Headache I Flashcards
(39 cards)
What is a headache?
What are the 3 categorical causes for headaches?
A symptom - a common symptom
Structural, Pharmacological, Psychological
What are the 5 different headache pattern categories?
Acute single headache Dull headache that increases in severity over time Dull headache, unchanged over months Recurrent headaches Triggered headaches
What are some possible causes of each of the headache categories?
Acute single headache Dull headache that increases in severity over time Dull headache, unchanged over months Recurrent headaches Triggered headaches
Acute single headache - sinusitis, migraine, following a head injury, subarachnoid haemorrhage, meningitis, tumour, dugs, toxins, stroke, low BP
Dull headache that increases in severity over time - usually benign, overuse of medication, OCP, HRT, neck disease, temporal arteritis, benign intracranial hypertension, cerebral tumour, cerebral venous sinus thrombosis
Dull headache, unchanged over months - chronic tension headache, depressive, atypical facial pain
Recurrent headaches - migraine, cluster headache, episodic tension headache
Triggered headaches - coughing, straining, exertion, coitus, food and drink
What are some red flags for headaches?
Onset - thunderclap (like they have been hit on the head), acute. subacute
Meningism (linings of the brain are irritated) - photophobia, stiff neck, vomiting
Systemic symptoms - fever, rash, losing weight
Neurological symptoms or focal signs - visual loss, confusion, seizures, double vision, CN III palsy, Horner’s syndrome
Orthostatic - better lying down
Strictly unilateral - same headache pain in exactly the same spot
What are some focal signs that can come with headaches?
Double Vision
Oculomotor palsy
Horner’s syndrome - damage to sympathetic nerves of the face = droopy eyelid and no sweating of the face
What are the headache symptoms of a subarachnoid haemorrhage?
What are subarachnoid haemorrhages usually caused by?
Sudden generalised headache - like they have been hit on the head
Develop meningism - stiff neck and photophobia
Most caused by ruptured aneurysms, some due to arteriovenous malformations, some unexplained
How are subarachnoid haemorrhages treated?
Around 50% fatal so:
Vasospasm may stop the leak
Nimodipine and BP control
High risk of a further bleed
Early neurosurgical assessment will confirm the bleed
and establish the cause
CT brain (to find bleed), Lumbar puncture (spinal fluid = contain blood) and angiogram (blood may obscure aneurysm on CT scan)
Aneurysm found and platinum coil fed up the vessels in the groin, to the cerebral arteries, and platinum coil is used to plug the aneurysm to prevent it from being filled with blood again
What is the issue with raised intracranial pressure (ICP)?
How does it lead to death?
Skull = fixed
Bleed takes up space
Brain can only tolerate up to a certain volume, before the pressure begin to increase exponentially
Brain gets pushed against areas of weakness e.g. brain squeezed out of the skull via foramen magnum
Brainstem = squashed = loss of blood supply = death (as brainstem is responsible for control of breathing, HR etc.)
How can a headache arise die to pathologies in the large arteries of the neck e.g. carotid artery, vertebral artery etc.
Carotid and vertebral arteries made up of many layers of tissue
Layers of tissue may split - blood collects in the split
Results in turbulent flow in the tube
Vertebral = pain back of neck and occipital lobe
Carotid = pain side of neck and front of head
How are pathologies in the neck arteries diagnosed?
How are these treated and why??
Diagnosed via - MRI, MR angiogram, ultrasound scan of the blood vessel to look for turbulent flow, doppler (dye injection to look at vessel)
Turbulent flow = sticky blood = easily clotting blood, therefore:
treated with: aspirin, anti-coagulation (prevention of stroke)
What is a chronic subdural haemorrhage?
How it is treated?
Collection of blood on the brain’s surface, under the dura
Forms after several days or weeks after bleeding starts
Shows up black on the MRI - old / rotting blood
(White = fresh blood)
Drill a hole into the skull and drain the blood
What is Temporal Arteritis?
How does it present clinically?
Most common in females aged over 55 - inflammation of arteries in the head and neck e.g. temporal artery (involvement of posterior ciliary arteries = blindness)
Constant unilateral headache, scalp tenderness, pain in the jaw when chewing (claudication), some shoulder muscle tenderness
How is Temporal Arteritis diagnosed?
Blood test - elevated ESR (erythrocyte sedimentation rate) and CRP
Temporal artery inflamed and torturous (lost their pulse)
Visible on ultrasound (halos seen around the arteries)
Biopsy - shows inflammation (disruption of the internal elastic lamina) and giant cells (many nuclei)
How is Temporal Arteritis treated?
Steroids - anti-inflammatory
Aspirin - prevents stroke
Course of 3-4 years
What is Cerebral Venous Thrombosis (CVT)?
How does it present clinically?
Thrombosis in dural venous sinus or cerebral vein
Unusual amount of headache due to raised ICP
Vein = fragile, therefore increased pressure = haemorrhage = venous infarcts
What can cause CVT to develop?
Due to sticky blood i.e. thrombophilia
Pregnancy
Dehydration
Behcets (blood vessel inflammation throughout the body)
What is meningitis?
How does it present clinically?
Infection of the meninges
Cause headaches - malaise, headache, FEVER (give away), neck stiffness, photophobia, confusion, alteration of consciousness
What can cause meningitis?
Viral - Coxs, ECHO, Mumps, EBV
Bacterial - most worrying, e.g. TB, pneumococci, haemophilus, meningococci
Fungal - usually in immunocompromised patients e.g. cryptococci
Granulomatous - infections that cause granulomas e.g. Lyme disease, Brucella, Syphillis, Sarcoid
Cancer cells - sugarcoating the meninges causing meningitis
Are meningitis patients diagnosed first or treated first?
What is the treatment for meningitis?
What can be used to diagnose meningitis?
Treat then diagnose - meningitis can kill v. quickly
Antibiotics
Blood and urine cultures
CT or MRI scan - looks for swelling
Lumbar puncture to look for: increased WCC, decreased glucose, antigens, cytology (abnormal cells), grow a bacterial culture
Why must an MRI or CT scan always be done before a lumbar puncture in meningitis patients?
Inflamed meninges and cerebral oedema = high pressure environment
Inserting needle into a patient’s back decompresses the high pressure, brain goes hurtling through foramen magnum
What is Herpes Simplex Encephalitis?
Usually affects temporal lobe
What is sinusitis?
How does it present clinically?
Malaise, headache, fever, blocked nasal passages, loss of vocal resonance, anosmia, local pain and tenderness, blocked nose
Frontal pain - worst 1-2 hours after rising, clears up during the afternoon
How can sinusitis be diagnosed?
Xray - sinus shows up more greyish, compared to normal air in sinus shows up as black
What is a brain tumour?
How does it present clinically?
Tumour in the brain
Tumour and swelling = raised ICP
Painful headaches
May have papilloedema at the back of their eyes
