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Flashcards in headache Deck (61)
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1

what percentage of people have migraines?

1 in 10

2

what perecentage of people people seen in Neurology clinics have benign headaches?

1 in 10

3

if the onest of the headache is sudden, what does that indicate?

Vascular problem
SAH/Intra-cerebral haemorrhage/coital/thunderclap

4

if the onset of headache evolves over hours to days what does it indicate?

Infection/inflammatory/↑ICP ( intra cranial pressure)

5

if the onset of headache evolves over weeks to months(chronic) what does it indicate?

Chronic daily headache/ ↑ICP

6

if the headache is constant and does not stop what is that a indication of?

Medication overuse/chronic migraine/hemicrania continua

7

If the headache is episodic in periodicity what is that a indication of?

Migraine /Cluster headache

8

what is hemicrania continua? How do you treat it?

is a persistent unilateral headache responds to indomethacin

9

what are the assoicated symptoms of headaches?

Diurnal variation/postural element
Nausea and vomiting
Photophobia/ phonophobia
Autonomic features (lacrimation/Horners/red eye)  runny nose

10

what are the red flags for headaches?

Cognitive effects
Seizures
Fever
Visual disturbance
Vomiting
Weight loss

11

if a patient who has a headache lies down in a dark room to help relieve the pain what is that a indicate of?

migraine

12

if a patient who has a headache is agitated and paces to help relieve the pain what is that a indicate of?

cluster headache

13

is migraine familial?

yes

14

on examination of someone with a headache what are you looking for?

ever/rash/neck stiffness/↑BP/organomegaly
Fundal changes (papilloedema)
Cranial nerve signs/Horners Syndrome
Focal abnormalities
Long tract signs  intracerebral space occupying lesion

15

what are the primary headache syndromes?

Migraine
Tension headache
Cluster headache
Paroxysmal hemicrania
Exertional headache
Ice-pick headache
Coital headache
Hypnic headache

16

what are the secondary headache syndromes?

SAH
Intra-cerebral haemorrhage/Stroke
Meningoencephalitis
Intracranial venous thrombosis
Giant cell arteritis
Tumour with raised ICP
Benign intracranial hypertension

17

what is hypnic headache?

headache that wakes a person up at night

18

when does Coital headache occur?

during sexual activity

19

what is Cluster headache ?

a type of severe headache in which the pain is usually limited to one side of the head, tending to recur over a period of several weeks

20

what are symptoms of SAH?

Awoken with severe, sudden onset (seconds) head pains
Back of head

Vomitting and confused

Clinically apyrexial, refusing fundoscopy and globally hyper-reflexic

Ocular movements appear impaired --> SO and LR unnoposed -->right oculomotor nerve palsy

21

what is the most common cause of SAH?

Coiling/clipping berry aneurysm (85% of cases)

22

if the Ct scan of a person with suspected SAH what is the next step?

Lumbar puncture by experienced hand(>/= 12 hours)
Xanthochromia (bilirubin released from lysing red cells)

23

when should CT scan be done for a person with SAH??

95% sensitive if done within first 48 hours

24

why would you not give morphine for someone with SAH?

morphine increase ICP

25

if both the LP and CT are normal then should we still suspect SAH?

no we shouldn't unless if the tests were done 48hrs after the person had a SAH. Then it is not sensitive enough and a angiograph should be done

26

wht are diabetics at further risk of infection?

because they are immunocompromised

27

what are the reasons for increase ICP?

Mass Effect (brain tumour, abscess)
Brain swelling (Hypertensive encephalopathy)
Increased venous pressure
CSF outflow obstruction (hydrocephalus)
Increased CSF production (meningitis/SAH)

28

what are the symptoms of increase ICP?

Headache (worse on lying or awakening)
Vomiting
Seizures

29

signs of increaes ICP?

Papilloedema
lateralising signs

30

what is done to manage someone who has a headache due to infection? Acute settting

Resuscitation

Broad spectrum IV antibiotics (cefotaxime)
Think about other bugs in immunocompromised patient
d/w microbiology

Steroids (dexamethasone) in patients with streptococcus pneumoniae meningitis

Neurosurgical consultation (craniotomy and drainage)