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1 Neurology > Headache > Flashcards

Headache Flashcards

1
Q

Differentials for acute onset headache

A

SAH
Raised ICP
Meningitis
Venous sinus thrombosis

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2
Q

Where is the headache/pain located in SAH?

A

occpital region

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3
Q

Where might you see blood in CT of a patient with SAH?

A

circle of willis and ventricles

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4
Q

What is a cause of SAH?

A

berry aneurysm

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5
Q

What is the treatment for SAH?

A

vasospasm- nimodipine

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6
Q

Which organism is the most common cause of meningitis in very young and old patients?

A

listeria

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7
Q

Name a virus that causes meningitis

A

HSV

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8
Q

Why do you treat meningitis with steroids?

A

to prevent hearing loss

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9
Q

Aside from taking CSF sample to investigate SAH/meningitis, what else must you do?

A

take serum sample to compare glucose, WCC etc

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10
Q

How would the CSF of fungal meningitis compare to viral cause?

A

fungal- low glucose and raised lymphocytes
viral- normal glucose and raised lymphocytes
bacterial- low glucose and raised neutrophils

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11
Q

Treatment for trigeminal neuralgia?

A

carbamazipine

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12
Q

Name two types of brain tumours

A

meningioma, glioblastoma multiforme, schwannoma

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13
Q

Which brain tumour has the worst prognosis?

A

glioblastoma multiforme

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14
Q

Which is the most common type of brain tumour?

A

secondary mets

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15
Q

Describe the headache seen with tension headaches

A

band across head

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16
Q

Describe the headache seen in cluster headaches

A

unilateral

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17
Q

Name the accompanying features of cluster headaches

A

lacrimation, conjunctival erythema, rhinorrhoea

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18
Q

What is an important differential for migraine?

A

seizures, due to visual aura

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19
Q

Which antibiotics used for meningitis in immunocompromised/older patient?

A

ceftriaxone + amoxicillin

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20
Q

Which bacteria typically causes meningitis in older/immunocompromised patients?

A

listeria monocytogenes

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21
Q

In listeria meningitis, will the CSF culture be positive?

A

less likely to be positive in CSF compared to other organisms but more likely to be positive in blood cultures

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22
Q

Which organism that causes meningitis is associated with hyponatraemia?

A

listeria

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23
Q

What is you differential diagnosis for young female with headache, nausea, papilloedema? (+seizure)

A

raised ICP: SOL, cerebral venous sinus thrombosis, idiopathic intracranial hypertension (this would not cause a seizure)

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24
Q

Investigations for raised ICP due to venous sinus thrombosis?

A

CT venogram

CT head

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25
Q

What are the risk factors for venous sinus thrombosis?

A

OCP, thrombophilia, infection, dehydration (e.g. following diarrhoeal illness)

26
Q

What is the treatment for venous sinus thrombosis?

A

anticoagulation for several months

27
Q

What percentage of people with cerebral venous sinus thrombosis present with seizure?

A

30-40%

28
Q

When can LP be performed in SAH?

A

12 hours after onset of headache

29
Q

What is the treatment of SAH?

A

Reduce blood pressure + surgical input (coiling or clipping) + nimodipine (to reduce risk of secondary vasospasm)

30
Q

WHat is the most common cause of SAH?

A

ruptured cerebral aneurysm (ant communicating artery)

31
Q

Patient with headache and neck pain. The headache disappears when he lies down and is worse when standing or sitting. He had LP performed one week ago to investigate optic neuritis.

A

Low pressure headache due to CSF leak (spontaneous or LP)

32
Q

What is the treatment of low pressure headache?

A 
conservative 
rest and lie down
fluids
analgesia
caffeine can help
33
Q

List three types of primary headaches

A

migraine
cluster headache
trigeminal neuralgia
tension type headache

34
Q

Which acronym can you use for migraine?

A 
POUND
Pounding/throbbing
hOurs in duration
Unilateral
Nausea/vomiting/photo/phonophobia
Disabling intensity (go to bed, no work)
35
Q

Name two triggers for migraines

A 
chocolate
cheese
alcohol
aspartame
mesntruation
36
Q

Patient with hemiplegia. Should migraine be differential?

A

yes- hemiplegic migraine

37
Q

What is the treatment for acute migraine?

A 
aspirin
NSAIDs
paracetamol
triptans
anti-emetics
(limit use to max 2 days per week)
38
Q

Which analgesia could exacerbate headache?

A

opioids

39
Q

Which co-morbidity is contraindicated with triptans?

A

cerebral vascular disease (triptans cause vasoconstriction)

40
Q

What is the prophylaxis for migraines?

A

propranolol (first line, do not use in asthma)
topiramate
duloxetine
amitriptyline

41
Q

In which group of people should you exert caution when prescribing topiramate for migraines?

A

pregnant women

42
Q

For how long should prophylactic therapy be tried on patient before deeming ineffective?

A

6 weeks

43
Q

Which sex are cluster headaches and migraines more common?

A

migraine- female 3:1

cluster headache- men 4:1

44
Q

List three autonomic features

A 
arise ipsilaterally
lacrimation
orbital oedema
nasal congestion
facial sweating
ptsosis/miosis
45
Q

Will a person with cluster headache be sitting still to improve symptoms?

A

no, they will be agitated and pacing around

46
Q

What is the treatment of cluster headaches?

A

acute- high flow O2 and subcut triptan

47
Q

What is the prophylactic treatment for cluster headaches

A

verapamil

48
Q

Name two triggers for trigeminal neuralgia

A

brushing teeth
shaving
combing hair

49
Q

Differentials for trigeminal neuralgia aside from other headaches?

A

MS

Tumour

50
Q

Name one prophylactic treatment for trigeminal neuralgia?

A

carbamazepine, amitriptyline, lamotrigine

51
Q

What is the timing for trigeminal neuralgia

A

refractory period, occurs over seconds

52
Q

Name three red flags for secondary headache

A 
SNOOP
systemic features (Weight loss, fever)
neuro signs
Older pop with new headache (>50)
Onset- thunderclap
Progression of headache (change in severity)
53
Q

List three secondary headaches

A 
SAH
cerebral sinus thrombosis
meningitis
temporal arteritis
dissection
idiopathic intracranial HTN
SOL
54
Q

Does meningism arise in SAH?

A

yes!!

55
Q

Three presenting features of temporal arteritis?

A

scalp tenderness
jaw claudication
visual disturbance

56
Q

Which nerve palsy is associated with idiopathic intracranial HTN?

A

6th nerve

57
Q

What are the visual features of idiopathic intracranial HTN?

A

optic disc swelling, enlarged blind spots, reduced visual acuity, colour desaturation

58
Q

Which drugs can raise ICP?

A

antibiotics used for acne!!! lymecyline

59
Q

Which drug can be used to treat IIH?

A

acetozolamide

60
Q

What prophylactic treatment can be used in migraines in a patient with asthma?

A

topiramate

propranolol contraindicated

1 Neurology (24 decks)

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