headache Flashcards

Question

clinical manifestations of GCA

Answer 1

above 50 -new onset localized headache that is usually unilateral, in the temporal area - temporal artery - tender, thick or nodule Systemic features (fever, fatigue, anorexia, weight loss, and depression Features of polymyalgia rheumatica (bilateral upper arm stiffness, aching, and tenderness; and pelvic girdle pain scalp tenderness intermittent jaw claudication visual disturbances - shade in one eye

Answer 2

herpes zoster cluster headache acute angle galucoma TIA Temporomandibular joint pain, sinus disease, and ear problems. Cervical spondylosis or other upper cervical spine disease.

Answer 3

For people with visual symptoms — 60–100 mg as a one-off dose (they should be seen by an ophthalmologist the same day) IVmethyl prednisolone prior to oral0,5-1.0g daily for 3/7. For people without visual symptoms — 40–60 mg daily (minimum 0.75 mg/kg). Reduce the dose of prednisolone to zero over 12–18 months providing there are no signs and symptoms or laboratory markers of inflammation. Consider the need for a proton pump inhibitor for gastroprotection in people at high risk of gastrointestinal bleeding or dyspepsia every 2-8 weeks for first 6 months

Answer 4

LFTs - ALP esp CRP ESR FBC - normochromic normocytic anaemia and an elevated platelet count are common.

Answer 5

tilted optic disc myelinated nerve fibres

Answer 6

MRI or MR/CT venography to exclude - hydrocephalus - mass lesion - venous thrombosis

Answer 7

``` Ch – chocolate O – Oral contraceptive C – caffeine (or withdrawal) O- orgasm L - lack of sleep A – alcohol T – travel E – exercise ``` irregular 💤

Answer 8

improves with increasing age pregnancy - improvement in frequency and severity of attacks the second and third trimesters

Answer 9

Reduced functional ability and quality of life Medication overuse headache progression to chronic migraine Status migrainosus — debilitating migraine attack lasting for more than 72 hours. Migrainous infarction — symptoms of aura lasting for more than 60 minutes with evidence of an ischaemic brain lesion on neuroimaging. Persistent aura without infarction — aura symptoms lasting for more than 1 week, with no radiographic evidence of infarction. increased risk of stroke - infarction - haemorrhagic

Answer 10

Headache lasting 4–72 hours in adults or 2–72 hours in adolescents. Headache with at least two of the following characteristics: - UNILATERAL location (more commonly bilateral in children). - PULSATING quality — may be described as ‘throbbing’ or ‘banging' in young people. - MODERATE/SEVERE intensity. - AGGRAVATION by, or causing avoidance of, routine activities of daily life (for example walking or climbing stairs). Headache with associated symptoms including at least one of: - N/V - PHOTOPHOBIA (sensitivity to light) and PHONOPHOBIA (sensitivity to sound)

Answer 11

One or more typical fully reversible aura symptoms including: - VISUAL - zigzag lines / scotoma - transient hemianopic disturbance - spreading scintillating scotoma ('jagged crescent'). - SENSORY -> symptoms such as unilateral pins and needles or numbness. - SPEECH and/or language symptoms such as dysphasia. At least three of the following: - At least one aura symptom spreads gradually over at least 5 minutes. - Two or more aura symptoms occur in succession. - Each individual aura symptom lasts 5-60 minutes. - At least one aura symptom is unilateral. - At least one aura symptom is positive. - The aura is accompanied, or followed within 60 minutes, by headache.

Answer 12

- simple analgesia - oral sumatripatan (50-100mg) fails - intra-nasal or subcutaneous - antiemetic - such as metoclopramide 10mg or prochlorperazine 10mg even in the absence of N/V

Answer 13

- significant impact on quality of life and daily function - acute treatment is shit - at risk of medication overuse headache

Answer 14

the aim of treatment is to reduce the frequency and severity of migraine symptoms and not complete remission or cure of migraine. - Propranolol (80–160 mg daily, in divided doses) or - Topiramate (50–100 mg daily, in divided doses [contraindicated in pregnancy — highly effective contraception is required prior to initiation]) or - Amitriptyline (25–75 mg at night).

Answer 15

- Behavioural interventions (such as relaxation techniques [for example mindfulness or meditation] or cognitive behavioural therapy). - Acupuncture (up to 10 sessions over 5–8 weeks) if both topiramate and propranolol are unsuitable or ineffective. - Riboflavin 400 mg once a day — may be effective in reducing migraine frequency and intensity for some people (avoid if planning a pregnancy or pregnant).

Answer 16

Frovatriptan (2.5 mg twice daily) on the days migraine is expected or from two days before until three days after bleeding starts. Zolmitriptan (2.5 mg twice or three times daily) on the days migraine is expected or from two days before until three days after bleeding starts.

Answer 17

