headache and CNS infections

Question 1

what are headache “red flags”

Answer 1

-severity of pain
-sudden onset
-increase in intracranial pressure
-visual changes
-confusion
-loss of consciousness
-meningism (stiff neck), fever, rash
associated history e.g cancer HIV- at risk of cns infections

Question 2

what are primary headaches?

Answer 2

-unpleasant but not lasting damage

Question 3

list the examples of primary headaches

Answer 3

-tension headaches
-migraine
-cluster headache
-trigeminal neuralgia
-medication overuse headache

Question 4

describe a tension headache

Answer 4

-gradual onset
-symmetrical
-stress related
-worse at end of the day

Question 5

what is the treatment for tension headaches

Answer 5

conventional analgesia

Question 6

describe a migraine

Answer 6

-pre headache aura- visual problems/focal symptoms
-migraine within 1 hr- throbbing on one side, nausea/vomitting, photophobia

Question 7

what is the treatment for migraines?

Answer 7

-conventional analgesia
-metoclopramide
-serotonin antagonists

Question 8

describe a cluster headache

Answer 8

-common in males/smokers
-episodic
-sever pain around eye

Question 9

what is the treatment for cluster headaches

Answer 9

-“triptans”
-oxygen

Question 10

describe trigeminal neuralgia

Answer 10

-severe stabbing pain
-affects 2 branches of nerve
- evoked by light touch

Question 11

what is the treatment for trigeminal neuralgia?

Answer 11

-carbamazepine
-surgery

Question 12

describe medication overdose headache

Answer 12

-chronic headaches
-common in those taking opiates, triptans and paracetamol

Question 13

what is the treatment for medication overdose headache?

Answer 13

medication withdrawal

Question 14

what are secondary headaches?

Answer 14

headaches associated with mortality and permanent disability

Question 15

what is giant cell arteritis?

Answer 15

inflammation of the arteries in the temple
-affects branches of external carotid artery

Question 16

what are the symptoms of giant cell arteritis?

Answer 16

-headache
-scalp tenderness
-loss of temporal pulse
-jaw claudication- not enough blood supply to jaws of mastication
-can lead to blindness as it affects retinal artery

Question 17

what is the risk of giant cell arteritis?

Answer 17

risk of blindness- refer to gp

Question 18

what is glaucoma?

Answer 18

causes an increase in pressure of the eye

Question 19

what are the symptoms of glaucoma?

Answer 19

-reduced vision
-constant eye ache
-red cloudy eye
this requires an urgent referral

Question 20

what are two CNS infections?

Answer 20

meningitis and encephalitis

Question 21

what is meningitis an infection of?

Answer 21

infection of inner lining of the brain

Question 22

what are symptoms of bacterial meningitis

Answer 22

-headache
-photophobia
-meningism - neck stiffness
-fever
-rash
-nausea
-impaired consciousness

Question 23

what is the treatment for bacterial meningitis?

Answer 23

-hospitalisation
-antibiotics
-prophylaxis for contacts

Question 24

how is meningitis investigated?

Answer 24

-lumbar puncture
-brain imaging
-blood cultures

Question 25

viral meningitis is less serious than bacterial meningitis- what are the symptoms of viral meningitis?

Answer 25

-headache
-meningism- neck stiffness
-photophobia

Question 26

what is encephalitis?

Answer 26

a viral infection causing inflammation of the parenchyma (whole brain)

Question 27

what are the symptoms of encephalitis?

Answer 27

-headache
-viral infection
-change in personality
-seizures

Question 28

how is encephalitis investigated?

Answer 28

EEG, MRI

Question 29

how is encephalitis treated?

Answer 29

-hospitalisation
-prolonged antiviral therapy

Question 30

how is a cerebral abscess investigated?

Answer 30

CT
MRI
Biopsy

Question 31

how is a cerebral abscess treated?

Answer 31

-neurosurgically treated- drained to relieve pressure
-antibiotics