headache

Question 1

what are some serious headaches

Answer 1

Thunderclap type
Raised ICP
Infection
Giant cell arteritis

Question 2

What are primary headaches

Answer 2

Migraine
Tension or medication overuse headache
Cluster headache

Question 3

what are some other signs of SAH apart from thunderclap headache

Answer 3

loss of consciousness, vomiting

Neck stiffness subhyaloid haemorrhage

Question 4

What is essential to do for a thunderclap headache

Answer 4

CT

Lumbar puncture is needed if presenting after >12 hours to detect xanthchromia

Question 5

Mimics of thunderclap headache

Answer 5

Coital headache: however timing is different as it lasts 30-60 mins

Migraine: diagnose after excluding serious causes

Reversible vasoconstriction syndrome

Question 6

Signs of raised ICP

-What can be the cause

Answer 6

Progressively worsening headache
Whole head 
Occipital area if posterior fossa mass
Sub-acute: days to weeks
Worst: morning, bending, cough and strain
Focal symptoms point to mass lesion
-Papilloedema (optic disc swelling)
-Check BP as if high can cause

Question 7

what does a raised pressure headache need

Answer 7

Urgent CT/MRI brain

Question 8

What are the causes of a raised pressure headache

Answer 8

MAss lesion
Hydrocephalus
Idiopathic intracranial hypertension

Question 9

what are the signs of meningitis

Signs of encephalitis

Answer 9

Sub-acute: hours to days 
Fever 
Altered mental status 
Rash and neck stiffness 
Focal signs and seizures- encephalitis or abscess

Question 10

Management of meningitis and encephalitis

Answer 10

speed
Assess, investigate and empirical treatment before tests are back
Bloods include blood cultures
Empirical anti-microbial treatment

Question 11

When do you do imaging first in suspected meningitis+encephalitis

When is a lumbar puncture not suitable

Answer 11

Imaging first if: GCS <13; Seizures, Focal signs, papilloedema
LP first otherwise (no LP in Septic shock, anticoagulation)

Question 12

signs of encephalitis

Answer 12

headache, fever, confusion, focal signs, seizures

Question 13

how to manage encephalitis including investigations

Answer 13

CT, lumbar puncture then MRI
(no lumbar puncture if raised ICP).
Lumbar puncture tests for Herpes simplex and HIV

-Acyclovir

Question 14

Signs of giant cell arteritis

Answer 14

Over 50yo
New headache 
Temples or occipital region
Tender scalp
polymyalgia symptoms (aches and stiffness)
Jaw claudication- pain worse when chewing
Visual symptoms 
Weight loss

Question 15

How serious is giant cell arteritis and why

Answer 15

Urgent as threat of blindness

Question 16

how to manage giant cell arteritis

Answer 16

CRP/ESR
High dose steroids
Temporla artery biopsy pathway

Question 17

Benign severe headache types

Answer 17

Migraine
Cluster headache
Low pressure headache

Question 18

how do migraines present

Answer 18

Evolving focal aura
Unilateral throbbing pain
Nausea / vomiting
Photosensitivity
Dislikes Movement
Lasts hours

Question 19

How do cluster headaches present

Answer 19

Severe orbital pain
Lasts 90 minutes
1-3 per day
Tearing / running nose

Question 20

How do low pressure headaches present

Answer 20

Often recall the day on onset
Absent supine, restarts upright
Whole head
CSF leak