Y4 Headaches

Question 1

What two conditions would increase the Lumbar opening pressure?

Answer 1

SAH

meningitis

Question 2

what is the presentation of SAH?

Answer 2

Sudden onset, worst ever, occipital headache.

􏰀 Meningism, focal signs, ↓consciousness

Question 3

what is the presentation of transverse sinus thrombosis?

Answer 3

headache ± mastoid pain, focal CNS

signs, seizures, papilloedema

Question 4

what is the presentation of sagittal sinus thrombosis?

Answer 4

headache, vomiting, seizures, ↓vision,

papilloedema

Question 5

what is the presentation of meningitis?

Answer 5

Fever, photophobia, neck stiffness, kernig’s +ve
􏰀 Purpuric rash
􏰀 ↓consciousness

Question 6

what is kernig’s +ve?

Answer 6

straight leg raising and triggering pain from the stretching of meninges

Question 7

what is the presentation of encephalitis ?

Answer 7

ever, odd behaviour, fits, focal neuro, ↓consciousness

Question 8

what does hemicrania respond well to?

Answer 8

indomethacin

Question 9

where does trigeminal neuralgia affect on the face?

Answer 9

V2/V3

Question 10

what is the treatment for trigeminal neuralgia ?

Answer 10

Carbamazepine, lamotrigine, gabapentin 􏰀

microvascular decompression

Question 11

what investigations should be done for GCA and what would the results be?

Answer 11

ESR↑↑↑, plats↑, ALP↑, Hb↓, temporal artery biopsy

Question 12

what are two risk factors for migraines?

Answer 12

obesity

PFO (patent foramen ovale)

Question 13

what are some triggers for migraines ?

Answer 13

CHOCOLATE 􏰀 
CHeese
􏰀 OCP
􏰀 Caffeine
􏰀 alcohOL
􏰀 Anxiety
􏰀 Travel
􏰀 Exercise

dehydration

Question 14

what is a common migraine ?

Answer 14

Migraine w/o aura

Question 15

what is the treatment for migraines ?

Answer 15

1st: Paracetamol + metoclopramide / domperidone 􏰀
2nd: NSAID (e.g. ketoprofen) + M/D
􏰀 3rd: Rizatriptan
􏰁 - CI: IHD, uncontrolled HTN, SSRIs 􏰀
4th: ergotamine (vasoconstrictor)

Question 16

what is the prophylaxis for migraines ?

Answer 16

Avoid triggers
􏰀 1st: Propanolol, topiramate
􏰀 2nd: Valproate, pizotifen (↑ wt.), gabapentin

Question 17

what type of aneurysm commonly causes SAH?

Answer 17

saccular aneurysms

Question 18

state some RFs for SAH?

Answer 18

Smoking
􏰀 HTN
􏰀 EtOH
􏰀 Bleeding diathesis
􏰀 Mycotic aneurysms (SBE)
􏰀 FH

Question 19

what investigations should be done for SAH?

Answer 19

CT

LP after 12 hours

Question 20

what is seen on LP after 12 hrs of a SAH?

Answer 20

Xanthochromia due to breakdown of bilirubin

Question 21

what is the treatment for SAH?

Answer 21

coiling of the aneurysm
Nimodipine (CCB for 3 weeks to prevent vasospasm)
maintain CPP

Question 22

what are four complications of SAH?

Answer 22

hyponatraemia (common)
cerebral ischaemia
rebleeding
hydrocephalus (Due to blockage of arachnoid granulations)

Question 23

what size of aneurysms in young patients should be offered surgery ?

Answer 23

> 7mm

Question 24

what three conditions are associated with berry aneurysms ?

Answer 24

polycystic kidneys
coarctation of the aorta
ehlers danlos