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BRS Year 2 > Headaches > Flashcards

Headaches Flashcards

1
Q

what are all the causes of acute single headaches?

A 
febrile illness, sinusitis
first migraine attack
post trauma headache
subarachnoid haemorrhage
meningitis
tumour
drugs
toxins
stroke
thunderclap
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2
Q

what are all the causes of dull headaches increasing in severity?

A 
overuse of medication
contraceptive pill
neck disease
temporal arteritis
benign intracranial hypertension
cerebral tumour
cerebral venous sinus thrombosis
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3
Q

what are all the causes of a dull headache, unchanging over months

A

chronic tension headache

depressive, atypical facial pain

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4
Q

what are all the causes of a triggered headache?

A

coughing, straining, exertion
sexual intercourse
food and drink

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5
Q

what are all the causes of recurrent headaches?

A

migraine
cluster headache
episodic tension headache
trigeminal or post hepatic neuralgia

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6
Q

what are the red flag signs of headaches?

A

acute/subacute and thunderclap headaches
photophobia, phonophobia, stiff neck, vomiting
fever, rash, weight loss
vision loss, confusion, seizures, hemiparesis, double vision, 3rd nerve palsy, Horner syndrome, papilloedema
orthostatic
unilateral

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7
Q

what is horners syndrome?

A

sympathetic supply to eyes disrupted

eye looks pushed in, pupil smaller, eyelid droopy

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8
Q

how fatal are subarachnoid haemorrhages?

A

~50% instantly fatal

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9
Q

how do you assess for the possibility of a subarachnoid haemorrhage?

A 
neurological assessment
CT brain
lumbar puncture (pink/red colour - RBC and xanthochromia)
MRA
angiogram
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10
Q

how do you treat a burst aneurysm?

A

filled with platinum coils via catheter

used to be clipped or wrapped

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11
Q

what is the cause of death following an acute intracerebral bleed?

A

coning - raised intracranial pressure forcing the brain out of weak areas e.g tentorium/falsine herniation

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12
Q

what is papilloedema?

A

optic disk swelling due to raised ICP

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13
Q

what is the mechanism of coning?

A

the brain can handle a small increase of fluid volume without increasing pressure until it hits a limit, pressure increases exponentially, causing herniation

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14
Q

what are the investigations for a carotid or vertebral dissection?

A

MRI/MRA
doppler ultrasonography
angiography

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15
Q

what is the pain distribution for a carotid dissection?

A

headache and neck pain - phantom of opera

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16
Q

what is more likely, carotid or vertebral dissection?

A

carotid

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17
Q

how should you treat carotid or vertebral dissection?

A

aspirin or anticoagulation x 6/12

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18
Q

how does a chronic subdural haemorrhage present?

A

long standing one sided headache, limb weakness on one side

commonly elderly patients

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19
Q

how do you treat a subdural haemorrhage?

A

drill a hole to release blood buildup

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20
Q

what is temporal arteritis

A

inflammation of the temporal arteries, often with presence of giant cells

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21
Q

what is the typical patient for temporal arteritis?

A

females over 55

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22
Q

what is the presentation of temporal arteritis?

A

constant unilateral headache, scalp tenderness, jaw claudication
possible shoulder pain
visual disturbances acutely

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23
Q

what investigations can be done for suspected temporal arteritis?

A

elevated ESR and CRP
temporal artery visibly inflamed on ultrasound
biopsy showing giant cells

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24
Q

how can temporal arteritis cause blindness?

