcus and gyri
Midline shift
PKD is associated with?
Berry aneurysms in circle of Willis - intracranial therefore can lead to Subarachnoid haemmorhage
How does the
Stops csf flow
Increase in intracranial pressure
Confusion
Another name for haemmoragic stroke
Intraparenchymal haemmorhage
Delayed onset confusion in elderly
Subdural haemmorhage
What is a subdural haemmorhage?
Venous bleed from bridging veins between skull and brain
Blood pools outside brain slowly hence delayed presentation
(Whereas arterial bleed)
Subdural haemmorhage sign on CT
Crescent shaped bleeding alongside outside of brain
Headache after c section
better when lying down
Diagnosis
Dural puncture headache due to leakage of CSF post epidural
In an elderly patient:
Recurrent Falls
Urinary incontinence
Ataxic gait
What is the diagnosis?
Normal pressure hydrocephalus
Lewy body dementia symptoms
Parkinsonism
Hallucinations