``` HTN smoking cocaine alcohol genetic - D polycystic kidney disease, EDS, neurofibromatosis ``` marfans - berry

Answer 18

circle of willis

Answer 19

sudden explosive headache - thunderclap vomiting confusion/altered level of consciousness neck stiffness and other signs of meningism 6 hours after onset of SAH

Answer 20

Other causes of stroke. Meningitis (rarely features thunderclap headache). Trauma. Thunderclap headache of other aetiology. Primary sexual headache. Cerebral venous sinus thrombosis. Cervical artery dissection. Carotid artery dissection. Hypertensive emergency (severely raised blood pressure). Pituitary apoplexy (infarction or haemorrhage of the pituitary gland).

Answer 21

first line CT scanning without contrast FAILS lumbar puncture should be undertaken over 12 hourse after the onset for xanthochromia to be detected by spectrophotometry

Answer 22

gold standard for detection, demonstration and localisation of ruptured aneurysms

Answer 23

cerebral angiography CT angiography

Answer 24

QT prolongation Q waves dysrhythmias ST elevation.

Answer 25

prevent further bleeding or rebleeding

Answer 26

death rebleeding - endovascular coiling/neurovascular clipping vasospasm - nimodipine 60mg hydrocephalus - CSF shunt epilepsy cognitive dysfunction Stroke/poor cerebral perfusion -> maintain hydration/control BP

Answer 27

- Vomiting more than once with no other cause. - New neurological deficit (motor or sensory). - Reduction in conscious level (as measured by the Glasgow coma score). - Valsalva (associated with coughing or sneezing) or positional headaches. - Progressive headache with a fever.

Answer 28

within one week after an injury or when they regain consciousness features are similar to a migraine

Answer 29

usually develops within 24-48 hours following LP but may occur up to one week later may last several days worsens with upright position improves with recumbent position

Answer 30

analgesia rest caffeine and fluids usually develops within 24-48 hours following LP but may occur up to one week later may last several days worsens with upright position improves with recumbent position

Answer 31

A- At least 5 attacks fulfilling criteria B-D B Headache attacks lasting 4-72 hours* (untreated or unsuccessfully treated) C Headache has at least two of the following characteristics: 1. unilateral location* 2. pulsating quality (i.e., varying with the heartbeat) 3. moderate or severe pain intensity 4. aggravation by or causing avoidance of routine physical activity (e.g., walking or climbing stairs) D During headache at least one of the following: 1. nausea and/or vomiting* 2. photophobia and phonophobia E Not attributed to another disorder (history and examination do not suggest a secondary headache disorder or, if they do, it is ruled out by appropriate investigations or headache attacks do not occur for the first time in close temporal relation to the other disorder)

Answer 32

attacks are shorter lasting more commonlu bilateral GI distubrance is more prominent

Answer 33

- are fully reversible - develop over at least 5 minutes - last 5-60 minutes

Answer 34

- motor weakness - double vision - visual symptoms - affecting only one eye - poor balance - decreased level of consciousness.

Answer 35

CT/MRI scanning to determine any underlying lesion. Check and monitor blood glucose, renal function, electrolytes and osmolality.

Answer 36

- management of severe closed head injury. - Appropriate in patients with severe head injury (GCS between 3 and 8 after CPR) and an abnormal CT scan (haematomas, contusions, oedema or compressed basal cisterns). - Appropriate in patients with severe head injury and a normal CT scan if two or more of the following features are noted on admission - -- age over 40 years - -- unilateral or bilateral motor posturing - -- systolic blood pressure <90 mm Hg. - Subarachnoid haemorrhage with associated hydrocephalus: ventriculostomy allows therapeutic drainage and ICP monitoring. - Reye's syndrome: active treatment of raised ICP decreases mortality. - Brain tumours: may be of value in selected patients deemed at high risk of swelling or obstructive hydrocephalus - eg, following posterior fossa surgery. - Normal pressure hydrocephalus. - Decompensated hydrocephalus: can be a valuable diagnostic tool in complex cases. - Idiopathic intracranial hypertension - --- diagnostic test - --- monitor response to treatment Other potential indications include hypoxic brain swelling after drowning, meningitis, encephalitis, venous sinus thrombosis and hepatic encephalopathy.

Answer 37

above 20mmHg

Answer 38

1. head elevation to 30° improves jugular venous outflow and lowers intracranial pressure mannitol osmotic diuretic - > controlled hyperventilation - aim is to reduce pCO2 → vasoconstriction of the cerebral arteries → reduced ICP - leads to rapid, temporary lowering of ICP. However, caution needed as may reduce blood flow to already ischaemic parts of the brain ``` -> removal of CSF, different techniques include: drain from intraventricular monitor (see above) repeated lumbar puncture (e.g. idiopathic intracranial hypertension) ventriculoperitoneal shunt (for hydrocephalus) ```

Answer 39

primary headache disorder infrequent - <1 day per month frequent - at least 10 episodes of headache chronic TTH - >15 per month for 3 months

Answer 40

bilateral Quality - pressing or tightening (non-pulsating) intensity - mild to moderate duration - lasting minutes to days. no aggravating factors or ass Sx pericranial tenderness on manual palpation may be present.

