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Neurology > Headache > Flashcards

Headache Flashcards

1
Q

Acute single headache

A 
Febrile illness, sinusitis
First attack of migraine
Following a head injury
Subarachnoid haemorrhage
Meningitis, tumour, drugs, toxins, stroke
Thunderclap (sudden onset), low pressure
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2
Q

Dull headache, increasing in severity

A 
Usually benign
Overuse of medication (e.g. codeine)
Contraceptive pill, hormone replacement therapy
Neck disease
Temporal arteritis
Benign intracranial hypertension
Cerebral tumour
Cerebral venous sinus thrombosis
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3
Q

Triggered headache

A

Coughing, straining, exertion
Coitus
Food and drink

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4
Q

Recurrent headaches

A

Migraine
Cluster headache
Episodic tension headache
Trigeminal or post-herpetic neuralgia

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5
Q

Dull headache, unchanged over months

A

Chronic tension headache

Depressive, atypical facial pain

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6
Q

Red Flags

A

Thunderclap, acute, subacute - onset
Photophobia, phonophobia, stiff neck, vomiting - meningism
Fever, rash, weight loss - systemic
Visual loss, confusion, seizures, hemiparesis, double vision, 3rd nerve palsy, Horner syndrome, papilloedema - neurological
Better lying down
Strictly unilateral

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7
Q

Focal Signs

A

Double vision
3rd nerve (oculomotor) palsy
Horner syndrome

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8
Q

Subarachnoid Haemorrhage

A

Sudden generalised headache, ‘blow to the head’.
Meningism - stiff neck and photophobia
Around 50% are instantly fatal.
High risk of a further bleed.
CT brain, Lumbar puncture (RBC and xanthochromia) and MRA, angiogram.

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9
Q

Aneurysm treatment

A

Aneurysms used to be clipped or wrapped.

Nowadays filled with platinum coils.

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10
Q

Acute intracerebral bleed

A

Fatal haemorrhage due to coning.

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11
Q

Raised Intracranial Pressure (ICP)

A

Mechanism of coning.

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12
Q

Papilloedema

A

Optic disc swelling due to raised ICP

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13
Q

Carotid and Vertebral Arteries

A

Headache can also arise due to pathology in the large arteries of the neck.
Headache and neck pain common
Mean age 40, carotid > vertebral

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14
Q

Carotid and Vertebral artery treatment

A

Aspirin or anticoagulation X 6/12

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15
Q

Temporal Arteritis

A

Over the age of 55.
Three times commoner in females.
Constant unilateral headache, scalp tenderness and jaw claudication
25% Polymyalgia Rheumatica-proximal muscle tenderness.
Elevated ESR and CRP.
Visible on ultrasound.
Biopsy shows inflammation and Giant Cells.
High dose steroids and aspirin.
Disruption of the internal elastic lamina

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16
Q

Cerebral Venous Thrombosis

A

Thrombosis in dural venous sinus or cerebral vein
Unusual amount of headache due to raised ICP
Non-territorial ischaemia “venous infarcts”
Haemorrhage
Thrombophilia, pregnancy, dehydration, Behcets

17
Q

Causes of meningitis

A

Viral- Coxsackie, ECHO, Mumps, EBV

Bacterial - Meningococci, Pneumococci, Haemophilus, Tuberculous

Fungal - Cryptococci

Granulomatous- Sarcoid, Lyme, Brucella, Behçet’s, Syphilis

Carcinomatous

18
Q

Meningitis

A 
Malaise
Headache 
Fever
Neck stiffness
Photophobia
Confusion
Alteration of consciousness
19
Q

Herpes Simplex Encephalitis

A

Classic haemorrhagic changes in the temporal lobes

20
Q

Meningitis treatment

A

Treat then diagnose

Antibiotics
Blood and urine culture
Lumbar puncture
		Increased White Cell Count, decreased glucose
		Antigens
		Cytology
		Bacterial Culture
CT or MRI Scan
21
Q

Sinusitis

A 
Malaise, headache, fever.
Blocked nasal passages. 
Loss of  vocal resonance.
Anosmia.
Nasal or postnasal catarrh.
Local pain and tenderness.

Frontal pain characteristically starts 1-2 hours after rising and clears up during the afternoon.

22
Q

Idiopathic Intracranial Hypertension

A

Pseudotumor Cerebri

Often young obese women
Headache, visual obscurations, diplopia, tinnitus
Papilloedema, +/- visual field loss
Drugs: hormones, steroids, antibiotics, vitamin E
Treatment: weight loss, diuretics, optic nerve sheath decompression, lumboperitoneal shunt, stenting of stenosed venous sinuses.