A

involvement of posterior ciliary arteries

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25
how should temporal arteritis be treated?
high dose steroids and aspirin
26
what is cerebral venous thrombosis?
thrombosis in dural venous sinus or cerebral vein causes lack of venous drainage and therefore raised ICP
27
what are the causes of cerebral venous thrombosis?
``` non-territorial ischaemia haemorrhage thrombophilia pregnancy dehydration Behcets ```
28
what are all the types of meningitis?
``` viral bacterial - pneumococci most common tuberculosis fungal granulomatous syphilis carcinomatous ```
29
what are the presenting symptoms of meningitis?
``` malaise headache fever neck stiffness photophobia confusion alteration of consciousness ```
30
what is the main thing to remember with meningitis?
treat then diagnose
31
what are the investigations for suspected meningitis?
CT or MRI lumbar puncture blood and urine culture
32
what would a lumbar puncture in someone with meningitis show?
``` increased white cell count decreased glucose antigens cytology bacterial culture possible ```
33
what are the first line treatments for suspected meningitis?
IV antibiotics sometimes corticosteroids fluids and oxygen
34
what are the presenting symptoms for sinusitis?
``` malaise headache fever blocked nasal passages, anosmia loss of vocal resonance local pain/tenderness frontal pain in morning, resolves slowly ```
35
how do you investigate brain tumours?
head CT or MRI
36
what is idiopathic intracranial hypertension?
buildup of pressure around the brain for no apparent cause | pseudotumour cerebri
37
who is most affected by idiopathic intracranial hypertension?
young obese women
38
what are the symptoms of idiopathic intracranial hypertension?
``` headache, visual obscurations, diplopia, tinnitus, papilloedema, possible visual field loss especially upon standing ```
39
how can you treat idiopathic intracranial hypertension?
hormones, steroids, antibiotics, vitamin E | weight loss, diuretics, optic nerve sheath decompression, lumboperitoneal shunt, stenting of stenosed venous sinuses
40
how does raised ICP appear on a head CT?
cerebral oedema with ventricle and sulci effacement with no mass lesion
41
what are low pressure headaches?
rupture of meninges (usually dura) causes CSF to leak
42
how do low pressure headaches typically occur?
traumatic post lumbar puncture or spontaneously
43
how do you treat low pressure headaches?
rehydration by fluids, caffeine, blood patch
44
what is chiari malformation?
normal brain but sits low in the skull from birth
45
how does chiari malformation cause headaches?
cerebellar tonsils descend through the foramen magnum, descend further upon coughing causing tugging of the meninges
46
how do you manage chiari malformation?
treat any underlying cough/sneeze | can do surgery to remodel the skull base
47
what is obstructive sleep apnoea?
walls of the throat relax during sleep interrupting normal breathing
48
what is a typical presentation of obstructive sleep apnoea?
high BMI, history of loud snoring and apnoeic spells
49
what are the symptoms of obstructive sleep apnoea?
hypoxia, co2 retention, non-refreshing sleep, depression, impotence, work difficulties, morning headaches
50
why does obstructive sleep apnoea cause morning headaches?
buildup of CO2 causes vasodilation of brain vessels
51
how do you diagnose obstructive sleep apnoea?
requires sleep study
52
what are the treatments for obstructive sleep apnoea?
nocturnal NIV, surgery
53
what is trigeminal neuralgia?
facial/neck pain (electric shock-like) in distribution of sensory nerve due to irritation of trigeminal
54
how is trigeminal neuralgia triggered?
by innocuous stimuli e.g chewing, something touching teeth
55
how is trigeminal neuralgia caused?
neurovascular conflict at point of entry of nerve to pons (nerve touches/is pinched by vessel) can be a symptom of MS
56
what is the treatment for trigeminal neuralgia?
carbamazepine, lamotrigine, gabapentin (anti-convulsants) | posterior fossa decompression
57
what is atypical facial pain?
daily, constant, poorly localised deep aching or burning in facial or jaw bones (may extend to neck ear or throat) no numbness or sensory loss
58
what is the typical presentation of atypical facial pain?
middle aged woman who is depressed or anxious, with daily constant poorly localised pain
59
how should you diagnose atypical facial pain?
exclude pathology in teeth, TMJ, eye, nasopharynx, sinuses
60
how do you manage atypical facial pain?
tricyclics
61
what is a post traumatic headache?
no previous history of headaches, dependent upon nature of head injury
62
what is the prevalence of post traumatic headaches?
high in victims of car accidents low in perps of car accidents low in sports injuries (psychological aspect?)
63
how do you manage post traumatic headaches?
explain the cause of headache prevent analgesic abuse NSAIDs tricyclic antidepressants (amitriptyline)
64
what is cervical spondylosis?
bilateral steady pain worsened by moving the neck, caused by narrowing of the joint space due to worn discs
65
what is the most common cause of new onset headaches in elderly?
cervical spondylitis
66
how do you manage cervical spondylitis?
rest, deep heat, massage, antiinflammatory analgesics | chiropraction not recommended
67
typical SOCRATES for a migraine
S- unilateral O- sudden recurrence/intensification of symptoms C - pulsating/throbbing R- none A- nausea/vom, aura (lights, halluc), tingling, tinitis, paralysis, photophobia, phonophobia T - 4-72 hrs E - physical activity, foods, bad sleep, hormones S - moderate/severe
68
treatment for acute migraine
aspirin nasal sprays short naps TMS
69
lifestyle recommendations for migraines
``` dietary - fresh foods, avoid MSG takeaways hormonal - OCP drink plenty of water dont have late nights or oversleep avoid caffeine ```
70
prophylaxis for migraines
``` OTC - magnesium etc TCAs - amitriptyline beta blockers - propanolol serotonin agonists - PIZOTIFEN (very effective) anticonvulsants botox suppress ovulation - OCP ERENUMAB injections monthly ```
71
how is erenumab used in treating headaches?
prophylactic injections for migraines 2x month | monoclonal antibody
72
what are the phases of a migraine?
``` prodromal aura headache resolution recovery ```
73
what is the prodromal phase of a migraine
``` changes in mood inc urination fluid retention food craving yawning ```
74
what is the aura phase of migraine
``` visual or sensory numbness/tingling weakness speech arrest hallucinations ```
75
what is the headache phase of migraine
head and body pain nausea photophobia phonophobia
76
what is the recovery like from a migraine
mood disturbed food intolerance feeling hungover for about 48hrs
77
what are positive and negative auras
positive - flashes, zigzags | negative - blindspots
78
what is the SOCRATES of a tension headache
``` S - generalised, bilateral O - gradual onset usually C - dull, tight band-like R - neck/shoulders A- pericranial muscle tenderness, NO NAUSEA/vomiting/photophobia etc T - 3-4hrs E - analgesics, rest S - moderate ```
79
treatments for tension headache
analgesics - NSAIDs preferred, paracet | if chronic, TCAs and SSRIs
80
when should TCAs/SSRIs be considered for tension headaches?
if chronic - 7-9 headache days/month
81
SOCRATES for cluster headaches
S - strictly unilateral, behind eye common, usually same side each time O- acute onset, same time of day C - excruciating, steady pain R - none A - eye watering, nose blocked, ptosis, eye redness, sweating, restlessness (autonomic features), photophobia, phonophobia T - 15min-3hr, same length each time, often nocturnal, come in clusters with long remissions E - S - worst pain ever experienced
82
acute management of cluster headaches
high flow O2 | serotonin agonist - Sumatriptan (subcut or nasal)
83
what autonomic disorder is associated with cluster headaches
horners syndrome
84
prophylaxis of cluster headaches
``` verapramil prednisolone lithium valproate gabapentin topiramate pizotifen ```
85
differences between cluster and migraine
women migraine, men cluster migraine longer duration but cluster have long remissions and daily attacks nausea in migraine not cluster pain in migraine is pulsating, cluster is steady migraine has aura, cluster has ptosis etc migraine patients lie in dark, cluster patients pace around

BRS Year 2 (67 decks)

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