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Year 3 > MedEd headache > Flashcards

MedEd headache Flashcards

1
Q

how often should heachache patients be allowed to take analgesia?

A

2 days a week

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2
Q

what might happen if headache patients take too much simple analgesia and what is ‘too much’?

A

they might get a medication overuse headache

too much= more than 2 days a week

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3
Q

how do you manage a medication overuse headache?

A

stop all analgesic medication

warn the patient that the headache will get worse at first but then it will get better

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4
Q

what triad of symptoms occurs in cluster headaches?

A

lacrimation
rhinorrhea
partial horners (ptosis, miosis, anyhdrosis)

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5
Q

describe the characteristics of a migraine

A 
unilateral headache 
excruciating pain
2-4 hrs
photophobia
aura (visual or smells) 
n+ v
has identifiable triggers
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6
Q

describe the characteristics of a cluster headache

A 
lacrimation
rhinorrhea 
partial horners
episodic 
excruciating 
unilateral pain behind an eye
drinking hx
previous head injury
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7
Q

what type of headaches are unilateral?

A

migraine

cluster headache

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8
Q

describe the characteristics of acute angle closure glaucoma?

A 
severe headache 
unilateral pain behind an eye 
redness of eye
visual disturbance- eg blurring of vision, halos around lights 
n+ v
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9
Q

what ix might you do in cluster headache and why?

A

no specific ix at all
MRI to exclude anything more sinister
ESR to exclude giant cell arteritis
pituitary function tests to check for pituitary adenoma

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10
Q

how is cluster headache managed acutely?

A

sub cut sumatriptan

high dose high flow o2

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11
Q

what prophylaxis can be given for cluster headache?

A

verapamil (CCB)

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12
Q

what is jaw claudication a sign of and why?

A

temporal arteritis- when the jaw moves it contracts the temporalis muscle and irritates the inflammed artery

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13
Q

what is kernig’s sign used for, how do you carry it out and what is a positive result?

A

it is used to diagnose meningitis
lie the patient on their back, flex hip with extended knee
if pain is ellicited this is positive for meningitis

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14
Q

what ix is contraindicated in someone with raised ICP and why?

A

lumbar puncture because it can cause herniation

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15
Q

what makes symptoms worse when someone has raised ICP?

A

lying down

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16
Q

what makes symptoms better when someone has raised ICP?

A

standing up/NOT lying down

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17
Q

what is a sign of raised ICP? explain why

A

bilateral visual loss- if caused by hydrocephalus it can compress the optic nerve

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18
Q

what side of the head is a migraine on?

A

unilateral

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19
Q

what is the onset of a migraine like?

A

comes on gradually

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20
Q

what is the character of pain in a migaine?

A

pulsating and throbbing

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21
Q

how long do migraines last?

A

4-72 hrs

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22
Q

what is a characteristic feature of a migraine you should remember and need to ask about?

A

it interferes with the current activities someone is doing

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23
Q

what are rf for migraine?

A

family hx
stressful life event
female sex
sleep disorder

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24
Q

how is conservative management of migraines carried out?

A

headache diary
avoid triggers
relaxation techniques eg CBT and mindfulness

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25
Q

what drug must you not give to a migraine patient to help them manage their migraines?

A

opiods

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26
Q

how is acute management of a migraine carried out?

A

simple analgesia eg paracetamol/ibuprofen

triptans- these are analgesia specific to migraines but should only be used if really needed

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27
Q

what medication is an analgesia specific to migraines?

A

triptans

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28
Q

what preventative medications can be given for migraines?

A

first line propanolol or topimarate

second line amitriptyline

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29
Q

what are associated symptoms for migraine?

A 
aura: flashing lights and tingling 
photophobia
phonophobia
nausea and vomitting 
visual changes 
numbness
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30
Q

what is trigeminal neuralgia?

A

facial pain syndrome in one or more distribution of the trigeminal nerve

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31
Q

how does pain theoretically arise in trigeminal neuralgia?

