hazel_121
Mind Map by , created over 5 years ago

NCOTE Mind Map on Headache, created by hazel_121 on 02/09/2014.

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hazel_121
Created by hazel_121 over 5 years ago
Anatomy of Cranial Nerves: Clinical Testing
Matthew Coulson
Physiology I: Introduction to Neurones, Excitatory and Inhibitory Neurotransmission in the CNS
Matthew Coulson
Neuroanatomy Lecture III
Matthew Coulson
GCSE Biology B1 (OCR)
Usman Rauf
Function and Structure of DNA
Elena Cade
NeuroAnatomy
أطباء 2020
PMU - 2nd/2t Semester Anatomy - End Questions 5 x Parts
Sole C
Anatomy
أطباء 2020
Anatomy of the Peripheral Nervous System
Matthew Coulson
Neuroanatomy Lecture II
Matthew Coulson
Headache
1 Primary
1.1 Pulsatile, tempero-frontal pain, GI Sx, photo and phonophobia. possible aura

Annotations:

  • Aura - negative - hemianopia, hemiplegia, scotoma or positive e.g. fortification spectra
  • Genetic predisposition
  • often triggered by lack of sleep, stress oe foods or related to OCP or mensruation
1.1.1 Migraine

Annotations:

  • Uncommon forms; familial, hemiplegic, basilar-type and periodic syndromes e.g. abdominal migraine and BPV
1.1.1.1 Management
1.1.1.1.1 Preventers
1.1.1.1.1.1 Beta-blockers

Annotations:

  • Contraindicated in asthma!
1.1.1.1.1.1.1 AE; fatigue, cold limbs, postural hypotension, vivid dreams
1.1.1.1.1.1.2 CI; peripheral vascular disease, pregnancy, asthma
1.1.1.1.1.2 Anti-epileptic medications - sodium channel blockers
1.1.1.1.1.2.1 Sodium valproate

Annotations:

  • Not child bearing age!
1.1.1.1.1.2.1.1 AE; liver dysfunction, weight gain, alopecia, tremor, PCOS, pancreatitis
1.1.1.1.1.2.1.2 CI; pregnancy, liver disease, juvenile onset myoclonic epilepsy?
1.1.1.1.1.2.2 Topiramate
1.1.1.1.1.2.2.1 Weight loss, memory and concentration, acute glaucoma
1.1.1.1.1.2.2.2 CI; pregnancy
1.1.1.1.1.3 5-HT antagonists e.g. pizotifen
1.1.1.1.1.3.1 AE; weight gain
1.1.1.1.1.3.2 CI; pregnancy
1.1.1.1.2 Relievers
1.1.1.1.2.1 Aspirin 600-900mg
1.1.1.1.2.2 Triptans
1.1.1.1.2.2.1 Sumitriptan - 5HT1 agonist
1.1.1.1.2.2.1.1 AE - chronic daily headache
1.2 severe, unilateral retro/ periorbital +/- temporal pain. autonomic features; ptosis, miosis, lacrimation, rhinorrhoea, sweating, pallor, restlessness, last 15 -180 mins up to 4 x/day
1.2.1 Cluster headache

Annotations:

  • more common in middle aged men, can be triggered by alcohol
1.2.1.1 triptans - injection?
1.3 Constriction band, gradual onset, no other Sx
1.3.1 Tension headache
1.3.1.1 Management
1.3.1.1.1 Relivers
1.3.1.1.1.1 triptans
1.3.1.1.2 Psychological support and stress reduction
1.3.1.1.3 Preventers
1.3.1.1.3.1 Amytriptaline
1.4 trigeminal or other cranial neuralgia
2 Secondary
2.1 Feature of raised ICP; worse on lying down and morning, personality and mood changes, morning vomiting, VIth nerve palsy, papilloedema, enlarged blind spot and reduced visual fields (late),
2.1.1 SOL
2.1.1.1 Other possible features
2.1.1.1.1 Visual field defects - lesion in optic pathway
2.1.1.1.2 CN abnormalities
2.1.1.1.3 Abnormal gait
2.1.1.1.4 torticollis
2.1.1.1.5 headache wakes up
2.1.1.1.6 Growth failure
2.1.1.2
2.1.2 Idiopathic intracranial hypertension
2.1.2.1 Clinical features
2.1.2.1.1 Overweight females or pregnant
2.1.2.1.2 Blindess on stooping
2.1.2.1.3 Tinnitus
2.1.2.2 Management
2.1.2.2.1 Monitor vision e.g. blind spot to prevent permanent damage
2.1.2.2.2 Weight loss
2.1.2.2.3 Investigations; exclude other causes, LP therapeutic and diagnostic - raised opening pressure
2.1.2.2.4 Diuretics - acetazolamide, furosemide
2.1.2.2.5 intra-ventricular shunt
2.2 Trauma
2.2.1 Sudden collapse after lucid period following head injury
2.2.1.1 Extra dural haematoma

Annotations:

  • Middle meningeal artery tear
2.2.1.1.1 CT; lenticular / biconvex, midline shift
2.2.1.1.2 Pupillary changes - depending on severity (see notes)
2.2.2 confusion, fluctuating consciousness, possible raised ICP, focal; seizure, hemiplegia, aphasia. following head injury
2.2.2.1 chronic or acute subdural haematoma

Annotations:

  • elderly and alcoholics particularly at risk due to brain atrophy, coagulation problems (liver, drugs etc) and risk of falls.
2.2.3 head and neck pain - spontaneous or secondary to deceleration or rotational injury
2.2.3.1 Arterial dissection
2.3 Cranial or cervical vascular e.g. haemorrhage, vascular malformation, thrombosis
2.3.1 Sudden onset, worst headache ever, cant sleep, meningism - neck stiff, photophobia (blood irritates meninges)
2.3.1.1 Urgent CT scan
2.3.1.1.1 White haemorrhage
2.3.1.1.1.1 Subarachnoid haemorrhage
2.3.1.1.1.1.1 management
2.3.1.1.1.1.1.1 calcium channel blocker
2.3.1.1.1.1.1.2 saline fluids
2.3.1.1.2 LP - once raised ICP ruled out - check for meningitis
2.3.2 nausea, vomiting, drowsy, seizures, focal signs, usually female, pregnant
2.3.2.1 Venous sinus thrombosis
2.3.2.1.1 Management
2.3.2.1.1.1 CT
2.3.2.1.1.2 IV unfractionated heparin +/- thrombolysis
2.3.2.1.1.3 Control seizures and raised ICP
2.4 Infection e.g. meningitis / encephalitis or sinusitis

Annotations:

  • Check sinus tenderness
2.5 Substance abuse/ withdrawl / medication overuse
2.6 homeostatic disorder e.g. hypercapnia or hypertension
2.7 Psychiatric
2.8 Refractive errors

Annotations:

  • Check vision esp in children
2.9 Worst headache ever, subacute onset, scalp tenderness, pain brushing hair, sudden onset blindness, jaw claudication (on chewing), pulseless temporal artery, muscle aches
2.9.1 Giant cell arteritis

Annotations:

  • In over 60s only
  • Associated with polymyalgia rheumatica
2.9.1.1 Management
2.9.1.1.1 TA biopsy
2.9.1.1.2 Raised ESR and CRP
2.9.1.1.3 Immediate corticosteroids e.g. prednisolone 60-80mg / day

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