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Year 2 BRS Neuro > Headache > Flashcards

Headache Flashcards

1
Q

Causes of dull headache

A

Overuse of medication (e.g. codeine)

Contraceptive pill, hormone replacement therapy

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2
Q

Causes acute single headache

Thunderclap (sudden onset), low pressure

A 
Febrile illness, sinusitis
 head injury
Subarachnoid haemorrhage
Meningitis,
 drugs,
 toxins, 
stroke
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3
Q 
What headache patterns are these? 
Cluster 
Migraine 
Episodic tension headache 
Trigeminal / post herpetic neuralgia
A

Recurrent

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4
Q

Triggered headache

A

Coughing, straining, exertion
Coitus
Food and drink

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5
Q

Red flags
onset?
presence of systemic symptoms?
what neuro symptoms?

better standing or lying down?

A

Onset : Thunderclap, acute, subacute

Meningism : Photophobia, phonophobia, stiff neck, vomiting

Systemic symptoms : Fever, rash, weight loss

neurological symptoms / focal signs : Visual loss, confusion, seizures, hemiparesis, double vision, 3rd nerve palsy, Horner syndrome, papilloedema,

Orthostatic-better lying down

Strictly unilateral

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6
Q

Horner syndrome?

A

decreased pupil size, a drooping eyelid and decreased sweating on the affected side of your face

inhibition of sympathetic nerve supply

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7
Q

3rd Nerve Palsy

A

CN III impacted so actions of CN IV/ VI

completely closed eyelid and deviation of the eye outward and downward

the eye cannot move inward or up, and the pupil is typically enlarged and does not react normally to light

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8
Q

Papilloedema

A

Papilledema or papilloedema is optic disc swelling that is caused by increased intracranial pressure due to any cause. The swelling is usually bilateral

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9
Q

Signs headache is due to Subarachnoid haemorrhage

A
  • blow to the head
  • stiff neck photophobia
  • ruptured aneurysm , arteriovenous
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10
Q

Subarachnoid Haemorrhage headache : Course of action

what drug? what needs monitoring

A
  • Vasospasm : stop leak
  • Nimodipine : calcium channel blocker used in preventing vasospasm secondary to subarachnoid hemorrhage
  • BP control needed
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11
Q

Markers of Subarachnoid Haemorrhage ?

A
  • CT brain
  • Lumbar Puncture : will show xanthochromia
  • MRA, Angiogram
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12
Q

what is xanthochromia ?

A

yellowish appearance of cerebrospinal fluid that occurs several hours after bleeding into the subarachnoid space
- sign of Subarachnoid Haemorrhage

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13
Q

How is an unruptured aneurysm dealt with ?

A
  • Clipped
  • Wrapped
  • Platinum coils
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14
Q

Optic disc swelling

A
  • due to raised intracranial pressure
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15
Q

Temporal Arteritis

characteristics

A

<55
3x more in women
Constant unilateral headache
Scalp tenderness and jaw claudication + present w polymyalgia rheumatica
Elevated ESR, CRP
Inflamed and tortuous
Biopsy inflammation and giant cells : disruption of internal elastic lamina

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16
Q

Polymyalgia Rheumatica

A

Proximal muscle tenderness

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17
Q

Temporal Arteritis

can cause blindness why?

A

inflamed temporal artery can get posterior ciliary arteries are involved

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18
Q

ESR and CRP what do they show?

A

signs of inflammation

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19
Q

Unusual amount of headache due to raised ICP

A
  • Cerebral Venous Thrombosis
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20
Q

Why does Cerebral Venous Thrombosis occur?

