Headaches Flashcards
Give 2 risk factors for tension headache
What is concern for patient taking medication for tension headache?
- Stress, disturbed sleep
- Beware of medication over-use headaches.
Give 5 triggers of migraine
- Bright lights
- Stress
- Diet: wine, cheese, chocolate, hangover
- Lack of sleep, lie-ins
- Hormonal changes
Give the soc(r)ates of migraine
- Unilateral
- Gradual onset, paroxysmal
- Pulsating/ throbbing character
- Associated with aura, photophobia, N&V, vision changes.
- 4-72 hours
- Physical activity/ stress, noise, light
- Moderate to severe.
What are two steps in acute medical management of migraine?
What are two steps in preventative management of migraine?
Acute: Paracetamol/ NSAID. Triptans if not effective.e
Preventative:
- BB (propanolol) or antieplipetic (topiramate)
- Amitriptyline (antidepressant) if not effective
Give 3 associated symptoms of cluster headaches.
Give an examination finding of cluster headaches
- Watery/ red eye, facial flushing, nasal congestion
Examination: partial Horner’s- ptosis and miosis.
What is pathophysiology of trigeminal neuralgia?
Which condition is trigeminal neuralgia associated with?
Give 4 exacerbating factors of trigeminal neuralgia.
Caused by compression of trigeminal nerve by a loop of artery or vein.
- MS
- Exacerbated by brushing teeth, chewing, talking, shaving.
Which bacterial causes of meningitis affect the following age groups:
- neonates
- Young children
- Teenagers and young adults
- older adults, elderly.
Neonate: E. Coli, Group B Strep.
Kids: H. Influenzae, Strep. pneumoniae
Young people: Neisserial meningitidis
Older: Strep pneumoniae, listeria monocytogenes.
What is Kernig’s sign?
What is Brudzinski’s sign
Kernig: lifting leg to 90 degrees
Brudzinski: tilting head forward causes hip and knee flexion.
Give a contraindication for LP in investigation of meningitis.
What type of white cells are seen in CSF in bacterial vs viral meningitis.
What is seen in CSF in TB?
Raised intracranial pressure.
- Bacterial has increased neutrophils, polymorphs. Viral has increased lymphocytes, mononuclear.
- TB has fibrin web in CSF.
What should be immediately administered in community setting if bacterial meningitis suspected
What should be administered in A&E if bacterial meningitis suspected.
Why may Dexamethasone be considered?
- GP land: give benzylpenicillin IM. Urgent referral to hospital.
- A&E: broad spectrum antibiotics.
- Dexamethasone may be used to reduce cerebral oedema.
What is most common complication of meningitis?
- hearing loss.
Give SOCTE (from socrates) of raised ICP headache. Give 3 associated symptoms of raised ICP headache.
S: bilateral O: Gradual C: throbbing/ bursting T: worse in the morning- raise in ICP during night, less CSF absorption. E: Coughing/ sneezing
- Vomiting, altered GCS, seizures.
Give 3 signs of raised ICP.
- Papilloedema
- Cushing’s reflex: cushing’s triad: raised SBP, irregular breathing, bradycardia.
- Cheyne-stokes respiration: abnormal breathing pattern- increase and decrease in resp. rate up to apnoea.
What is urgent investigation for raised ICP?
CT head
What is common cause of extradural haemorrhage?
What age group?
What is onset of the headache?
What shape is seen on non-contrast CT?
- Trauma
- Young males
- Acute following lucid interval.
- Lemon shape
What is pathophysiology of subdural haemorrhage?
Which two groups of people are susceptible to subdural haemorrhage.
What is the onset of subdural haemorrhage?
Give 4 risk factors for subdural.
- Rupture of bridging veins in brain atrophy.
- Alcoholics and elderly are susceptible.
- Gradual onset.
- Head trauma and falls, old age, alcoholism, anticoagulation.
Give 4 associated symptoms of subdural haemorrhage.
- Fluctuating consciousness
- Confusion
- Personality changes
- Symptoms of raised ICP.
What is immediate management of subdural haemorrhage?
- ABCDE and Neurosurgery referral.
- If greater than 10mm or significant neurological dysfunction, Burr hole or craniotomy.
Give SOCTS of subarachnoid haemorrhage.
- Occipital or diffuse
- Thunderclap
- hit by brick, worst headache ever
- Continuous
- very severe, maximum intensity in minutes.
What is first investigation for subarachnoid haemorrhage and within what time?
What is next investigation and what is being looked for?
- CT head in less than 12 hours.
- LP if normal CT. Look for xanthochromia and oxyhemoglobin.
Which cells do most brain tumours arise from?
Which brain tumours are more common in children?
- Most tumours from glial cells (supportive CNS cells)
- medulloblastomas
What symptoms do the following types of tumour produce:
- Frontal lobe tumour
- R parietal lobe tumour
- Vestibular schwannoma
Frontal: personality disturbance
- R parietal: L homonymous hemianopia, L sided hemiparesis and sensory loss
- Vest. Schwann: progressive deafness. Benign tumour.
Give the red flags in headache according to acronym SNOOP.
- Systemic signs: FLAWS, HIV, meningismus, pregnancy
- Neurologic signs: papilloedema, hemiparesis, hemisensory loss, diplopia, dysarthria.
- Onset: worst headache of life
- Older: new headache >50
- Progression of existing disorder: change in quality, frequency, location.
