Z YEAR 2 BRS NEURO > Headache Part 1 > Flashcards

Headache Part 1 Flashcards

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1
Q

How common are headaches and migraines?

A
  • Headache are a symptom
  • Half to three quarters of adults aged 18–65 years in the world have hadheadachein the last year and, among those individuals, 30% or more have reportedmigraine
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2
Q

What are the basis of headache generation?

A
  • Some structural
  • Some perhaps pharmacological
  • Some psychological
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3
Q

What are examples of acute single headache?

A
  1. Febrile illness, sinusitis
  2. First attack of migraine
  3. Following a head injury
  4. Subarachnoid haemorrhage
  5. Meningitis, tumour, drugs, toxins, stroke
  6. Thunderclap (sudden onset), low pressure
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4
Q

What are examples of dull headaches with increasing severity?

A
  1. Usually benign
  2. Overuse of medication (e.g. codeine)
  3. Contraceptive pill, hormone replacement therapy
  4. Neck disease
  5. Temporal arteritis
  6. Benign intracranial hypertension
  7. Cerebral tumour
  8. Cerebral venous sinus thrombosis
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5
Q

What are examples of dull headache, unchanged over months?

A
  1. Chronic tension headache

2. depressive atypical facial pain

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6
Q

What are examples of recurrent headaches?

A
  1. Migraine
  2. Cluster headache
  3. Episodic tension headache
  4. Trigeminal or post-herpetic neuralgia
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7
Q

What are examples of triggered headaches?

A
  1. Coughing, straining, exertion
  2. Coitus
  3. Food and drink
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8
Q

What are onset red flags?

A
  1. Thunderclap
  2. acute
  3. subacute
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9
Q

What are meningism red flags?

A
  1. Photophobia
  2. phonophobia
  3. stiff neck
  4. vomiting
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10
Q

What are some red flag systemic symptoms?

A

Fever, rash, weight loss

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11
Q

What are some red flag neurological. symptoms or focal signs?

A
  1. Visual loss
  2. confusion
  3. seizures
  4. hemiparesis
  5. double vision
  6. 3rd nerve palsy (droopy eye and dilated pupil and point wrong way)
  7. Horner syndrome (pupil smaller on one side)
  8. papilloedema
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12
Q

What are some other red flags?

A
  • Orthostatic-better lying down

- Strictly unilateral

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13
Q

What type of headache is a subarachnoid haemorrhage?

A
  • Sudden generalised headache ‘blow to the head’.

- Meningism - stiff neck and photophobia

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14
Q

What are subarachnoid haemorrhages caused by?

A

by a ruptured aneurysm, a few from arteriovenous malformations and some are unexplained

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15
Q

How fatal are subarachnoid haemorrhages?

A

50% instantly fatal

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16
Q

What can control the leak in a subarachnoid haemorrhage?

A
  • Vasopasm may stop leak, give nimodipine and control BP

- High risk of further bleed

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17
Q

How do you confirm subarachnoid haemorrhage?

A
  1. Early neurosurgical assessment will confirm the bleed
    and establish the cause.
  2. CT brain, Lumbar puncture (RBC and xanthochromia) and MRA, angiogram.
    -If Don’t see blood on scan do lumbar puncture to see if bleeding in brain, blood can obscure blood anatomy
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18
Q

How do you coil an aneurysm?

A
  • Aneurysms used to be clipped or wrapped

- Nowadays filled with platinum coils (catheter through blood vessel in groin and dye and feed platinum coil)

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19
Q

What is an acute intracerebral bleed?

A

Fatal haemorrhage due to coning

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20
Q

What is coning?

A

Brain has compliance but to certain point without pressure rises, but when volume goes over limit so for a little increase in volume, pressure grows a lot more steeply, brain starts to seep under areas of weakness (e.g. tentorial herniation) - once squash brain stem - brain stem loose blood supply so death

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21
Q

How can you see raised intracranial pressure?

A
  • Papilloedema
  • Optic disc swelling due to raised ICP
  • Retina looks like its been pushed (swelling at back of eye)
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22
Q

Which arteries can cause headaches?