A

Non-territorial ischaemia “venous infarcts”
Haemorrhage
Thrombophilia, pregnancy, dehydration,
- Behcets :blood vessel inflammation throughout your body

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21
Q

Cause of Headache

A

Viral- Coxsackie, ECHO, Mumps, EBV
Bacterial - Meningococci, Pneumococci, Haemophilus
Tuberculous
Fungal - Cryptococci
Granulomatous- Sarcoid, Lyme, Brucella, Behçet’s, Syphilis
Carcinomatous

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22
Q

Meningitis

Presenting symptoms

A 
Malaise
Headache 
Fever
Neck stiffness
Photophobia
Confusion
Alteration of consciousness
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23
Q

Herpes Simplex Encephalitis

A

Classic haemorrhagic changes in the temporal lobes

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24
Q

Meningitis

Treat then diagnose

A 
Antibiotics
Blood and urine culture
Lumbar puncture
		Increased White Cell Count, decreased glucose
		Antigens
		Cytology
		Bacterial Culture
CT or MRI Scan
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25
Bacterial Meningitis | characterisitic
Cerebral oedema with effacement of ventricles and sulci and inflamed meninges
26
Sinusitis | characteristic
Malaise Headache Fever Blocked nasal passages loss of vocal resonance (increased air present) build of mucus in nasal / postnasal : Catarrh Anosmia: loss of smell
27
Idiopathic Intracranial Hypertension
Pseudotumor Cerebri - young , obese women - headache, diplopia, tinnitus
28
What can cause? idiopathic intracranial hypertension? | Treatment?
Hormones, steroids, antibiotics, Vit E | -weight loss, diuretics, optic nerve sheath decompression, lumboperitoneal shunt, stenting of stenosed venous sinuses
29
Low Pressure Headache
CSF leak due to tear in Dura
30
What can cause L-Pessure Headcache
Traumatic post lumbar puncture or spontaneous
31
Treatment for LPH
Treatment rehydration, caffeine, blood patch
32
Chiari Malformation
Normal brain sits low within skull
33
Why in Chiari Malformation does a cough trigger a headache?
Cerebellar tonsils descending through the foramen magnum. Descend further when patient cough and tug on the meninges causing cough headache.
34
Cause of headache : Obstructive sleep apnoea causes of headache is due to? treatment?
- loud snoring - apnoeic spell Hypoxia, CO2 retention, non refreshing sleep Nocturnal NIV Surgery
35
Cause of headache : Trigeminal Neuralgia why? Drug treatments?
Electric shock like pain in the distribution of a sensory nerve Neurovascular conflict at point of entry of nerve into pons Can be symptom of MS Carbamazepine [ inhibts sodium channels] , lamotrigine [ binds sodium channels, inhibits glutamate], gabapentin [ mimic GABA? inhibits calcium channels not sure hot it works]
36
Cause of headache : Trigeminal Neuralgia Drug treatments? [3] sodium channel inhibitor? calcium channel blocker
Carbamazepine, lamotrigine, gabapentin.
37
Atypical facial pain
Middle aged women - Depressed or anxious - Daily, constant, poorly localised deep aching or burning. - Not piercing pain [ exclude any nerve pain] - No sensory loss - Pathology in teeth, temporomandibular joints, eye, nasopharynx and sinuses must be excluded.
38
treatment for : | Atypical facial pain
Unresponsive to conventional analgesics, opiates and nerve blocks. - Mainstay of management tricyclics.
39
Post traumatic headache who? mechanims?
High in victims of car accidents Low in perpetrators of car accidents Low in sports injuries - Neck, Scalp, Vasodilation, depression
40
What is the most common cause of new headache in older patients?
Cervical Spondylosis
41
Cervical Spondylosis
- Bilateral - Occipital pain radiates forwards to the frontal region - steady pain - worsened by neck movements - steady pain
42
management of | Cervical Spondylosis
Rest, deep heat, massage | Anti-inflammatory analgesics
43
Vascular and Circulatory causes of headaches:
