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Neurology and Neuroscience > Headache > Flashcards

Headache Flashcards

1
Q

List patterns of headache.

A 
acute single headache
dull headache, increasing in severity
dull headache, unchanged over months
recurrent headache
triggered headache
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2
Q

Possible explanations for dull headache increasing in severity?

A

usually benign, medication overuse, HRT/contraceptive pill, neck disease, temporal arteritis, benign intracranial hypertension, cerebral tumour, cerebral venous sinus thrombosis

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3
Q

Possible explanations for acute single headache?

A

febrile illness, sinusitis, 1st attack of migraine, after head injury, subarachnoid haemorrhage, meningitis, tumour, drugs, toxins, stroke, thunderclap

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4
Q

Possible explanations for dull headache unchanged over months?

A

chronic tension headache

depressive, atypical facial pain

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5
Q

Possible explanations for recurrent headaches?

A

migraine
cluster headache
episodic tension headache
trigeminal or post herpetic neuralgia

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6
Q

Possible explanations for triggered headaches?

A

coughing, straining, exertion
coitus
food and drink

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7
Q

What are red flags for headaches?

A

onset: thunderclap, acute, subacute
meningism: photophobia, phonophobia , stiff neck, vomiting
systemic symptoms, neurological symptoms, orthostatic, strictly unilateral

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8
Q

List examples of focal signs.

A 
double vision
Horner syndrome
3rd nerve (oculomotor) palsy
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9
Q

list vascular and circulatory causes of headache

A

subarachnoid haemorrhage, coiling an aneurysm, acute intracerebral bleed, raised intracranial pressure, papilloedema, carotid and vertebral arteries, chronic subdural haemorrhage, temporal arteritis, cerebral venous thrombosis

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10
Q

list infective causes of headache

A

herpes simplex encephalitis
meningitis
sinusitis

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11
Q

list causes of headaches involving intracranial pressure

A

brain tumour
idiopathic
chiari malformation
obstructive sleep apnoea

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12
Q

list facial pain causes of headache

A

trigeminal neuralgia

atypical facial pain

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13
Q

list traumatic causes of headache

A

post traumatic headache

management of post traumatic headache

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14
Q

list cervicogenic pain causes of headache

A

cervical spondylosis

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15
Q

symptoms of subarachnoid haemorrhage

A

sudden generalised headache, meningism - stiff neck and photophobia

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16
Q

most subarachnoid haemorrhages are caused by?

A

ruptured aneurysm

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17
Q

some subarachnoid haemorrhages are caused by?

A

arteriovenous malformations

unexplained

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18
Q

what % of subarachnoid haemorrhages are instantly fatal?

A

50

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19
Q

what physiological action may stop the leak in a subarachnoid haemorrhage?

A

vasospasm (sudden constriction of a blood vessel)

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20
Q

list medication used to treat subarachnoid haemorrhage

A

diazepam (manage mental conditions)
amlodipine (reduce BP)
clonazepam (seizure prevention)

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21
Q

list surgical procedures used to treat subarachnoid haemorrhage

A

craniotomy

endovascular coiling

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22
Q

why is nimodipine used in subarachnoid follow up treatment?

A

prevention of problems after a subarachnoid haemorrhage > high risk of further bleed

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23
Q

imaging used in assessment of subarachnoid haemorrhage

A

CT brain
lumbar puncture (RBC and xanthochromia) and MRA
angiogram

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24
Q

what is aneurysm coiling?

