Neuro - Headaches Flashcards
How common are headaches
half to two thirds of the population between 18-65 have experienced a headache in the past year, 30% of these have reported a migraine
What are the 3 main causes of headaches
Structural
Pharmacological
Psychological
What is a pharmacological cause of headache
GTN spray
What is a psychological cause of headache
Stress
What are the main headache patterns
Single acute headache
Dull headache
What type of dull headaches can we have
Increasing in severity
Unchanged in the past few months
What other types of headaches can we see
Triggered headache
Recurrent headache
What are the red flags for a headache
Systemic symptoms Onset Meninigism Neurological deficit/ focal signs Orthostatic Strictly unilateral
What is third nerve palsy
Third nerve dysfunction leading to ptosis and eye dropping and looking outwards
What can be a cause of third nerve palsy
PCA aneurysm rupture
What is Horner’s syndrome
Problem with sympathetic innervation of the eye leading to ptosis, miosis and anhydrosis unilaterally
What is the presentation of a Sub arachnoid haemorrhage
Acute thunderclap
Where do SAH often occur in the head
Often occipital
What causes SAH
Commonly due to ruptured aneurysms, but also due to arteriovenous malformations and sometimes unknown
What is the mortality of SAH
50% fatal
What may help with SAH
Vasospasm to try and stop the bleeding
How can we investigate SAH
We can do an MRA Angiogram, CT brain and lumbar puncture
How do we treat an aneurysm
Coiling
What is an acute intracerebral bleed
Extensive bleeding that fills up the ventricles
How does an intracerebral bleed cause death
Coning - increase in intracranial pressure therefore brain will crush brainstem to cut off blood supply and thus kill us
What are the weakpoints for coning
Falx cerebri
Tentorium cerebelli
Foramen magnum
What is seeping of the falx called
Falcine herniation
What is seeping of the tentorium called
Tectorial herniation
What is seeping of the foramen magnum called
Herniation of the foramen magnum
What may be observed with acute intracerebral bleed
Papilloedema - swelling of the optic disc due to increased pressure
How does dissection cause headache
Dissection in vertebral or carotid arteries means we get turbulent blood flow in the true lumen, therefore possible ischaemia and pain
What pain does vertebral dissection cause
Occipital or neck
What pain does carotid dissection called
Phantom of the opera mask pain
What age is ischaemic stroke common
20% occur in those younger than 45 - mean age is 40
What ischaemic stroke is most common
Carotid
What can cause iscahemic stroke
Spontaneous
Trauma
Ehler Danlos (collagen defect)
How do we investigate ischaemic stroke
MRI/ MRA, Dopple, Angiography
How do we treat iscahemic stroke
Aspirin or anticoagulants as blood gets more sticky with turbulent flow therefore we want to prevent clotting
What happens in an SDH
Slow onset due to venous sinus or cerebral vein bleeding
Who is commonly affected by SDH
Old people on anticoagulants
What is temporal arteritis
Inflammation of the blood vessels
Who is affected by temporal arteritis most
Women over the age of 55
How does temporal arteritis present
Constant unilateral headache Sensitive scalp Jaw pain when eating 25% have polaymglia rheumatic Blindness due got blockage of he ciliary arteries
How do we investigate temporal arteritis
Inflammatory markers increase
Visual inspection of the temporal arteritis
Ultrasound shows halos surrounding the temporal artery
Biopsy reveals inflammation and giant cells
What is cerebral vein thrombosis
Occurs in the dural venous sinus or cerebral vein
What may we see in cerebral vein thrombosis
ICP increases and papilloedema
Veins may infarct due to ICP and fragility
What may cause cerebral vein thrombosis
Thrombophilia
Pregnancy
Dehydration
Bechets
What is meningitis
Inflammation and irritation of the meninges
What are the viral causes of meningitis
Coxsachie
ECHO
Mumps
EBV
What are the fungal causes of meningitis
Cryptococci
What are the bacterial causes of meningitis
Meningococci Pneumococci Haemophilus influenza type B TB Staphylococci (neonates)
What are the granulomatous causes of meningitis
Lyme disease
Brucella
Syphilis
Sarcoid
What are the symptoms of meningitis
Malaise Photophobia Phonophobia Headache Neck stiffness Confusion Alteration of consciousness Fever - sepsis if left untreated
What do we see in post herpetic encephalitis
Classic haemorrhage changes n the temporal lobes
How do we treat meningitis
Antibiotics
Blood and urine culture
Lumbar puncture
CT/MIR scan
What do we see in sinusitis x ray
Opacification of the sinuses
What are the symptoms of sinusitis
Malaise Headache Blocked nose Anosmia Nasal/post nasal catarrh Local pain/tenderness Worse in morning - gets better throughout day
What is IIH
Idiopathic intracrhail hypertnesion
What are the signs of IIH
Headaches Visual disturbance Tinnitus Diplopia Papilloedema
What are the causes of IIH
Antibiotics
Hormones such as birth control drugs
Steroids
Vitamin E
What is the treatment for IIH
Optic nerve sheath decompression Lumbo-peritoneal shunt Stening of stenosed venous sinuses Weight loss Diuretics
What happens in a low pressure headache
Loss of CSF therefore when we lie down, everything is fine but when we stand up, there is less CSF in the head therefore the brain is tugged down causing pain
What causes low pressure headaches
Trauma post lumbar puncture
Spontaneous
What do we see on MRI in low pressure headache
Meningeal enhancement with contrast injection
What is the treatment for low pressure headache
Rehydration
Caffeine
Blood patch
What is a Chiari malformation
Normal brain sits very low within the skull
Cerebellar tonsils descending through foramen magnum therefore when the patient coughs, ICP rises and the meninges are tugged on
What triggers pain in chiari malformation
Straining to increase ICP
How do we treat chiari malformation
Treat underlying cause of the straining, or remodel the skull base
What is OSA
Patient retains Co2 due to breathing obstruction when sleeping. Co2 acts as a vasodilator therefore acts on the head to cause headaches
What are the symptoms of OSA
Depression
Impotence
Poor performance at work
Fatigue
How do we treat OSA
Sleep study, then we can move to NIV or surgery
What is trigeminal neuralgia
When there is neurovascular conflict that affects any branch of the trigeminal nerve therefore causing electric shock pain
What triggers trigeminal neuralgia
Innocuous stimulus e.g. shaving
What is linked with trigeminal neuralgia
MS
What is the treatment for trigeminal neuralgia
Lamotrigine
Gabapentin
Carbamazepine
Posterior fossa decompression when severe pain
What is atypical face pain
Usually affects depressed/anxious middle aged ladies - aching pain that extends in the jaw bones, neck and throat
What is not present in atypical face pain
Not lacinating
No sensory loss
Hard to find cause
How do we treat atypical face pain
Painkillers, opiates and nerve blocks do not work therefore we move to tricyclic antidepressants
What is a post traumatic headache
Headache present after head trauma
How common are post traumatic headache
Affects 36% at discharge, and 16% still have it after 12 months since trauma
How is post traumatic headache managed
Explanation that recovery may take a long time
Stop analgesic abuse e.g, opiates - use modulatory drugs such as amitriptyline or NSAIDs
Be patient - recovery can last 3-4 years
What is cervical spondylosis
Narrowing of the joint space due to wearing of the disc
Who is commonly affected by cervical spondylosis
Elderly patients - constant pain in the bakc of the head worse in the morning and with neck movement
No nausea and vomiting, but pain sometimes radiates froward
How do we manage cervical spondylosis
Rest, deep heat massage
Anti-inflammatory analgesics