A

Vertebral and carotid arteries

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23
Q

What happens in dissection

A

-Layers of tissue splits blood collects in split and turbulent flow

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24
Q

What happens in vertebral artery dissection?

A

Headache in occipital lobe area. and back of neck

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25
What happens in carotid artery dissection?
Pain in phantom of opera (eye and forehead)
26
Are dissections common in young people?
- 20% of ischaemic strokes <45 years (young stroke) - Mean age 40, carotid > vertebral - Sometimes traumatic (seat belt snags on neck) and sometime spontaneous
27
How do you diagnose a dissection?
MRI/MRA, Doppler (ultrasound), Angiography
28
How do you treat a dissection and why?
- Aspirin or anticoagulation X 6/12 | - Turbulent. flow: sticky blood and then coat and break off and lodge in brain, so prevent stroke
29
What is Chronic subdural haemorrhage?
Can sheer veins and so form subdural, blood dark on scan, ventricles gone on one side and brain being pushed
30
Who gets temporal arteritis?
1. Over the age of 55. | 2. Three times commoner in females.
31
What are the symptoms of temporal arteritis?
1. Constant unilateral headache 2. scalp tenderness a 3. jaw claudication 4. 25% Polymyalgia Rheumatica-proximal muscle tenderness
32
Can you go blind with temporal arteritis?
Involvement of the posterior ciliary arteries causes blindness (gets blocked)
33
What is elevated in temporal arteritis? What is inflamed?
- ESR and CRP (blood test) | - Temporal artery usually inflamed and torturous
34
How can you tell if someone has temporal arteritis?
- Visible on ultrasound | - Biopsy shows inflammation and Giant Cells
35
How do you treat temporal arteritis?
High dose steroids (3-4 years) and aspirin
36
How do you see vasculitis?
Disruption of internal elastic lamina
37
What is central venous thrombosis?
1. Thrombosis in dural venous sinus or cerebral vein | 2. Unusual amount of headache due to raised ICP
38
What happens in CVT?
- Venous infarcts as fragile (non-territorial ischamia) | - Haemorrhage into these infarcts
39
What are the causes of CVT?
1. Thrombophilia 2. pregnancy 3. dehydratiom 4. Behcets
40
What are the viruses for meningitis?
1. Coxsackie 2. ECHO 3. Mumps 4. EBV
41
What are. the bacterias for meningitis?
1. Meningococci 2. Pneumococci 3. Haemophilus 4. Tuberculous
42
What are the fungal causes of meningitis?
Cryptococci
43
What are the. granulomatous causes of meningitis?
Sarcoid, Lyme, Brucella,  Behçet’s, Syphilis
44
Can carniomatous cause meningitis?
Yes, seeding of cancer cells in meninges causes a menigial reaction
45
What are the presenting symptoms of meningitis?
1. Malaise 2. Headache 3. Fever !!!! 4. Neck stiffness 5. Photophobia 6. Confusion 7. Alteration of consciousness
46
What does Herpes Simplex encephalitis cause changes to?
Classic haemorrhagic changes in the temporal lobes
47
How do you treat meningitis?
Treat then diagnose! 1. Antibiotics 2. Blood and urine culture 3. Lumbar puncture  - Increased White Cell Count, decreased glucose - Antigens - Cytology - Bacterial Culture 4. CT or MRI Scan
48
What would bacterial menignitis look like on a scan?
Cerebral oedema with effacement of ventricles and sulci and inflamed meninges -If needle in back, decompreess high pressure brain can go through foramen magnum and die
49
What are the symptoms of sinusitis?
1. Malaise, headache, fever. 2. Blocked nasal passages. 3. Loss of  vocal resonance. 4. Anosmia. 5. Nasal or postnasal catarrh. 6. Local pain and tenderness.
50
What is the pain like in sinusitis?
Frontal pain characteristically starts 1-2 hours after rising and clears up during the afternoon
51
What is idiopathic intracranial hypertension? Who is at risk?
- Pseudotumor Cerebri | - Young obese women
52
What. are the symptoms of IIH?
1. Headache, visual obscurations, diplopia, tinnitus | 2. Papilloedema, +/- visual field loss
53
What drugs can cause IIH?
- hormones - steroids - antibiotics - vitamin E
54
