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control > L19 - headaches > Flashcards

L19 - headaches Flashcards

1
Q

acute pain in headaches (seconds to minutes)

A

SAH/Intra-cerebral haemorrhage/coital/thunderclap

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2
Q

evolving pain in headaches (hours to days)

A

infection/inflammatory/ increased ICP

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3
Q

chronic pain in headaches (weeks to months)

A

increased ICP

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4
Q

episodic headaches (at least a few days between each attack)

A

migraine / cluster headache ‘ trigeminal neuralgia

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5
Q

chronic headaches (most days)

A

medication overuse / chronic migrine

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6
Q

associated features of headaches

A
  • Nausea and vomiting
  • Photophobia/ phonophobia
  • Autonomic features (lacrimation/Horner’s/red eye)
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7
Q

red flags for headaches

A
  • Cognitive effects
  • seizures
  • fever
  • visual disturbance
  • vomiting
  • weight loss
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8
Q

how to check for red flags

A

SNOOP4

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9
Q

SNOOP4

A
  • Systemic symptoms/signs
  • Neurologic symptoms/signs
  • Onset sudden
  • Older onset
  • Pattern change
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10
Q

S in SNOOP4

A

Systemic symptoms/signs

  • fever
  • rash
  • chills / sweats
  • weight loss
  • myalgia
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11
Q

myalgia

A

muscle pain

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12
Q

N in SNOOP4

A 
Neurologic symptoms/signs
- weakness
- change in level of consciousness
- diplopia
tinnitus
- ataxia
- seizure / collapse
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13
Q

O1 in SNOOP4

A

Onset sudden

- thunderclap headache

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14
Q

thunderclap headache

A

pain reaches maximal intensity instantly after onset

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15
Q

O2 in SNOOP4

A

Older onset

- after 50 years of age

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16
Q

P in SNOOP4

A

Pattern change

- progressive heacache

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17
Q

questions to ask

A
  • pattern of pain (onset and periodicity)
  • associated features
  • SNOOP4
  • behaviour of the headache
  • family history
  • medication
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18
Q

analgesia

A

medication which acts to relieve pain

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19
Q

what type of headache is it when the patient wants to lie down in a dark room

A

migraine

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20
Q

what type of headache is it when the person is agitated / pacing

A

cluster

21
Q

cluster headache

A
  • occurs in cluster patterns
  • commonly awakens you in the middle of the night
  • intense pain in or around one eye on one side of your head.
22
Q

causes of raised ICP

A
  • Mass Effect (brain tumour, abscess)
  • Brain swelling (Hypertensive encephalopathy)
  • Increased venous pressure
  • CSF outflow obstruction (hydrocephalus)
  • Increased CSF production (meningitis/SAH)
23
Q

causes of papilloedema

A

raised ICP

24
Q

symptoms of raised ICP

A

headache (worse on lying or awakening)
vomiting
seizures

25
Q

acute management for patients with raised ICP

A
  • Resuscitation
  • Broad spectrum IV antibiotics
  • neurological consultation
  • steroids in patients with strep. pneumoniae meningitis
  • neurosurgical consultation
26
Q

temporal arteritis

A

large vessel vasculitis affecting external and internal carotid artery

27
Q

signs and symptoms of temporal arteritis

A
  • weight loos
  • myalgia
  • transient loss of vision
  • jaw claudication
  • tender non-pulsatile temporal artery
28
Q

ESR - erythrocyte sedimentation rate

A

measures how quickly cells in the blood sink

29
Q

increased ESR

A

related to inflammatory conditions

30
Q

management of temporal arteritis

A
  • high dose steroids (prednisolone 60mg for 1 week)

- temporal biopsy

31
Q

aura

A

often occurs before a migraine or seizure
- may consist of flashing lights, a gleam of light, blurred vision, an odour, the feeling of a breeze, numbness, weakness, or difficulty in speaking

32
Q

occurrence of migraines

A

10% population

F>M

33
Q

why are females more likely to get migraines than males

A

oestrogen

34
Q

symptoms of migraines

A
  • unilateral headache
  • nausea
  • photophobia
  • dizziness
35
Q

triggers for migraines

A
  • sleep deprivation
  • hunger
  • stress
  • oestrogens
36
Q

subtypes of migraines

A

basilar
hemiplegic
Acephalgic

37
Q

basilar migraines

A

Cranial neuropathies/cerebellar signs (with aura or without aura)

38
Q

hemiplegic migraines

A

<0.15

weakness on one side of body

39
Q

Acephalgic migraines

A

aura but no headache

40
Q

CGRP

A

calcitonin gene related peptide

- released during migraine attack

41
Q

management of migraines

A

brain imagine

42
Q

conservative measures to manage migraines

A
  • Avoid caffeine/ increase water intake
  • Avoid tyramine foods (cheese/chocolate/red wine)
  • Sleep hygiene and regular meals
43
Q

analgesia for migraines

A

triptans / naproxen / NSAIDS

44
Q

preventative treatment for migraines

A 
antihypertensives
antidepressants
anti-epileptic medications
nerve blocks
botox
45
Q

who is more likely to get cluster headaches

A

men

46
Q

types of cluster headache

A
  • Cluster (attacks last 30-180 minutes; 1-8 per 24hrs)
  • Paroxysmal hemicrania (2-30)
  • SUNCT/SUNHA – short unilateral Neuralgiform Headache with Conjunctival injection and tears
47
Q

pain releief for cluster headache

A

sumatriptan
high flow oxygen
vagal nerve stimulation

48
Q

prevention for cluster headache

A
  • prednisolone
  • GON bocks
  • verapamil
  • indomethacin
49
Q

tension headche

A
  • bilateral
  • described as a tight band around head
  • unrelieved by paracetamol

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