A

compression of branches of the trigeminal nerve by veins or arteries

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32
Q

what are the 3 big risk factors for trigeminal neuralgia?

A

old age
woman
multiple sclerosis

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33
Q

why does multiple sclerosis increase risk of trigeminal neuralgia?

A

because there is inflammation of the myelin sheath which makes it more likely a vein or artery will compress it and cause pain

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34
Q

where is the pain located in tirgeminal nerve neuralgia?

A

unilateral

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35
Q

describe the character of pain in trigeminal neuralgia

A

short episodes of unilateral stabbing/ shock like pain associated with numbness

36
Q

what ix are done for trigeminal neuralgia?

A

none, usually diagnosis is clinical

37
Q

how is trigeminal neuralgia managed?

A

first line= anti convulsants

long term= microvascular decompression or ablation

38
Q

what surgery might be done for trigeminal neuralgia and when is this needed?

A

microvascular decompression or ablation surgery

usually needed for patients in hospital with severe disease because anticonvulsants are not enough to manage it

39
Q

what is papilloedema?

A

optic disc swelling due to raised ICP

40
Q

what causes papilloedema?

A

raised ICP

41
Q

how can you identify papilloedema on fundoscopy?

A

there will be a blurred edge of the optic disc (the circle in the center) instead of a well demarcated edge

42
Q

what symptoms do you get with a raised ICP?

A 
bilateral headache 
worse in the morning 
cushing's triad (irregular breathing, bradycardia, raised systolic BP) 
associated with vomitting 
papilloedema
43
Q

what do papilloedema, cushings triad, bilateral headache worse in the morning associated with vomitting point towards?

A

raised ICP

44
Q

why might a headache be worse in the morning?

A

if someone has raised ICP because they have been lying down

45
Q

what does a headache that is worse in the morning mean?

A

there is likely raised ICP

46
Q

what makes a headache due to raised ICP worse?

A

lying down

47
Q

what ix do you do immediately if there is raised ICP?

A

CT head

48
Q

what ix should you never do if there is raised ICP?

A

lumbar puncture

49
Q

between what 2 layers is the subarachnoid space?

A

under the arachnoid mater

above the pia mater

50
Q

what does the subarachnoid space contain?

A

CSF

51
Q

in what space is the CSF found?

A

subarachnoid

52
Q

in meningitis what space is the virus in?

A

subarachnoid

53
Q

what are the 2 ways you can acquire meningitis? explain what these mean (ie where the virus comes from and where it ends up)

A

direct spread- pathogen enters directly through an opening eg skull fracture, nose, deformity like spina bifida into subarachnoid space
haematogenosu spread- pathogen enters brain through bloodstream and leaves endothelial cells to enter subarachnoid space

54
Q

what are the 3 ways you can get meningitis?

A

virus
bacteria
TB

55
Q

what is the most common type of pathogen that causes meningitis?

A

virus

56
Q

if a neonate has bacterial meningitis, what organism is likely to have caused it?

A

e coli

57
Q

if a child has bacterial meningitis, what organism is likely to have caused it?

A

h influenzae, strep pneumoniae

58
Q

if a teenager/young adult has bacterial meningitis, what organism is likely to have caused it?

A

neisseria meningitidis

59
Q

if an elderly person has bacterial meningitis, what organism is likely to have caused it?

A

strep pneumoniae, listeria monocytogenes

60
Q

if a uni student has meningitis what organism is likely to have caused this? why is this concerning?

A

neisseria meningitidis

this is concerning as it can cause meningococcal disease

61
Q

what pathogen can cause meningococcal disease and is therefore dangerous? in who is this more likely

A

neisseria meningitidis

this is most likely in teens/young adults/ uni students

62
Q

what are rf for meningitis?

A

below 5 y/o
over 65 y/o
crowded spaces eg uni accomodation

63
Q

what are symptoms of meningitis?

A

meningism- neck stiffness, photophobia and headache
fever
nausea and vomiting

in later stages:
seizures
altered mental status
malaise

64
Q

what is the triad of meningism?