A

instead of clipping ro wrapping, fill the aneurysm with platinum coils

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25
cause of acute intracerebral bleed?
coning
26
coning refers to?
the herniation of the brain through the foramen magnum
27
mechanism of coning
raised intracranial pressure
28
what is papilloedema?
optic disc swelling due to raised intracranial pressure
29
headache can arise due to pathology of what large neck arteries?
vertebral | carotid
30
mean age for carotid/vertebral artery dissection
40
31
which is more common: carotid or vertebral artery dissection?
carotid
32
carotid and vertebral artery dissection can be divided into what causative categories?
traumatic | spontaneous
33
imaging for carotid + vertebral artery dissection
MRI/MRA Doppler angiography
34
treatment for carotid and vertebral artery dissection
aspirin or anticoagulation
35
epidemiology of temporal arteritis
>55 | 3x commoner in females
36
temporal arteritis presents as?
constant unilateral headache, scalp tenderness, jaw claudication 25% present with polymyalgia rheumatica - proximal muscle tenderness
37
involvement of the posterior ciliary arteries in temporal arteritis causes?
blindness
38
what is notable in lab results of temporal arteritis?
elevated ESR and CRP
39
describe the temporal artery in temporal arteritis
inflamed | tortuous
40
is the state of the temporal artery visible on ultrasound?
yes
41
biopsy shows what in temporal arteritis?
inflammation and Giant cells
42
treatment for temporal arteritis
high dose steroids | aspirin
43
cerebral venous thrombosis
thrombosis in dural venous sinus or cerebral vein
44
risk factors for cerebral venous thrombosis
thrombophilia pregnancy dehydration Behcet's
45
causes of meningitis
viral, bacterial, tuberculous, fungal, granulomatous, syphilis, carcinomatous
46
how does meningitis present?
malaise, headache, fever, neck stiffness, photophobia, confusion, alteration of consciousness
47
herpes simplex encephalitis causes what changes in the brain?
haemorrhagic changes in the temporal lobes
48
what is the approach for meningitis?
treat then diagnose
49
treatment for meningitis
antibiotics
50
investigations for meningitis
blood and urine culture lumbar puncture: antigens, cytology, bacterial culture CT or MRI
51
lab findings for meningitis
increased white cell count | decreased glucose
52
classic findings on imaging of bacterial meningitis
cerebral oedema with effacement of ventricles and sulci and inflamed meninges
53
how does sinusitis present?
malaise, headache, fever, blocked nasal passages, loss of vocal resonance, anosmia, nasal or postnasal catarrh, local pain and tenderness
54
describe the pattern of pain in sinusitis
frontal pain characteristically starts 1-2 hours after rising and clears up during the afternoon
55
imaging findings in sinusitis
opacification of the paranasal sinus
56
what is pseudotumor cerebri?
increased pressure inside the skull for an unknown reason
57
pseudomotor cerebri is also known as?
idiopathic intracranial hypertension
58
pseudotumor cerebri often presents in what population?
young obese women
59
pseudotumor cerebri presents as?
Headache, visual obscurations, diplopia, tinnitus | Papilloedema, +/- visual field loss
60
treatment of pseudotumor cerebri
weight loss, diuretics, optic nerve sheath decompression, lumboperitoneal shunt, stenting of stenosed venous sinuses
61
what is the cause of low pressure headache?
CSF leak due to tear in dura
62
low pressure headache occurs in response to?
spontaneous or traumatic post lumbar puncture
63
treatment for low pressure headache
rehydration caffeine blood patch
64
imaging findings for low pressure headache
meningeal enhancement
65
what is the chiari malformation?
cerebellar tonsils descend through foramen magnum
66
when a patient with chiari malformation coughs, what happens?
brain tissue descends further and tugs on the meninges causing cough headache
67
imaging findings with chiari malformation
normal brain that just sits very low within the skull
68
risk factors for obstructive sleep apnoea
often characteristic body habitus, history of loud snoring and apnoeic spells
69
consequences of obstructive sleep apnoea
hypoxia, CO2 retention, non-refreshing sleep, depression, impotence, poor performance at work
70
diagnosis + treatment of obstructive sleep apnoea
require sleep study | nocturnal NIV, surgery
71
describe the pain in trigeminal neuralgia
Electric shock like pain in the distribution of a sensory nerve
72
trigeminal neuralgia is often triggered by?
innocuous stimuli
73
which divisions of the trigeminal can be affected by neuralgia?
any division
74
where is the neurovascular conflict in trigeminal neuralgia?
at the point of entry of the nerve into the pons
75
trigeminal neuralgia can be a symptom
multiple sclerosis
76
treatment of trigeminal neuralgia
carbamazepine, lamotrigine, gabapentin | posterior fossa decompression
77
atypical facial pain presents most commonly in what population?
middle aged women
78
how does atypical facial pain present?
Daily, constant, poorly localised deep aching or burning. Facial or jaw bones, but may extend to the neck, ear or throat. Not lancinating. Not conforming to the strict anatomical distribution of any nerve. No sensory loss
79
for a diagnosis of atypical facial pain, pathology in what must be excluded?
in teeth, temporomandibular joints, eye, nasopharynx and sinuses
80
atypical facial pain is unresponsive to?
conventional analgesics, opiates and nerve blocks
81
atypical facial pain is managed by?
tricyclics
82
post traumatic headache can occur after?
car accidents | sports injuries
83
treatment of post traumatic headache
NSAIDs - ibuprofen, naproxen | Tricyclic antidepressants - amitriptyline
84
what is the commonest cause of new headache in older patients?
cervical spondylosis
85
how does cervical spondylosis present?
usually bilateral, occipital pain can radiate > frontal region, steady pain, no nausea or vomiting, worsened by moving the neck
86
imaging findings of cervical spondylosis
narrowing of joint space due to worn disc
87
management of cervical spondylosis
Rest, deep heat, massage. Anti-inflammatory analgesics. Over-manipulation may be harmful.

Neurology and Neuroscience (15 decks)

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