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Year 3 - GP Block > Headaches > Flashcards

Flashcards in Headaches Deck (51):
1

Is a rapid onset headache typically concerning?

Yes

2

What can cause a rapid onset headache?

Sub-arachnoid haemorrhage

Meningitis

Encephalitis

3

How is a sub-arachnoid haemorrhage often described?

‘Worst ever headache’

‘Thunderclap headache’

4

Where in the head does a headache caused by a sub-arachnoid haemorrhage typically occur?

Occipital region

5

How does a sub-arachnoid haemorrhage affect consciousness?

Decreased consciousness

6

What can a sub-arachnoid haemorrhage cause within the cranium?

Raised ICP

7

What are some signs of raised ICP that can be seen in GP?

Papilloedema on fundoscopy

History of nausea and vomiting

Double vision (diplopia)

8

Why does raised ICP cause double vision?

Raised ICP disproportionately affects the VI cranial nerve

9

Why does ICP disproportionately affect the VI cranial nerve?

Because it has the longest intracranial course

10

What is the name of the VI cranial nerve?

Abducens

11

What muscle is innervated by the abducens?

Lateral rectus

12

What other symptoms accompany meningitis?

Fever

Photophobia

Purpuric, non-blanching rash

Neck stiffness

13

What other symptoms accompany encephalitis?

Odd behaviour

Fits

Fever

14

How should suspected encephalitis be investigated?

Urgent CT scan

15

What can cause a gradual onset headache?

Sinusitis

Tropical infections

Venous sinus thrombosis

Intra-cranial hypotension

16

What sign may suggest venous sinus thrombosis?

Papilloedema

17

What can make sinusitis pain worse?

Bending over

18

How is a headache caused by sinusitis described?

Dull, constant headache in the distribution of the nasal sinuses

19

What does palpation of the area over inflamed sinuses elicit?

Tenderness

20

Why might a tropical infection be a suspected cause of a headache?

A travel history with accompanying flu-like symptoms

21

What tropical infection can cause headaches?

Typhus

22

What can cause intra-cranial hypotension?

CSF leakage (possibly due to lumbar puncture)

23

When is a headache due to intracranial hypotension worse?

When standing up

24

What do recurrent (not ongoing) headaches typically suggest?

Usually benign

25

What can cause recurrent headaches?

Migraines

Cluster headaches

Trigeminal neuralgia

26

How does a cluster headache present?

The most disabling of primary headaches

Pain around the eye

Watery/bloodshot eye

Unilateral

27

What can be used to treat cluster headaches?

100% O₂ for ~15 mins through non-rebreath mask

Sumatriptan

29

How does trigeminal neuralgia present?

Unilateral

Stabbing pain

Typically affects maxillary and mandibular divisions

30

How do migraines typically present?

Preceded by an aura

Followed within 1 hr by unilateral throbbing headache

31

What types of aura can precede a migraine?

Visual - melting or jumbling of lines or dots, or hemianopia

Somatosensory - parasthesia from fingers to face

Motor - dysarthria, ataxia, or dysphasia

32

What percentage of the population do migraines affect?

15%

34

What mnemonic can be used to remember migraine triggers?

CHOCOLATE

35

What does C stand for in the CHOCOLATE mnemonic?

Chocolate/Cheese/Caffiene

36

What does H stand for in the CHOCOLATE mnemonic?

Hangovers

37

What does O stand for in the CHOCOLATE mnemonic?

Orgasms/oral contraceptives

38

What does C stand for in the CHOCOLATE mnemonic?

Chocolate/Cheese/Caffiene

39

What does O stand for in the CHOCOLATE mnemonic?

Orgasms/Oral contraceptives

40

What does L stand for in the CHOCOLATE mnemonic?

Lie-ins

41

What does A stand for in the CHOCOLATE mnemonic?

Alcohol

42

What does T stand for in the CHOCOLATE mnemonic?

Travel

43

What does E stand for in the CHOCOLATE mnemonic?

Exercise

44

What are migraines associated with?

Obesity

Family history

45

How are migraines diagnosed?

Clinical diagnosis based on history:

If no aura: ≥5 headaches lasting 4-72 hours + N&V + any 2 of:

Pulsating
Unilateral
Impairs (or worsened by) regular activity

46

What is a chronic progressive headache suggestive of?

Raised ICP due to:

Haemorrhage

Tumour

Aneurysm

47

A head ache with eye pain +/- visual loss may suggest what?

Acute glaucoma

48

How should acute glaucoma be handled?

Immediate referral

49

What can cause headaches?

Food

Sex

Analgesia

Trauma

50

What part of a social history is it important to identify when thinking about headaches?

Possible stressors

51

What part of a drug history is it important to identify when thinking about headaches?

Medication overuse

52

How can migraines be treated?

Avoid triggers

Prophylactic treatment - 1st line = propranalol

During attack - oral triptan + NSAID or paracetamol

Non-pharmacological therapies

53

What percentage of migraines can the CHOCOLATE mnemonic be applied to?

50%