Answer 41

migraine trigeminal neuralgia trauma

Answer 42

analgesia sleep hygiene chronic TTH - A course of up to 10 sessions of acupuncture over 5–8 weeks. - low dose amitryptilline 10-75 mg

Answer 43

stress tiredness squint

Answer 44

- > Infrequent episodic tension-type headache (TTH) occurs in a large proportion of the population. It is self-limiting and simple analgesia is usually effective. - > Chronic TTH can evolve from frequent episodic TTH, with daily or very frequent episodes of headache. It is a serious condition which decreases quality of life and leads to high disability.

Answer 45

- > Frequent episodic tension-type headache (TTH) and chronic TTH can be associated with considerable disability and loss of quality of life. - > Self-medication is common in TTH and may lead to medication overuse headache.

Answer 46

Prodromal - fatigue - poor concentration - neck stiffness - yawning - occur hours or 1–2 days before onset of other symptoms of migraine. Postdromal - fatigue - elated - depressed mood - may occur after resolution of the headache and last up to 48 hours.

Answer 47

- > Tension-type headache. - > Trigeminal autonomic cephalgias for example cluster headache and paroxysmal hemicranias. - > Other primary headache disorders such as primary cough headache and cold-stimulus headache.

Answer 48

improve after discontinuation of the overused medication

Answer 49

Drugs such as triptans and simple analgesics (such as NSAIDS and paracetamol) can generally be stopped abruptly. Advise the person to stop taking all overused acute headache medications for at least 1 month. Warn the person that withdrawal may initially worsen symptoms and that headache improvement may not occur for weeks after discontinuation. Advise the person to keep a diary recording symptoms and medication use during withdrawal and to maintain good hydration.

Answer 50

Episodic cluster headache — attacks occur in periods lasting from 7 days to 1 year and are separated by pain-free periods lasting at least 1 month. Chronic cluster headache — attacks occur for more than 1 year without remission, or with remission periods lasting less than 1 month.

Answer 51

lifelong disorder - periods of remission may lengthen with increasing age.

Answer 52

unilateral peri-orbital pain associated with ipsilateral cranial autonomic symptoms (such as conjunctival injection, lacrimation and eyelid oedema). rhinorrhoea - pulsating, boring, burning, or pressure-like. - 15 and 180 minutes. - characteristically restless or agitated, cannot lie still and may pace the floor.

Answer 53

- At least five attacks of severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15–180 minutes and - Headache associated with at least one of: ipsilateral conjunctival injection and/or lacrimation; nasal congestion and/or rhinorrhoea; eyelid oedema; forehead and facial sweating or flushing; a sensation of fullness in the ear; or miosis and/or ptosis; and/or a sense of restlessness or agitation. - Attacks occur between one every other day and eight per day for more than half of the time when the disorder is active.

Answer 54

- Sumatriptan by subcutaneous injection (for adult) - 6mg for one dose contraindicated in pts w CAD have potential to cause coronary vasospasm - Sumatriptan by intranasal administration (for adult aged 18–65 years - 10-20mg - provide 100% oxygen at a flow rate of 12–15 litres per minute via a non-rebreather face mask for 15 to 20 minutes.

Answer 55

inflammation of the two inner meninges (the pia and arachnoid mater) of the brain and spinal cord.

Answer 56

bacterial -> Neisseria meningitidis (meningococcus), Streptococcus pneumoniae (pneumococcus), and Haemophilus influenzae type b viral -> enteroviruses mycobacterium TB

Answer 57

neisseria - 3/5 days strep - 1-3 days

Answer 58

``` young age winter absent or non-functioning spleen immunocompromised cancer organ dysfunction smoking ```

Answer 59

``` hearing loss brain abscess seizures visual impairment distal limb loss in septicaemia hemi and quadraparaesis cognitive impairment hydrocephalus reduced QOL anciety learning difficulties ```

Answer 60

Low Glasgow Coma Scale score on admission (low level of consciousness). Tachycardia. Absence of rash. Thrombocytopenia. Elevated erythrocyte sedimentation rate (ESR). Positive blood culture. Cerebrospinal fluid leucocyte count of less than 1000 x 109 cells per mL.

