Headaches Flashcards
(101 cards)
1
Q
Primary headaches (4)
A
Migraine*
Tension*
Cluster
Trigeminal neuralgia
2
Q
Secondary headaches (7)
A
Meningitis* Encephalitis Haemorrhages Extradural Subdural* Subarachnoid CNS tumours
3
Q
Age and gender of tension headaches
A
Young females more commonly
4
Q
Site of tension headaches
A
Generalised, Bilateral
5
Q
Onset of tension headaches
A
Gradual or acute onset
6
Q
Character of tension headaches
A
Dull – “tight band”
7
Q
Time it lasts of tension headaches
A
Lasts 3-4 hours
8
Q
Alleviating factors of tension headaches
A
E: Analgesics help
§§
9
Q
Radiation of tension headaches
A
Neck/shoulders
10
Q
RF of tension headaches
A
Stress
Disturbed sleep
11
Q
Mx of tension headaches
A
Conservative: Headache diaries (avoid triggers, relaxation) Medical: Simple analgesia (paracetamol, ibuprofen)
12
Q
Epidemiology of migraine
A
Young adult females
13
Q
Site of migraine
A
Unilateral
14
Q
Onset of migraine
A
Paroxysmal, comes on gradually
15
Q
Character of migraine
A
Pulsating/throbbing
16
Q
Timing of migraine
A
4 – 72h
17
Q
Exacerbating factors of migraine (3)
A
Physical activity/stress, noise, light
18
Q
Alleviating factors of migraine
A
lying in a quiet, dark room
19
Q
Associated symptoms of migraine (8)
A
Aura: flashing lights, tingling Photophobia, phonophobia Nausea, vomiting Visual changes Tingling Numbness Migraine interferes with current activities
20
Q
RF of migraine
A
FHx
21
Q
How long does a migraine prodrome last
A
Can last for days
22
Q
Migraine Mx (conservative, medical 4, preventative 3)
A
① Conservative: Headache diary, avoid triggers
②Acute Medical
Paracetamol, Ibuprofen, NSAIDs
Triptans
③ Preventative
Propranolol (BB) or topiramate (antiepileptic)
Amitriptyline (antidepressant)
23
Q
Site of cluster headache
A
S: UNILATERAL, behind the eye
24
Q
Onset of cluster headache
A
: Acute onset, CYCLICAL PATTERN,
Same time each day
25
Character of cluster headache
C: intense, sharp, penetrating
26
Timing of cluster headache
T: 15 minutes – 3 hours
27
Exacerbating factors of cluster headache
E: triggered by alcohol & strong smells
28
Severity of cluster headache
S: Severe – Can be disabling and cause suicidal thoughts
29
Associated symptoms of cluster headache (3)
Watery, red eye
Facial flushing
Nasal congestion
30
Examination of cluster headache
Partial Horners (ptosis, miosis)
31
What is trigeminal neuralgia associated with
MS
32
Site of trigeminal neuralgia
S: Unilateral, along the trigeminal division
33
Onset of trigeminal neuralgia
O: paroxysmal, lasting for seconds
34
Character of trigeminal neuralgia
C: stabbing, shooting
35
Exacerbating factors of trigeminal neuralgia
E: brushing teeth, speaking, shaving, talking
36
Associated symptoms of trigeminal neuralgia
Numbness
37
What is the common cause of meningitis in babies (2)
E. Coli, Group B Strep
38
What is the common cause of meningitis in children (2)
H. influenzae,
| Strep. pneumoniae
39
What is the common cause of meningitis in adults
Neisseria meningitidis
40
What is the common cause of meningitis in elderly (2)
Strep pneumoniae,
| Listeria monocytogenes
41
What does a non-blanching rash suggest
Meningococcal disease
42
Associated symptoms of meningitis (6)
```
Meningism
Neck stiffness
Photophobia
Fever
Rash
Vomiting
Seizures
```
43
3 signs of meningitis on examination
Kernig’s Sign:
Brudzinski’ s sign
Petechial/purpuric Rash
(non-blanching)
44
What is Kernigs sign
with the hips flexed, there is pain/resistance on passive knee extension - this is due to severe stiffness in the hasmstrings
45
What is Brudzinskis sign
- flexion of the hips and knees when the neck is flexed - this is due to severe neck stiffness
46
Contraindications for lumbar puncture (3)
↑ ICP is a CONTRAINDICATION for LP
CT-head before LP if: neurological deficit or ↓ Consciousness
47
```
CSF bacterial:
Appearance
Cells
Glucose
Protein
```
```
Bacterial
Turbid (Cloudy)
↑ neutrophils (polymorphs)
↓
↑
```
48
```
CSF viral:
Appearance
Cells (which type)
Glucose
Protein
```
```
Clear
↑ lymphocytes
(mononuclear)
Normal
Normal or ↑
```
49
```
CSF TB:
Appearance
Cells (which type)
Glucose
Protein
```
```
TB
Fibrin web
↑ lymphocytes
(mononuclear)
↓
↑
```
50
Meningitis Mx at GP and then at A&E
at GP: benzylpenicillin IM & URGENT REFERAL TO THE HOSPITAL
at A & E: Broad spectrum antibiotics (ceftriaxone IV, benzylpenicillin IM, acyclovir if viral)
Targeted antibiotic Tx depending on sensitivities.
