1. Describe a  thunder-clap headache?
    • Reaches maximum intensity within 5 minutes.
    • Lone acute severe headache.
    • Lasts several days usually.

    Think: sub-arachnoid haemorrhage, cerebral venous sinus thrombosis, or cerebral artery dissection.
  2. Describe cluster headaches?
    • Unilaterally behind the eye.
    • Severe pain due to nerve pain.
    • streaming eye and runny nose unilaterally.
    • 30-90mins each.
    • 6-8 episodes over days/weeks.
  3. Describe trigeminal neuralgia.
  4. Describe trigeminal neuralgia?
    • Feels like lightening bolts through the face.
    • Lasts only seconds but very severe pain.
    • Cold air can trigger it.
    • Unknown cause.
  5. Name 2 signs of raised ICP?
    • Decreased level of consciousness.
    • Papilledema.

    Raised ICP is a contraindication for lumbar puncture.
  6. Describe cavernous sinus thrombosis?
    • DVT in brain, where the veins drain from the skull base.
    • Causes a gaze palsy due to 3-6th nerves.
    • Hilary Clinton had it.
    • Cause is usually spreading infection from noses, sinus, ears & teeth.

    Signs: proptosis, chemosis, periorbital oedema, photosensivity, cranial nerve palsy and headache.
  7. Describe Giant cell arteritis?
    Also known as temporal arteritis.

    • Inflammation of the blood vessels of the head.
    • Mainly the external carotid artery.
    • The most serious complication is occlusion of the ophthalmic artery causing blindness.
    • Associated with scalp and jaw pain.
    • Diagnosed via biopsy.
    • Causes elevated ESR and CRP.
    • Treated with steroids (glucocorticoids).

  8. How is a subarachoidnoid haemorrhage diagnosed?
    • 1. CT brain (best for fresh blood and bone).
    • 2. Lumbar puncture (red cells present in fluid).
    • 3. CT brain angio.

    Then send to Beaumont for clip & coil.
  9. What is a 'Bloody Tap'?
    Blood in CSF due to piercing of a blood vessel.

    • This is shown by fewer RBCs in successive bottles. 
    • 3 bottle should be taken during every lumbar puncture.
    • Xanthchromia is yellowing of CSF due to RBCs.
    • 100 RBCs for every 1 WCC is normal.
    • RBCs in CSF will excite an inflammatory response within 48hr (↑ CRP & ESR).
  10. What would cause raised protein in CSF?
    • Raised protein:
    •                    MS.
    •                    Meningitis.
    •                    Guillain-Barré syndrome.

    • Very raised protein:
    •                    Severe bacterial meningitis.
    •                    TB.
    •                    Spinal block.
  11. Describe a space occupying lesion headache?
    • Headache made worse by
    •                 -Lying down (Gravity increases ICP).
    •                 -Coughing (raises intraabdominal pressure).
    •                 -bending over (also seen in sinusitis).
    •                 -Valsalva manoeuvre.

    • 7 - 15 mmHG normal ICP at rest.
    • 20-25 mm Hg higher end of normal range.
    • 40-50 mm Hg causes loss of consciousness and infarction.
  12. What are red flags in a patient suffering from a headache?
    • New headache >50yo.
    • Thunderclap headache.
    • Meningism (stiff neck).
    • Immunosuppressed patient.
    • Symptoms of temporal arteritis (sore scalp & jaw, vision disturbance, >50yo).
    • Neurological symptoms & signs (cranial nerve palsy).
    • Papilledema. 
    • Red eyes and halos seen around lights (acute angle closure glaucoma).
  13. What causes the
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GMS medicine