- Subarachnoid Haemorrhage [circle of willis] - Acute intracerebral haemorrhage - Raised Intracranial Pressure (ICP) > - Cerebral Venous Thrombosis - Chronic subdural haemorrhage [venous] - Temporal Arteritis [temporal artery]
44
3 most common types of Primary headaches?
Migraine , Cluster , Tension
45
Migraine | common characteristic
``` repeat attacks has triggers unilateral pulsating visual vertigo motion sickness ```
46
Migraine phases | 5
Prodrome : Changes in mood, urination, fluid retention, food craving, yawning Aura (can occur wo) : Visual, sensory, weakness, speech arrest Headache: pain , nausea, photophobia Resolution : rest / sleep Recovery :mood disturbed, food intolerance, feeling hungover - 48 hours or so
47
Define visual aura | Migraine
Scintillations and blindspots
48
Treatment for | Acute Migraine attack
NSAIDS: aspirin / ibuprofen Anti-emetic: metoclopramide [anti nausea] Vasoconstrictors synergise with NSAIDS Triptans : ssragonist : triptans work by stimulating serotonin, a neurotransmitter found in the brain, to reduce inflammation and constrict blood vessels, thereby stopping the headache or migraine Nap
49
Migraine | long term treatment
dietary, environmental, hormonal, weather, dehydration, stress Drink 2 litres water/day Avoid caffeinated drinks Don’t skip meals. Fresh food. Avoid ready meals & take-aways Don’t oversleep or have late nights. Electronics downstairs. Analgesic abuse
50
Migraine prophylaxis over the counter
``` feverfew coenzyme Q10 riboflavin magnesium EPO nicotinamide ```
51
MIgraine treatments prophylaxis
``` TCA's Beta blockers Serotonin antagonists calcium channel blockers anticonvulsants Suppress ovulation (progesterone only pill or implant/injection greater occipital nerve blocks ```
52
Migraine wonder drug? | also for episodic migraine, chronic migraine or cluster headache
Erenumab CGRP mAbs: targets calcitonin gene related peptide or its receptor 8 a month to 4/5 a month injectable
53
Tension type headache
Bilateral 'Head in a vice' Nsaids : naproxen , diclofenac Paracetamol TCAs SSRIs - less effective
54
Cluster
Severe unilateral 15-180 mins Trigeminal autonomic cephalgia ipsilateral : Conjunctival redness and/or lacrimation Nasal congestion and/or rhinorrhoea Eyelid oedema restlessness miosis / ptosis site of pain most common : EYE , FOREHEAD , TEMPLE
55
Cluster : headache | Acute
Acute : Inhaled oxygen. Oxygen inhibits neuronal activation in the trigeminocervical complex S/C or Nasal Sumatriptan
56
Prophylactic treatment Cluster what type of drugs is Verapamil? : steroid example? drug which inhibits glutamate[nmda downregulations] and upregulates inhibitory NT GABA increases GABA blocks voltage-dependent sodium and calcium channels
``` calcium channel blocker Prednisolone : steroid Lithium Valproate Gabapentin Topiramate Pizotifen ```
57
how does erenumab work? | what is it used for?
migraines | monoclonal antibody which blocks calcitonin gene-related peptide
58
``` Neck disease Temporal arteritis Benign intracranial hypertension Cerebral tumour Cerebral venous sinus thrombosis ``` these present as what type of headache?
Dull
59
temporal arteritis pathophysiology, imaging and treatment?
temporal artery is inflamed serious and needs clinical attention straight away ultrasound : see inflamed temporal artery give HIGH dose steroids [anti-inflammatory] and aspirin [antiplatelets /avoid clot] impact posterior ciliary arteries = causing blindness
60
migraine drug which 'blocks serotonin (or 5HT) receptors in the brain. Blocking these receptors stops blood vessels in the brain from dilating and contracting. Pizotifen also blocks histamine receptors in the brain. Histamine is responsible for causing inflammation and widening of blood vessels'
Pizotifen for cluster headaches

Year 2 BRS Neuro (8 decks)

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