What is the treatment of IIH?
1. weight loss 2. diuretics 3. optic nerve sheath 4. decompression 5. lumboperitoneal shunt 5. stenting of stenosed venous sinuses
55
What do you see on scan of IIH?
No tumour, no gliblastoma, but no sulci markers, and no ventricles to see or very small
56
When can you get a low pressure headache?
1. CSF leak due to tear in dura - when lying down pressure around head is ok, but because low volume when stand up feel pain 2. Traumatic post lumbar puncture or spontaneous - Orthostatic
57
What is. the treatment for a low pressure. headache?
rehydration, caffeine, blood patch
58
How is low pressure headache diagnosed?
MRI with contrast injection. meningeal enhancement shown
59
What is Chiari Malformation?
Normal brain that just sits very low within the skull
60
Where are the cerebellar tonsils in chiari malformation?
- Descending through foramen magnum - Descend further when patient coughs and tug on meninges causing cough headache - Treat: stop sneezing, or remodel by surgery if that doesnt work
61
What is obstructive sleep apnoea?
Often characteristic body habitus, history of loud snoring and apnoeic spells
62
Why do people with obstructive sleep apnoea get a headache?
- Hypoxia, - CO2 retention (vasodilator) - banging headache - non-refreshing sleep
63
What are the symptoms of obstructive sleep apnoea?
- Depression - impotence - poor performance at work
64
How do you diagnose obstructive sleep apnoea?
Require sleep study
65
How do you treat obstructive sleep apnoea?
Nocturnal NIV, Surgery
66
What is trigeminal neuralgia?
Electric shock like pain in the distribution of a sensory nerve
67
What is trigeminal neuralgia often triggered by?
- innocuous stimuli - Any division of the trigeminal can be affected - Neurovascular conflict at the point of entry of the nerve into the pons - Can be symptom of M.S
68
What is the treatment of trigeminal neuralgia?
- Carbamazepine, lamotrigine, gabapentin | - Posterior fossa decompression
69
Who usually gets atypical facial pain?
- commonly in middle aged women | - depressed or anxious
70
What are the symptoms of atypical facial pain?
1. Daily, constant, poorly localised deep aching or burning. 2. Facial or jaw bones, but may extend to the neck, ear or throat. 3. Not lancinating. 4. Not conforming to the strict anatomical distribution of any nerve.  5. No sensory loss. 6. Pathology in teeth, temporomandibular joints, eye, nasopharynx and sinuses must be excluded.
71
What is the treatment. for atypical facial pain?
1. Unresponsive to conventional analgesics, opiates and nerve blocks. 2. Mainstay of management tricyclics.
72
What are the likelihood of. headache with head trauma admittance?
Headache: - 36% at discharge - 24% at 6 months - 16% at 12 months - Correlates with previous history of  headache - Unrelated to duration of post-traumatic amnesia
73
What is the likelihood of having post-traumatic headache with the type of injury?
- High in victims of car accidents - Low in perpetrators of car accidents - Low in sports injuries
74
What are the mechanisms for post traumatic headache
``` multiple Neck injury Scalp injury  Vasodilation  ? autonomic damage Depression -  often delayed ```
75
What is the treatment for traumatic headache?
1. Explanation: no structural damage, always potential, for full recovery 2. Prevent analgesic abuse  3. Non-steroidal anti-inflammatories - ibuprofen, naproxen - only if have to 4. Tricyclic antidepressants - Amitriptyline - Be patient: 3-4 years
76
When is cervical spondylosis common?
-Commonest cause of new headache in older patients (as get arthritis) -Narrowing of joint space due to worn disc
77
What is the pain like in cervical spondylosis?
- Usually bilateral - Occipital pain can radiate forwards to the frontal region - Steady pain - No nausea or vomiting - Worsened by moving the neck - Worse in morning
78
What is the management for cervical spondylosis?
1. Rest, deep heat, massage. 2. Anti-inflammatory analgesics. 3. Over-manipulation may be harmful
Z YEAR 2 BRS NEURO
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