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Year 3 > MedEd headache > Flashcards

MedEd headache Flashcards

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1
Q

how often should heachache patients be allowed to take analgesia?

A

2 days a week

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2
Q

what might happen if headache patients take too much simple analgesia and what is ‘too much’?

A

they might get a medication overuse headache

too much= more than 2 days a week

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3
Q

how do you manage a medication overuse headache?

A

stop all analgesic medication

warn the patient that the headache will get worse at first but then it will get better

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4
Q

what triad of symptoms occurs in cluster headaches?

A

lacrimation
rhinorrhea
partial horners (ptosis, miosis, anyhdrosis)

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5
Q

describe the characteristics of a migraine

A 
unilateral headache 
excruciating pain
2-4 hrs
photophobia
aura (visual or smells) 
n+ v
has identifiable triggers
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6
Q

describe the characteristics of a cluster headache

A 
lacrimation
rhinorrhea 
partial horners
episodic 
excruciating 
unilateral pain behind an eye
drinking hx
previous head injury
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7
Q

what type of headaches are unilateral?

A

migraine

cluster headache

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8
Q

describe the characteristics of acute angle closure glaucoma?

A 
severe headache 
unilateral pain behind an eye 
redness of eye
visual disturbance- eg blurring of vision, halos around lights 
n+ v
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9
Q

what ix might you do in cluster headache and why?

A

no specific ix at all
MRI to exclude anything more sinister
ESR to exclude giant cell arteritis
pituitary function tests to check for pituitary adenoma

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10
Q

how is cluster headache managed acutely?

A

sub cut sumatriptan

high dose high flow o2

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11
Q

what prophylaxis can be given for cluster headache?

A

verapamil (CCB)

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12
Q

what is jaw claudication a sign of and why?

A

temporal arteritis- when the jaw moves it contracts the temporalis muscle and irritates the inflammed artery

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13
Q

what is kernig’s sign used for, how do you carry it out and what is a positive result?

A

it is used to diagnose meningitis
lie the patient on their back, flex hip with extended knee
if pain is ellicited this is positive for meningitis

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14
Q

what ix is contraindicated in someone with raised ICP and why?

A

lumbar puncture because it can cause herniation

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15
Q

what makes symptoms worse when someone has raised ICP?

A

lying down

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16
Q

what makes symptoms better when someone has raised ICP?

A

standing up/NOT lying down

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17
Q

what is a sign of raised ICP? explain why

A

bilateral visual loss- if caused by hydrocephalus it can compress the optic nerve

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18
Q

what side of the head is a migraine on?

A

unilateral

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19
Q

what is the onset of a migraine like?

A

comes on gradually

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20
Q

what is the character of pain in a migaine?

A

pulsating and throbbing

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21
Q

how long do migraines last?

A

4-72 hrs

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22
Q

what is a characteristic feature of a migraine you should remember and need to ask about?

A

it interferes with the current activities someone is doing

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23
Q

what are rf for migraine?

A

family hx
stressful life event
female sex
sleep disorder

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24
Q

how is conservative management of migraines carried out?

