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Flashcards in [headache] Deck (78)
1

[Headache]: What does neck stiffness implicate

meningeal irritation

2

[Headache]: Accompanying neck stiffness implicates meningeal irritation. In which 3 headaches can this occur.

Meningitis
Encephalitis
SAH

3

[Headache]: Odd behaviour, reduced consciousness with infectious prodromes indicate

Encephalitis

4

[Headache]: What symptoms may make you suspect encephalitis (3)

Odd behaviour
reduced consciousness
fits

5

[Headache]: Photophobia, neck stiffness and a purpuric rash are associated with

Meningitis

6

[Headache]: Where does the headache localise to in SAH

Occipital (often, not always)

7

[Headache]: What initial Ix should you do for suspected meningeal irritation

Urgent CT
(SAH presents with meningeal irritation)

8

[Headache]: If the CT is -ve for meningeal irritation, what 2nd Ix should you do

LP
(infection or blood products in CSF)

9

[Headache]: In head trauma the major worries are (2)

Subdural haematoma
Extradural haematoma

10

[Headache]: What is the 1st line investigation following head trauma

CT

11

[Headache]: CT of head post -trauma is to exclude what (2)

Subdural haematoma
extra-dural haematoma

12

[Headache]: Headache with papilloedema indicates what causes

Venous sinus thrombosis

13

[Headache]: How would the pain be described in sinusitis

dull constant ache

14

[Headache]: where would the pain localise to in sinusitis (2)

frontal sinuses
maxillary sinuses

15

[Headache]: What is the main organism responsible for sinusitis

Rhinoviruses

16

[Headache]: Coryza is aka as ... and is the most common Dx for sinusitis

Common cold

17

[Headache]: Skull fracture or post LP, what may cause a headache

Low pressure CSF (leakage)

18

[Headache]: consant pain around one eye radiating to the forehead indicates

acute glaucoma

19

[Headache]: Reduced vision/visual disturbances and a headache indicate

Acute glaucoma

20

[Headache]: What is the treatment for Acute glaucoma

IV Acetazolamide
(pilocarpine)

21

[Headache]: How does pilocarpine work

M3 muscle-r agonist. Causes cilliary contraction. Increases outflow of aqueous humour.

22

[Headache]: How does acetazolamide work

Carbonic anhydrase-i
Decreases secretion of aqueous humour

23

[Headache]: Describe the timecourse of a SAH

sudden onset

24

[Headache]: How is a SAH often described

worst ever headache

25

[Headache]: How will the pupil respond to light in acute glaucoma

Dilated and unresponsive

26

[Headache]: a red and congested eye indicates what headache causing phenomenon

acute glaucoma

27

[Headache]: What are the 3 causes of a chronic headache

Medication overuse
(aka analgesic rebound headache)
Tension headache
Raised ICP

28

[Headache]: What actions may worsen a raised ICP headache

Coughing
Bending over
on waking

29

[Headache]: Papilloedema may be observed in raised ICP T/F

T

30

[Headache]: What is the 1st Ix if raised ICP suspected

imaging to look for space occupying lesion (CT)

31

[Headache]: When would you do LP in a raised ICP patient

AFTER imaging

32

[Headache]: raised ICP may present with what 4 signs

Odd behaviour
Papilloedema
seizures
vomiting

33

[Headache]: How does a tension headache characteristically present

Bilateral non-pulsatile headache
(not affected by head movement)

34

[Headache]: What is the commonest reason for an episodic headache becoming chronis

analgesic overuse (esp. mixed analgesics)

35

[Headache]: in analgesic rebound headaches how many days should you limit the pt to over the counter medications

6days/month

36

[Headache]: Tx for tension headache

stress relief

37

[Headache]: is vomiting a feature of tension headaches

no

38

[Headache]: What 4 headaches can cause recurrent attacks of acute headaches

Migraine
Cluster headache
Trigeminal neuralgia
Recurrent meningitis (Mollarets)

39

[Headache]: what would make you suspect Mollarets (recurrent meningitis) headache

recurring headaches with menigeal irritation signs and fever each time

40

[Headache]: If mollarets headache suspected what is the 1st line Ix and what are you looking for

LP and send CSF for HSV2 pcr

41

[Headache]: If there is access to the SAH (e.g. fracture) organisms may be given entry. What headache cause may follow

Mollarets (recurring meningitis)

42

[Headache]: What is the major worry with giant cell arteritis

blindness (GCA affect retinal artery, ischaemia is v damaging)

43

[Headache]: Giant cell arteritis must be excluded if the headache is in someone aged ....

