Secondary Headaches Flashcards
What is a primary headache?
1 - no known underlying cause
2 - trauma related headache
3 - infectious related headache
4 - headaches associated with a specific aetiology causing traction on or inflammation of pain-sensitive structures
1 - no known underlying cause
What is a secondary headache?
1 - no known underlying cause
2 - trauma related headache
3 - infectious related headache
4 - headaches associated with a specific aetiology causing traction on or inflammation of pain-sensitive structures
4 - headaches associated with a specific aetiology causing traction on or inflammation of pain-sensitive structures
Are primary or secondary headaches more common?
- primary
Which of the following is NOT a cause of a secondary headache?
1 - Tumour
2 - CNS infection
3 - Intracerebral/ subarachnoid haemorrhage
4 - Arteritis
5 - Migraine
6 - Idiopathic intracranial hypertension (IIH)
7 - Venous sinus thrombosis
8 - Carotid dissection
5 - Migraine
A common secondary headaches is a thunderclap headache. Do these come on gradually or rapidly?
- rapidly
- incredibly painful felt in head and/or neck
Typically what is the onset of a thunderclap headache?
1 - 30mins to 1 week
2 - 4-72h
3 - 15-180 minutes
4 - 3-5 minutes
4 - 3-5 minutes
Which type of headache would most likley be associated with the following:
- hemiparesis (weakness on 1 side)
- monoparesis (loss of function in one limb)
- fever, nausea, vomiting
- flu like symptoms
1 - migraines
2 - cluster headaches
3 - medication overuse headaches
4 - thunderclap headaches
4 - thunderclap headaches
- always associated with some form of pathophysiology
- most common secondary form of headache
What ages do thunderclap headaches typically affect?
1 - >20
2 - >40
3 - >50
4 - >65
3 - >50
In thunderclap headaches, are they more likely to be present when a patient wakes up in the morning, or is the headache more likely to wake patients up?
- more likely to wake patients whilst they are asleep
- typically DO NOT wake up with it when they would wake up normally
It can be very difficult to distinguish between a primary and secondary headache. Which of the following is NOT a useful symptom that may confirm pathology in a patient with a thunderclap headache?
1 - severity or response to treatment
2 - idiopathic intracranial hypertension causing papilledema
3 - CNS infection – systemic features eg pyrexia, +/- focal neurological features
4 - giant cell arteritis with systemic features, polymyalgia rheumatica, jaw claudication
1 - severity or response to treatment
Thunderclap headaches are the most common form of secondary type headaches with an underlying cause. Although these can be caused by a myriad of things, what is potentially the most severe that needs to be treated urgently?
1 - subarachnoid haemorrhage
2 - meningitis
3 - arteritis
4 - tumour
1 - subarachnoid haemorrhage
A sentinel headache can be dangerous, what is a sentinel headache?
1 - headache caused by stress and dehydration and is very painful
2 - the initial headache that precludes developing cluster headaches
3 - a mild headache that precludes a major potentially life threatening bleed such as an aneurysm
4 - could be any of the above
3 - a mild headache that precludes a major potentially life threatening bleed such as an aneurysm
If you suspect a patient has a thunderclap headache, what should be the first line management?
1 - refer to GP for close monitoring
2 - admit to hospital for fluids and close monitoring
3 - admit to hospital and request an urgent CT head scan
4 - admit to hospital and begin sepsis 6 protocol
3 - admit to hospital and request an urgent CT head scan
Sensitivity of CT scan:
- <6 hours of onset = 95.8-99.85%
- >6 hours = 90%
- sensitivity = positive test in those with condition
- specificity = negative test in those without the condition
If a patient has a suspected thunderclap headache and the CT scan is negative, what would be the next investigation?
1 - lumbar puncture
2 - MRI
3 - blood sample culture for microorganisms
4 - all of the above
1 - lumbar puncture
If a patient has a suspected thunderclap headache and the CT scan is negative, a lumbar puncture should be performed. All of the following should be performed on the CSF sample taken from the lumbar puncture, but which is potentially the most important?
1 - Protein Glucose (plus blood glucose)
2 - Bilirubin and xanthochromia (sampling MUST be protected from light)
CSF should not be examined for bilirubin > 12 hours after ictus
4 - microscopy culture and sensitivity
4 - microscopy culture and sensitivity