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cns > Lecture 14 - Headaches > Flashcards

Lecture 14 - Headaches Flashcards

1
Q

What are the 2 broad types of headaches?

A

Primary
Secondary

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2
Q

What is a primary headache?

A

Headache due to a headache condition

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3
Q

What is a secondary headache?

A

Headache due to another condition

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4
Q

What are the 2 types of headache in terms of how threatening they are?

A

Non life threatening/sight threatentgin (Benign)

Life/sight threatening

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5
Q

What are the 3 main causes of primary non life/sight threatening headaches?

A

Tension headache
Migraine
Cluster headache

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6
Q

What are some causes of secondary life/sight threatening headaches?

A

Tumour
Haemorrhage
Meningitis
Giant cell arteritis (temporal arteritis)
Acute glaucoma

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7
Q

How do primary and secondary headaches differ in how they present in clinical examination?

A

Primary = clincal exam typically normal

Secondary = may have clincal exam findings

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8
Q

What are the normal steps taken when doing a history for a patient with a headache?

A

History of presenting complaint (SQITARS/SOCRATES)
PMH (previous headache or condtions causing seconadry headache)
DH (Analgesia)
FHx (migraines?)
SHx (stress, sleep, alcohol, caffeine, diet)

RED FLAG ENQUIREIES

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9
Q

What is the pneumonic used to to remember headache red flags?

A

SNOOP

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10
Q

What does SNOOP stand for to remember life threatening headaches?

A

Systemic signs and disorders
Neurological symptoms
Onset new or changed patietn > 50yrs
Onset in thunderclap presentation
Papilledema, pulsation tinnitus, Positional, exercise worsens it

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11
Q

What may you be thinking if a patient has a headache with fever and neck stiffness?

A

Meningitis

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12
Q

What may you be thinking if a pregantn patient has a headache?

A

Preeclampsia

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13
Q

What may you be thinking if a patietn has a headache with neurological symptoms?

A

Space occupying lesions
Intra-cranial haemorrhage
Glaucoma (visual)

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14
Q

What may be thought if a patient has a headache with an onset thunderclap headache?

A

Vascular haemorrhage (subarachnoid haemorrhage)

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15
Q

What is the most common type of headache?

A

Tension type headache

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16
Q

How does a tension type headache present in terms of:
SQITARS?

Neuro exam?

A

S. Generalised for frontal and occipital regions
Q. Tight band like constricting radiates to neck
I. Mild-moderate intensity
T. Worse at end of day
A. Stress, poor posture, lack of sleep
R. Analgesia
S. Few associated symptoms maybe slight nausea

Clincal examination is normal

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17
Q

What is thought to be the pathophysiology for tension type headaches?

A

Tension in muscles in head and neck

18
Q

Who do tension type headaches commonly affect?

A

Females for than men
Younger most common first onset

19
Q

Who do migraines most commonly presetn in?

A

Women younger than 30

20
Q

What is thought to be the pathophysiology for migraines?

A

Vasodilation of meningeal blood vessels

Neurogenic inflammation of Trigeminal senosyr neurones inner acting large vessels and meninges, alters way pain processed by brain

21
Q

How does a migraine headache present in terms of:
SQITARS?

Neuro exam?

A

S: unilateral, temporal or frontal
Q: throbbing pulsating
I: moderate-severe and often disabling
T: prolonged headache between 4-72hrs
A: certain food, menstrual cycle, stress, lack of sleep, FHx
R: simple analgesia , may need Triptans
S: Photophobia, Photphonia, AURA, Nauses

Clincal exam normal

22
Q

What is aura?

A

Transient period of neurological signs or symptoms like shimmering lights and zig zags

23
Q

What causes medication over-use headache?

A

Using regular analgesics where the headache is not responding

24
Q

What are 2 common analgesics that can cause medication over ruse headache?

A

Codeine
Co-codamol

25
Q

How do you treat medication over-use headache?

A

Discontinue medication
Where the headache worsens before improves

26
Q

Who do cluster headaches most commonly presetn in?

A

Men
30-40
Smoking Hx

27
Q

What is the potential pathophysiology of cluster headaches?

A

Hypothalamic activation with seconadry Trigeminal and autonomic involvement

28
Q

How does a cluster headache present in terms of:
SQITARS?

Neuro exam?

A

S: unilateral around or behind eye
Q: sharp stabbing, penetrating
I: severe, intense, disabling, agitated
T: 15m - 3hrs occur in clusters with periods of remission
A: smoking, alcohol, volatile smells, warm temp, lack of sleep
R: Simple analgesia DOESNT work, O2 and triptans used
S: Ipsilateral autonomic symptoms (red watery eye, blocked runny nose and Ptosis)

Clincal exam may have autonomic features during attack

29
Q

What are some causes of secondary headaches?

A

Intracranial haemorrhage
Raised ICP (space occupying lesions)
Trigeminal neuralgia
Temporal (giant cell) arteritis

30
Q

How does a space-occupying lesion type headache present in terms of:
SQITARS?

Neuro exam?

A

S: gradual, progressive
Q: Dull, PROGRESSIVE
I: mild in severity and WORSE in morning
T: early morning on waking
A: worse leaning forward, cough, valsalva manoeuvre
R: simple analgesia may work in early stages
S: Nausea, vomiting, focal neurological or visual symptoms (behaviour/personialty change,seizures)

Clincal exam = papilloedmea (focal neurological signs)

31
Q

Who does Trigeminal neuralgia normally present in?

A

Women
50-60

32
Q

What is the pathophysiology of Trigeminal neuralgia?

A

Compression of Trigeminal nerve due to a loop of a blood vessel;

33
Q

How does a Trigeminal neuralgia headache present in terms of:
SQITARS?

Neuro exam?

A

S: unilateral pain felt in at least 1 division of Trigeminal nerve (ophthalmic branch often described as headache)
Q: sharp, stabbing, electric shock (sometimes burning)
I: severe, last few seconds - 2mins
T: sudden onset
A: light touch to face/scalp, eating, cold wind, combing hair
R: simple analgesics not effective
S: tingling, numbness, pain can radiate tot areas within CN V distribution

Clincal exam = normal

34
Q

What is temporal (giant cell) arteritis?

A

Vasculitis involving small and medium sized arteries of the head (Branches of External carotid artery)

35
Q

Who does temporal arteritis commonly. Present in?

A

Female
Over 50

36
Q

How does temporal arteritis commonly present?

A

> 50
Headaches + visual disturbance or jaw claudication (headache with pain in jaw)

May get irreversible loss of vision due to ischaemia of CNII

37
Q

What artery is affected in slide 21?

What is the most common artery affected in temporal arteritis?

A

Superficial temporal artery

Superficial temporal artery

38
Q

How is temporal arteritis normally treated?

A

Steroids

Biopsy may be done

39
Q

Do case study on slide 24

A

Tension headache

40
Q

Do case study on slide 26:

A

Raised ICP

41
Q

What is a headache diary?

A

Record headaches to determine patttern an possible triggers to aid diagnosis

cns (21 decks)

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