>50 yrs

44

[Headache]: What would be the main findings on palpation of temporal arteries in GCA (3)

pulseless
tender
thickened

45

[Headache]: GCA may have produce what sign in the jaw

jaw claudication

46

[Headache]: what is the pattern of onset in GCA

Sub acute

47

[Headache][cluster]: is more common in M or F?

M
5:1

48

[Headache][cluster]: time-course presentation?

rapid onset

49

[Headache][cluster]: where does the pain present?

around 1 eye

50

[Headache][cluster]: what eye-related features may be present on pain onset (4)

lacrimation
lid swelling
miosis
ptosis (20%)

51

[Headache][cluster]: do recurring attacks always affect the same eye?

YES

52

[Headache][cluster]: during what time do the attacks often occur

night time

53

[Headache][cluster]: how long does the cluster period last

4-12 weeks

54

[Headache][cluster]: how long can the latency period between cluster last

2 years

55

[Headache][cluster]: how long will the acute attack last

15 mins -2 hours

56

[Headache][cluster]: when is O2 CI

COPD

57

[Headache][cluster]: what is 1st line pharmacological Tx

Sumatriptan (sc)

58

[Headache][cluster]: how does sumatriptan work

5HT analog. receptor in cranial arteries, reduces vascular inflammation.

59

[Headache][cluster]: what should be given and 1st line Tx (non-pharmacological)

100% O2, non-rebreathe

(CI in what?)

60

[Headache][cluster]: what is an alternative to sumatriptan

Zolmitriptan nasal spray

61

[Headache][cluster]: Pain is strictly limited to .... side(s)

one side

62

[Headache][cluster]: this is the most debilitating headache T/F

T

63

[Headache][trigeminalneuralgia]: classical symptoms

paroxysmal stabbing pain

64

[Headache][trigeminalneuralgia]: where is the pain felt

Mandibular and maxillary usually

65

[Headache][trigeminalneuralgia]: unilateral or bilateral

unilateral

66

[Headache][trigeminalneuralgia]: length of symptoms

seconds

67

[Headache][trigeminalneuralgia]: explain 'tic doloureux'

face screwing up with pain

68

[Headache][trigeminalneuralgia]: How is the pain frequently brought on (5)

washing
shaving
eating
talking
dental prostheses

69

[Headache][trigeminalneuralgia]: typical age of onset

>50 yrs

70

[Headache][trigeminalneuralgia]: secondary causes (2)

compression of the trigeminal nerve
meningeal inflammation (MS, zoster)

71

[Headache][trigeminalneuralgia]: 1st line Ix

MRI

72

[Headache][trigeminalneuralgia]: why is the 1st line Ix important

exclude secondary causes

73

[Headache][trigeminalneuralgia]: 1st line Tx?

Carbamazepine 100mg

74

[Headache][trigeminalneuralgia]: how does carbamazepine work

Stabilises Na channels. Neurons less excitable

75

[Headache][trigeminalneuralgia]: If 1st line tx does not work in relapse; 2nd line drugs? (3)

Lamotrigine
phenytoin
gabapentin

76

[Headache][trigeminalneuralgia]: how do lamotrigine/phenytoin and carbamazepine all work

Block Na gate channels

77

[Headache][trigeminalneuralgia]: if relapse still occurs, what is non-pharmacological option

surgical intervention of peripheral CN 5

78

[Headache]: Giant cell arteritis must be excluded if the headache is in someone aged >50 and is persisting for ...

>2weeks