Neuro Conditions- Headaches & Syncope Flashcards
What are 3 types of headaches?
HEADACHES:
1. Migraine Headaches
2. Cluster Headaches
3. Tension Headaches
What are the key differentiating symptoms between these headaches- Migraine, Cluster, Tension
MIGRAINE Headache= severe pain, photophobia, nausea/vomiting
CLUSTER headache= pain behind eyes & eye changes on affected side (eg. crying)
TENSION headache= tight band/pressure around head, gradual onset, no other symptoms
What is the pathophysiology of Migraine Headaches?
[Hint- 2 steps, to do with a blood vessels]
MIGRAINE HEADACHES:
1. Vasoconstriction
2. Rebound Vasodilation
What is the pathophysiology of Cluster Headaches?
[Hint- starts with a release of ___ mediators]
CLUSTER HEADACHES:
1. Release of vasoactive mediators
2. They activate trigeminal nerve
3. Trigeminal nerve activates pain pathways in face
What is the pathophysiology of Tension Headaches?
[Hint- starts with hypersensitivity of __nerves]
- Hypersensitivity of afferent (sensory) nerves in face muscles
- Trigeminal nerve is activated
- Trigeminal nerve activates pain pathways in head
To determine if a headache has a life threatening pathophysiology/cause, we look for RED FLAGS using the mneumonic ‘S.N.O.O.P’. What does this stand for?
[you dont need to describe each component for this flashcard]
RED FLAGs for potential life threatening causes of headaches:
S- SYSTEMIC SYMPTOMS/CONDITIONS
N- NEURO SYMPTOMS
O- ONSET
O- OTHER FEATURES alongside
P- PATTERN change (to previous headaches)
RED FLAGs for potential life threatening causes of headaches can be remembered as ‘S.N.O.O.P’. The ‘S’ stands for SYSTEMIC SYMPTOMS/ CONDITIONS. What are some examples of these?
RED FLAGs for potential life threatening causes of headaches:
S- SYSTEMIC SYMPTOMS (meaning they affect the whole body)
= (symptoms) hypertension, fever
= (conditions) pregnancy, cancer, immunocompromised
RED FLAGs for potential life threatening causes of headaches can be remembered as ‘S.N.O.O.P’. The ‘N’ stands for NEURO SYMPTOMS. What are some examples of these?
RED FLAGs for potential life threatening causes of headaches:
N- NEURO CONDITIONS
= Confusion, Focal Deficits, Vision Changes, Seizures,
& Meningism [headache + neck stiffness + photophobia + nausea/vomiting
RED FLAGs for potential life threatening causes of headaches can be remembered as ‘S.N.O.O.P’. The 1st ‘O’ stands for ONSET. What are 2 red flags in terms of onset?
RED FLAGs for potential life threatening causes of headaches:
O- ONSET is:
1. SUDDEN onset with peak severity reached within minutes (‘thunderclap’)
2. NEW onset for >40yo
RED FLAGs for potential life threatening causes of headaches can be remembered as ‘S.N.O.O.P’. The 2nd ‘O’ stands for OTHER ASSOCIATED FEATURES. What are some other features that could be a red flag (that arent neuro or systemic)
RED FLAGs for potential life threatening causes of headaches:
O- OTHER ASSOCIATED FEATURES
- headache occurs alongside HEAD TRAUMA
- headache occurs alongside taking ILLICIT DRUGS
- headache is worse on COUGHING
RED FLAGs for potential life threatening causes of headaches can be remembered as ‘S.N.O.O.P’. The ‘P’ stands for PATTERN CHANGE. Compared to the pts previous headaches, what are some red flag pattern changes?
RED FLAGs for potential life threatening causes of headaches:
P- PATTERN CHANGES:
= headache QUALITY is different to past headaches
= headache SEVERITY is worse to past headaches
= the headaches ASSOCIATED SYMPTOMS are different to usual
= headache FREQUENCY has changed (eg. occuring more often)
What is the recommended pre-hospital PHARMACOLOGICAL management for Headaches?
PHARMACOLOGICAL management for Headaches:
- Paracetamol (not opioids)
- Ibuprofen
- Anti-emetics
What are some supportive/therapeutic pre-hospital management strategies for HEADACHES?
(non-pharmacological)
Supportive/Therapeutic Management for Headaches:
= low lights
= avoid sirens
= stretcher at 30 degrees to decrease ICP
What is the definition of a ‘Syncope’?
SYCOPE= A brief loss of consciousness caused by a stimulus which triggers a sudden drop in blood pressure
The syncopes we learnt this semester are all examples of ‘Reflex Syncope’ or ‘Neurally Mediated Syncope’. Briefly describe what this means
Reflex Syncope/Neurally Mediated Syncope occurs as a stimulus triggers the cardiovascular reflexes (which normally function fine in the pt) and they become intermittently inappropriate, resulting in a reflexive vasodilation and/or bradycardiac episode which causes a fall in BP and fall in global cerebral perfusion.
What is the pathophsyiology of a reflex syncope?
(regardless of the trigger, the mechanism is similar for all reflex/neurally mediated syncope)
REFLEX SYNCOPE:
1. Stimulus/Trigger
2. Brainstem is indirectly/directly stimulated
3. Brainstem stimulates Vagus nerve & vagus nerve activates parasympathetic NS
4. Parasympathetic NS triggers a vascular response (vasodilation + bradycardia)
5. This drops the BP
6. Results in Cerebral hypoperfusion
7. Transient loss of consciousness
What is the pathophysiological process which causes people to have a syncope after prolonged standing?
SYNCOPE from PROLONGED STANDING:
1. Prolonged standing
2. Blood pools in legs
3. Sympathetic NS stimulated (in an attempt to trigger vasoconstriction & increase blood flow up to head)
4. Sympathetic overload in left ventricle triggers ‘slow down reflex’
5. This causes bradycardia, decreased cardiac output