Consider IV dexamethasone
51
Why use dexamethasone in meningitis
Prevent cerebral oedema
| reduces complications such as cerebral oedema
52
Complications of meningitis (3)
Hearing loss (most common)
Sepsis
Impaired mental status
53
Usual causes of encephalitis (5)
Usually viral: HSV1-2, CMV, EBV, HIV, measles
54
Non-usual causes of encephalitis (6)
bacterial meningitis, TB, malaria, listeria, Lyme disease, legionella
55
Epidemiology of encephalitis
Affects mostly the extremes of age
<1
>65
56
Symptoms of encephalitis (4)
```
Viral prodrome
Fever
Headache
ALTERED MENTAL STATE
(Memory disturbances
Personality changes
Psychiatric manifestations
Impaired consciousness)
```
57
Ix for encephalitis (4)
LP
Bloods
EEG
CT/MRI (oedema/hyperintense lesions
58
Meningitis vs Encephalitis:
Location
Aetiology
Major symptomatic difference
MENINGITIS
Meninges
Bacterial, Viral, TB
Usually unimpaired
ENCEPHALITIS
Brain Parenchyma
Usually viral
Usually altered
59
4 causes of raised ICP
SOL (tumour, abscess, haemorrhage)
| Hydrocephalus
60
Raised ICP headache (site onset character timing and exacerbating factors)
```
S: Bilateral
O: Gradual
C: throbbing/bursting
T: worse in the morning
E: coughing, sneezing
```
61
Associated symptoms of raised ICP (3)
Associated symptoms:
Vomiting
Altered GCS
Seizures
62
What is Cushing's triad and what is it seen in
Raised ICP
↑SBP
Irregular breathing
Bradycardia
63
Signs of raised ICP (4)
```
Focal neurological symptoms
Papilloedema
Cushing’s reflex → Cushing’s triad
↑SBP
Irregular breathing
Bradycardia
Cheyne-stokes respiration
```
64
What is Cheynes Stokes respiration
: abnormal pattern of breathing characterised by progressively deeper and sometimes faster breathing followed by a gradual decrease that results in apnoea
65
Aetiology of extradural haemorrhage
Head trauma
66
Epidemiology of extradural haemorrhage
Young males
67
Extradural haemorrhage onset
Acute following a lucid interval
68
Associated symptoms of extradural haemorrhage (5)
N & V, confusion, seizure, paresis, brainstem herniation
69
Ix for extradural haemorrhage
Urgent Non-contrast CT head-scan (lemon shape)
| MRI
70
Massive sign of extradural haemorrhage from trauma
Continued bleeding causes ipsilateral pupil dilatation due to haemorrhage compressing parasympathetic nerve fibres
71
Aetiology of subdural haemorrhage
Rupture of the bridging veins (susceptible in elderly and alcoholics, due to brain atrophy)
72
What is a subdural haemorrhage bleeding between
Dura and arachnoid mater
73
RF of subdural haemorrhage (4)
Head trauma & falls (often following minor trauma up to 9 weeks before which patients have forgotten)
Old age
Alcoholics
Anticoagulation
74
Onset of subdural haemorrhage
Gradual
75
Timing of subdural haemorrhage
Continuing
76
Classifications of subdural haemorrhages (3)
Acute: Within 72 hours (younger patients, trauma)
Subacute: 3-20 days (worsening headache, elderly)
Chronic: After 3 weeks (headache, confusion)
77
Associated symptoms of a subdural haemorrhage (4)
Fluctuating consciousness
Confusion
Personality changes
Symptoms of ↑ ICP
78
Shape of lesion in a extradural haemorrhage
Lemon
79
Shape of lesion in a subdural haemorrhage
Banana
80
Mx of subdural haemorrhage
ABCDE & NEUROSURGERY REFERAL
Depends on size & presentation
If small (<10mm) and no significant neurological dysfunction: observe
If large or significant neurological dysfunction: Burr hole or craniotomy
81
SAH aetiology
Most commonly due to rupture of a saccular aneurysm
82
SAH site
Occipital or diffuse
83
SAH onset
Sudden "thunderclap"
84
SAH character
Like being hit with a ball
| Worst headache ever
85
SAH timing
Continuous
86
SAH severity
Very severe, maximum intensity in minutes
87
Associated symptoms with SAH (2)
Meningism
| Symptoms of ↑ ICP
88
RF of SAH (4)
Polycystic kidney disease
| Alcohol, smoking, HTN
89
Ix for SAH
Urgent CT head within 12 hours
| LP after 12 hours
90
What cells do most brain tumours arise from
Glial cells
91
Site of headache from brain tumour
Bilateral
92
Onset of headache from brain tumour
Gradual
93
Character of headache from brain tumour
Throbbing bursting
94
Timing of headache from brain tumour
Worse in morning
95
Exacerbating factors of headache from brain tumour
Coughing sneezing
96
Associated symptoms of brain tumours (6)
```
FLAWS
Focal neurological signs
Weakness
Difficulty walking
Seizures
Personality changes
```
97
RF of brain tumours (2)
History of cancer
| FHx of cancer
98
Symptoms of vestibular schwannoma
Progressive deafness
99
Symptoms of right parietal lobe tumour (3)
L homonymous
Hemianopia, L sided hemiparesis and sensory
loss
100
Symptoms of frontal lobe tumour (3)
personality disturbance,
| apathy, impaired intellect
101
Ix for brain tumour (4)
CT (quicker)
MRI (better resolution)
CXR, CT thorax, abdo & pelvis to check for metastases
Biopsy (definitive)