A

neck stiffness
photophobia
headache

65
Q

what 3 signs can be found in someone with meningitis?

A

kernig’s sign
brudzinski’s sign
petechial rash (non blanching)

66
Q

what ix are done for meningitis? what is GS

A 
obs, VBG
CT head before LP if there is neurological deficit or reduced consciousness
lumbar puncture (GS), 2 sets of blood cultures ideally one before treatment but do not delay treatment for it
67
Q

what is gold standard ix for meningitis? what must you do before it and why

A

lumbar puncture

must do a CT head before it to rule out raised ICP

68
Q

how are blood cultures done in meningitis and how many are needed?

A

you need 2 blood cultures, the first should ideally be before treatment is started but dont delay treatment for the blood culture

69
Q

when might you do an LP before CT head in a patient with meningitis and why?

A

if they don’t have neurological deficits or reduced consciousness do the LP first because there are no signs of raised ICP and LP is the most important ix in meningitis

70
Q

describe appearance, cells, glucose and protein level of CSF in bacterial meningitis and explain why this is so

A 
appearance= cloudy/turbid
cells= high neutrophils (polymorphs) 
glucose= low because bacteria metabolise the glucose 
protein= high because of inflammation of meninges
71
Q

describe appearance, cells, glucose and protein level of CSF in viral meningitis and explain why this is so

A 
appearance= clear
cells= high lymphocytes (mononuclear) 
glucose= normal or high as viruses dont use the glucose
protein= high due to meningeal inflammation
72
Q

describe appearance, cells, glucose and protein level of CSF in TB meningitis and explain why this is so

A 
appearance= fibrin web
cells= high lymphocytes (mononuclear) 
glucose= low as bacteria metabolises glucose
protein= high due to inflammation of meninges
73
Q

if CSF if cloudy, low in glucose, high in protein and neutrophils what is the likely cause of meningitis?

A

bacterial

74
Q

if CSF is clear, normal/high glucose, high protein and lymphocytes what is the likely organism of meningitis?

A

viral

75
Q

if CSF has a fibrin web, is low in glucose, high in protein and lymphocytes what is the likely cause of meningitis?

A

TB

76
Q

what causes of meningitis cause a low CSF glucose? why?

A

bacteria (inc TB)- they metabolise the glucose to multiply

77
Q

what causes of meningitis cause a normal/high CSF glucose? why?

A

viral- the virus doesnt need to metabolise glucose to replicate

78
Q

how is meningitis managed at GP?

A

immediate IM benzylpenicillin and urgently refer to hospital

79
Q

how is meningitis managed in A&E?

A

broad spec abx (ceftriaxone IV, benzylpenicillin IM)
acyclovir if viral
targeted abx treatment depending on sensitivity
IV dexamethasone due reduce cerebral inflammation

80
Q

what are complications of meningitis?

A

hearing loss
sepsis
impaired mental status

81
Q

what are some complications of meningitis?

A

hearing loss
sepsis
impaired mental status

82
Q

what broad spec medications are given for meningitis in hospital?

A

IV ceftriaxone
IM benzylpenicillin
acyclovir
IV dexamthasone

83
Q

what is giant cell arteritis?

A

inflammation of the temporal arteries

84
Q

what is the character of pain in giant cell arteritis?

A

dull ache

85
Q

what triggers pain in giant cell arteritis? what does not trigger pain in giant cell arteritis and can be used to help narrow your differential

A

movement of the jaw eg eating

touching of the jaw does not trigger the pain

86
Q

how can you differentiate giant cell arteritis from trigeminal neuralgia?

A

giant cell= a dull aching pain, triggered by jaw movements

trigeminal= electric shock like pain on one side of the face, triggered by touching the jaw

87
Q

what is the difference in pathophysiology between giant cell arteritis and trigeminal neuralgia?

A

giant cell arteritis= inflammation of the arteries causing pain
trigeminal neuralgia= compression of the facial nerve causing pain

Year 3 (104 decks)

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