A

headache diary
avoid triggers
relaxation techniques eg CBT and mindfulness

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25
what drug must you not give to a migraine patient to help them manage their migraines?
opiods
26
how is acute management of a migraine carried out?
simple analgesia eg paracetamol/ibuprofen | triptans- these are analgesia specific to migraines but should only be used if really needed
27
what medication is an analgesia specific to migraines?
triptans
28
what preventative medications can be given for migraines?
first line propanolol or topimarate | second line amitriptyline
29
what are associated symptoms for migraine?
``` aura: flashing lights and tingling photophobia phonophobia nausea and vomitting visual changes numbness ```
30
what is trigeminal neuralgia?
facial pain syndrome in one or more distribution of the trigeminal nerve
31
how does pain theoretically arise in trigeminal neuralgia?
compression of branches of the trigeminal nerve by veins or arteries
32
what are the 3 big risk factors for trigeminal neuralgia?
old age woman multiple sclerosis
33
why does multiple sclerosis increase risk of trigeminal neuralgia?
because there is inflammation of the myelin sheath which makes it more likely a vein or artery will compress it and cause pain
34
where is the pain located in tirgeminal nerve neuralgia?
unilateral
35
describe the character of pain in trigeminal neuralgia
short episodes of unilateral stabbing/ shock like pain associated with numbness
36
what ix are done for trigeminal neuralgia?
none, usually diagnosis is clinical
37
how is trigeminal neuralgia managed?
first line= anti convulsants | long term= microvascular decompression or ablation
38
what surgery might be done for trigeminal neuralgia and when is this needed?
microvascular decompression or ablation surgery | usually needed for patients in hospital with severe disease because anticonvulsants are not enough to manage it
39
what is papilloedema?
optic disc swelling due to raised ICP
40
what causes papilloedema?
raised ICP
41
how can you identify papilloedema on fundoscopy?
there will be a blurred edge of the optic disc (the circle in the center) instead of a well demarcated edge
42
what symptoms do you get with a raised ICP?
``` bilateral headache worse in the morning cushing's triad (irregular breathing, bradycardia, raised systolic BP) associated with vomitting papilloedema ```
43
what do papilloedema, cushings triad, bilateral headache worse in the morning associated with vomitting point towards?
raised ICP
44
why might a headache be worse in the morning?
if someone has raised ICP because they have been lying down
45
what does a headache that is worse in the morning mean?
there is likely raised ICP
46
what makes a headache due to raised ICP worse?
lying down
47
what ix do you do immediately if there is raised ICP?
CT head
48
what ix should you never do if there is raised ICP?
lumbar puncture
49
between what 2 layers is the subarachnoid space?
under the arachnoid mater | above the pia mater
50
what does the subarachnoid space contain?
CSF
51
in what space is the CSF found?
subarachnoid
52
in meningitis what space is the virus in?
subarachnoid
53
what are the 2 ways you can acquire meningitis? explain what these mean (ie where the virus comes from and where it ends up)
direct spread- pathogen enters directly through an opening eg skull fracture, nose, deformity like spina bifida into subarachnoid space haematogenosu spread- pathogen enters brain through bloodstream and leaves endothelial cells to enter subarachnoid space
54
what are the 3 ways you can get meningitis?
virus bacteria TB
55
what is the most common type of pathogen that causes meningitis?
virus
56
if a neonate has bacterial meningitis, what organism is likely to have caused it?
e coli
57
if a child has bacterial meningitis, what organism is likely to have caused it?
h influenzae, strep pneumoniae
58
if a teenager/young adult has bacterial meningitis, what organism is likely to have caused it?
neisseria meningitidis
59
if an elderly person has bacterial meningitis, what organism is likely to have caused it?
strep pneumoniae, listeria monocytogenes
60
if a uni student has meningitis what organism is likely to have caused this? why is this concerning?
neisseria meningitidis | this is concerning as it can cause meningococcal disease
61
what pathogen can cause meningococcal disease and is therefore dangerous? in who is this more likely
neisseria meningitidis | this is most likely in teens/young adults/ uni students
62
what are rf for meningitis?
below 5 y/o over 65 y/o crowded spaces eg uni accomodation
63
what are symptoms of meningitis?
meningism- neck stiffness, photophobia and headache fever nausea and vomiting in later stages: seizures altered mental status malaise
64
what is the triad of meningism?
neck stiffness photophobia headache
65
what 3 signs can be found in someone with meningitis?
kernig's sign brudzinski's sign petechial rash (non blanching)
66
what ix are done for meningitis? what is GS
``` obs, VBG CT head before LP if there is neurological deficit or reduced consciousness lumbar puncture (GS), 2 sets of blood cultures ideally one before treatment but do not delay treatment for it ```
67
what is gold standard ix for meningitis? what must you do before it and why
lumbar puncture | must do a CT head before it to rule out raised ICP
68
how are blood cultures done in meningitis and how many are needed?
you need 2 blood cultures, the first should ideally be before treatment is started but dont delay treatment for the blood culture
69
when might you do an LP before CT head in a patient with meningitis and why?
if they don't have neurological deficits or reduced consciousness do the LP first because there are no signs of raised ICP and LP is the most important ix in meningitis
70
describe appearance, cells, glucose and protein level of CSF in bacterial meningitis and explain why this is so
``` appearance= cloudy/turbid cells= high neutrophils (polymorphs) glucose= low because bacteria metabolise the glucose protein= high because of inflammation of meninges ```
71
describe appearance, cells, glucose and protein level of CSF in viral meningitis and explain why this is so
``` appearance= clear cells= high lymphocytes (mononuclear) glucose= normal or high as viruses dont use the glucose protein= high due to meningeal inflammation ```
72
describe appearance, cells, glucose and protein level of CSF in TB meningitis and explain why this is so
``` appearance= fibrin web cells= high lymphocytes (mononuclear) glucose= low as bacteria metabolises glucose protein= high due to inflammation of meninges ```
73
if CSF if cloudy, low in glucose, high in protein and neutrophils what is the likely cause of meningitis?
bacterial
74
if CSF is clear, normal/high glucose, high protein and lymphocytes what is the likely organism of meningitis?
viral
75
if CSF has a fibrin web, is low in glucose, high in protein and lymphocytes what is the likely cause of meningitis?
TB
76
what causes of meningitis cause a low CSF glucose? why?
bacteria (inc TB)- they metabolise the glucose to multiply
77
what causes of meningitis cause a normal/high CSF glucose? why?
viral- the virus doesnt need to metabolise glucose to replicate
78
how is meningitis managed at GP?
immediate IM benzylpenicillin and urgently refer to hospital
79
how is meningitis managed in A&E?
broad spec abx (ceftriaxone IV, benzylpenicillin IM) acyclovir if viral targeted abx treatment depending on sensitivity IV dexamethasone due reduce cerebral inflammation
80
what are complications of meningitis?
hearing loss sepsis impaired mental status
81
what are some complications of meningitis?
hearing loss sepsis impaired mental status
82
what broad spec medications are given for meningitis in hospital?
IV ceftriaxone IM benzylpenicillin acyclovir IV dexamthasone
83
what is giant cell arteritis?
inflammation of the temporal arteries
84
what is the character of pain in giant cell arteritis?
dull ache
85
what triggers pain in giant cell arteritis? what does not trigger pain in giant cell arteritis and can be used to help narrow your differential
movement of the jaw eg eating | touching of the jaw does not trigger the pain
86
how can you differentiate giant cell arteritis from trigeminal neuralgia?
giant cell= a dull aching pain, triggered by jaw movements | trigeminal= electric shock like pain on one side of the face, triggered by touching the jaw
87
what is the difference in pathophysiology between giant cell arteritis and trigeminal neuralgia?
giant cell arteritis= inflammation of the arteries causing pain trigeminal neuralgia= compression of the facial nerve causing pain

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