Neuro - Headache Flashcards
What are the focal signs of a headache?
Double vision
3rd nerve (oculomotor palsy) - droopy eyelid, wide pupil and eye potentially facing wrong direction
Horner syndrome - droopy eye, enopthalmos, smaller pupil
What can cause a subarachnoid haemorrhage?
A sudden generalised blow to the head, ruptured aneurysm
What are the symptoms of a subarachnoid haemorrhage?
Meningism - stiff neck and photophobia
What is the treatment for a subarachnoid haemorrhage?
Nimodipine and BP control
What is the mechanism of coning?
Blood clots can occur in the brain, but once the units of volume pass a threshold, the intracranial pressure increases exponentially causes the brain to move in weak spots, where the falx cerebri is - falsine herniation and tentorial herniation at the tentorium cerebelli and herniation through the foramen magnum
What are the signs of a migraine?
- Tendency to repeated attack
- Triggers
- Easily hung-over
- Visual vertigo
- Motion sickness
Does not always have to have pain, can be just focal symptoms or both
What are the treatments for a migraine?
- Aspirin/ibuprofen (Non-steroidals) and paracetamol and metoclopramide (anti-emetic)
- Soluble preparations to aid absorption
- Hit the headache hard and fast
- A short nap
What are the lifestyle issues associated with people who suffer from migraines?
- Have sensitive heads even between attacks
- Over-react to any sort of stimulation
- Cant ignore the world around them because it overstimulates their brain
What are the potential triggers for migraines?
- Diet
- Not drinking enough water
- Having caffeinated drinks
- Skipping meals or eating ready meals and take-aways
- Oversleeping or undersleeping
- Analgesic abuse
What is migraine prophylaxis?
Given people who suffer from chronic migraines medication more than just painkillers
What causes tension type headaches?
Tight muscles around the head and neck bilaterally, as though the head is in a vice
What are the potential treatments for tension headaches?
- NSAID’s
- Paracetamol
- Tricyclic antidepressants
- Hot bath/massage/hot water bottle
What are cluster headaches?
- Severer unilateral pain lasting from 15-180 minutes untreated
- Classified as a trigeminal autonomic cephalgia
What are the symptoms of cluster headaches?
- At least one of the following, ipsilaterally:
- Conjunctival redness and/or lacramation
- Nasal congestion and/or rhinorrhoea
- Eyelid oedema
- Forehead or facial sweating
- Miosis and/or ptosis
- Restlessness or agitation
- Frequency between one on alternate days to 8 per day
- No brain lesion on MRI
What are the acute treatments for cluster headaches?
Acute:
- Inhaled oxygen; inhibits neuronal activation in the trigeminocervical complex
- S/C or Nasal Sumatriptan