Answer 61

- Non-blanching rash. - Stiff neck. - Capillary refill time of more than 2 seconds, cold hands and feet. - Unusual skin colour. - Shock and hypotension. - Leg pain. - Back rigidity. - Bulging fontanelle. - Photophobia. - Kernig's sign (person unable to fully extend at the knee when hip is flexed). - Brudzinski's sign (person’s knees and hips flex when neck is flexed).

Answer 62

viral - conservative management - enteroviruses, HSV fungal - life threatening TB meningitis sepsis pneumonia encephalitis

Answer 63

single dose of parenteral benzylpenicillin (intravenously or intramuscularly) Children younger than 1 year of age — 300 mg. Children 1–9 years of age — 600 mg. Adults and children 10 years of age or older — 1200 mg.

Answer 64

All children should have a review with a paediatrician 4–6 weeks after hospital discharge to assess their recovery.

Answer 65

inflammation of the brain parenchyma - caused by viral infections HSV1

Answer 66

``` acute TRIAD Fever headache altered mental status ``` ``` Viral - may begin flu or headached altered consciousness confusion drowsiness seizures coma ``` increased ICP Sx

Answer 67

``` meningitis behcet SLE stroke MS syphillis leukaemia ```

Answer 68

CSF - lymphocytosis, elevated protein PCR test for HSV, VXV and enteroviruses - Elevated protein - elevated CSF specific antibody levels FBC and blood film - leukocytosis CT scan - rule out SOL, strokes and basilar fractures - identify ICP EEG

Answer 69

- urgent hospital admission - immediate parentral ABx - IV aciclovir - no specific Mx for other causes - role of steroids

Answer 70

inappropriate antidiuretic hormone secretion DIC cardiac and respiratory arrest epilepsy

Answer 71

- nasal blockage (obstruction/congestion) or nasal discharge (anterior/posterior nasal drip) - facial pain/pressure (or headache) - loss) of the sense of smell. - Altered speech indicating nasal obstruction. - Tenderness, swelling, or redness over the cheekbone or periorbital areas. - Cough. Inspecting and palpating the maxillofacial area to elicit swelling and tenderness. Performing anterior rhinoscopy (using the largest speculum of an otoscope, or a head light and nasal speculum) to identify: Signs which support a diagnosis of acute sinusitis such as nasal inflammation, mucosal oedema, and purulent nasal discharge. Associated pathology such as nasal polyps, or anatomical abnormalities such as septal deviation. more than 12 weeks

Answer 72

``` URTI allergic rhinits nasal foreign body adenoiditis/tonsillitis sinonasal tumour turbinate hypertrophy ```

Answer 73

more than 10 days | high dose nasal corticosteroid for 14 days

Answer 74

Appearance: cloudy and turbid Opening pressure: elevated (>25 cm H₂O) WBC: elevated >100 cell/µL (primarily polymorphonuclear leukocytes (>90%)) Glucose level: low (<40% of serum glucose) Protein level: elevated (>50 mg/dL)

Answer 75

Appearance: clear Opening pressure: normal or elevated WBC: elevated (50 – 1000 cells/µL, primarily lymphocytes, can be PMN early on) Glucose level: normal (>60% serum glucose, however, may be low in HSV infection) Protein level: elevated (>50 mg/dL)

Answer 76

Appearance: opaque, if left to settle it forms a fibrin web Opening pressure: elevated WBC: elevated (10 – 1000 cells/µL, early PMNs then mononuclear) Glucose level: low Protein level: elevated (1-5 g/L)

Answer 77

Appearance: blood-stained initially, then xanthochromia (yellowish) >12 hours later Opening pressure: elevated WBC: elevated (WBC to RBC ratio of approx 1:1000) RBC: elevated Glucose level: normal Protein level: elevated

Answer 78

Appearance: clear or xanthochromia Opening pressure: normal or elevated WBC: normal Glucose level: normal Protein level: elevated (>5.5 g/L)

Answer 79

1. Suspected subarachnoid haemorrhage 2. Suspected meningitis/encephalitis 3. Immunological disorders such as multiple sclerosis or Guillain-Barré Syndrome

Answer 80

mefanamic acid or a combination of aspirin, paracetamol and caffeine. Triptans are also recommended in the acute situation

Answer 81

``` full set of obs including BM Full neuro examination including fundoscopy CT scan NBM cannulate ```

Answer 82

``` stroke intoxicated/drug overdose metabolic imbalance - hypoglycaeamia septicaemia acute bleed into a brain tumour ```

Answer 83

``` increasing age - brain shrinkage occurs chronic alcoholism epilepsy long term anticoagulation falls ``` surgical evaluation of the haematoma thru burr holes

Answer 84

``` washing shaving touching brushing teeth brushing hair cold wind eating ```

Answer 85

MS lesions of the cerebellopontine angle atrioventricular malformation tumors of CNV

Answer 86

amitryptilline

headache Flashcards

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