23
Q

Low pressure headache

A

CSF leak due to tear in dura
Traumatic post lumbar puncture or spontaneous
Treatment rehydration, caffeine, blood patch

24
Q

Chiari Malformation

A

Normal brain that just sits very low within the skull

Cerebellar tonsils descending through the foramen magnum. Descend further when patient cough and tug on the meninges causing cough headache.

25
Q

Obstructive sleep apnoea

A

Often characteristic body habitus, history of loud snoring and apnoeic spells

Hypoxia, CO2 retention, non-refreshing sleep

Depression, impotence, poor performance at work

Require sleep study

Nocturnal NIV, Surgery

26
Q

Trigeminal neuralgia

A

Electric shock like pain in the distribution of a sensory nerve.
Often triggered by innocuous stimuli.
Any division of the trigeminal can be affected
Neurovascular conflict at the point of entry of the nerve into the pons.
Can be symptom of M.S.

Carbamazepine, lamotrigine

27
Q

Atypical facial pain

A

Most commonly in middle aged women. Depressed or anxious.
Daily, constant, poorly localised deep aching or burning.
Facial or jaw bones, but may extend to the neck, ear or throat.
Not lancinating.
No sensory loss.
Pathology in teeth, temporomandibular joints, eye, nasopharynx and sinuses must be excluded.

Unresponsive to conventional analgesics, opiates and nerve blocks.
Mainstay of management tricyclics.

28
Q

Post traumatic headache

A

High in victims of car accidents
Low in perpetrators of car accidents
Low in sports injuries

Neck injury
Scalp injury
Vasodilation ? autonomic damage
Depression - often delayed

Non-steroidal anti-inflammatories - ibuprofen, naproxen
Tricyclic antidepressants - Amitriptyline
Prevent analgesic abuse

29
Q

Cervical Spondylosis

A

Commonest cause of new headache in older patients

Usually bilateral
Occipital pain can radiate forwards to the frontal region
Steady pain
No nausea or vomiting
Worsened by moving the neck

Rest, deep heat, massage.
Anti-inflammatory analgesics.
Over-manipulation may be harmful

30
Q

Migraine

A

Disorder

Tendency to repeated attacks
Triggers
easily hung-over 
visual vertigo 
motion sickness

3 forms - pain, focal, or both

31
Q

Migraine: phases

A

Prodrome: Changes in mood, urination, fluid retention, food craving, yawning

Aura: Visual, sensory (numbness/paraesthesia), weakness, speech arrest

Headache: Head and body pain, nausea, photophobia

Resolution: rest and sleep

Recovery: mood disturbed, food intolerance, feeling hungover

32
Q

Migraine: aura

A

Positive & negative symptoms together:
scintillations & blindspot
Expanding ‘C’s
Elemental visual disturbance

33
Q

Migraine: treatment

A

Acute attack
Aspirin/ibuprofen (Non-steroidals) and paracetamol and metoclopramide (anti-emetic)
Hit the headache hard and fast
Opiates-caution! Analgesic abuse potential.
A short nap

Look for triggers and avoid them

Nasal sumatriptan (serotonin, 5HT1 agonist)

34
Q

Migraine: prophylaxis

A

Beta-blockers - Propranolol, Atenolol
Serotonin antagonists: pizotifen, methysergide
Calcium channel blockers: flunarazine, verapamil
Tricyclic antidepressants (TCAs): amitriptyline 7pm

Erenumab

35
Q

Tension type headache

A

Tight muscles around head and neck bilaterally, as though head is in a vice.

NSAID’s preferred:
Ibuprofen Naproxen, Diclofenac

Paracetamol

Tricyclic antidepressants - amitryptyline

36
Q

Cluster headache

A

Severe unilateral pain lasting 15-180 minutes untreated.
Classified as a trigeminal autonomic cephalgia.
At least one of the following, ipsilaterally:
Conjunctival redness and/or lacrimation
Nasal congestion and/or rhinorrhoea
Eyelid oedema

Forehead and facial sweating

Miosis and/or ptosis

A sense of restlessness or agitation

Frequency between one on alternate days to 8 per day.

Not associated with a brain lesion on MRI

37
Q

Cluster headache: treatment

A

Acute
Inhaled oxygen. Oxygen inhibits neuronal activation in the trigeminocervical complex

Prevention
Verapamil
Prednisolone
Lithium

Subcutaneous or nasal triptan
NO paracetamol or NSAIDs

38
Q

Migraine vs Cluster headache

A

M - more women C - more men
M - longer C - shorter
M - monthly C - daily
M - long remissions unusual C - long remissions common
M - visual or sensory aura. C - eye waters, nose blocked, ptosis
M - lie in dark C - pace about

Neurology (9 decks)

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