1. Headache Flashcards
What are the sinister causes of a headache?
VIVID
Vascular, infection, vision threatening, raised intracranial pressure, dissection
When asking questions about their headache, think SOCRATES!
What are the vascular causes of a headache?
Subarachnoid haemorrhage, haematoma (extradural or subdural), cerebral venous sinus thrombosis, cerebellar infarct
What are the infective causes of a headache?
Meningitis and encephalitis
What are vision threatening causes of a headache?
Temporal arteritis, acute glaucoma, cavernous sinus thrombosis, pituitary apoplexy, posterior leucoencephalopathy
What are the causes of a raised intracranial pressure?
Space occupying lesion, cerebral oedema, hydrocephalus, malignant hypertension, idiopathic intracranial hypertension
What are the red flags to look out for in someone with a headache?
Decreased level of consciousness, sudden onset worst headache, seizure, no previous episodes, reduced visual acuity, headaches worse when lying down, progressive persistent headache, constitutional symptoms
What might a decreased level of consciousness suggest in someone with a headache?
subdural haematoma- fluctuating consciousness
extradural haematoma- altered consciousness following a lucid interval
subarachnoid haemorrhage
What does a persistent headache, worse when lying down with early morning nausea suggest?
Raised intracranial pressure
What might a progressive persistent headache suggest?
Expanding space occupying lesion
What are constitutional symptoms?
weight loss, night sweats, fever
What might a focal limb deficit suggest with a headache?
Intracranial pathology is more likely
What signs are seen in a third nerve palsy?
Ptosis, mydriasis, eye deviated down and out
What signs are seen in a sixth nerve palsy?
Convergent squint and/ or failure to abduct the eye laterally
What are signs of horner’s syndrome?
Partial ptosis, anydrosis, miosis
What does scalp tenderness suggest?
Classically seen in temporal arteritis
What are the causes of non sinister headache?
tension type headache migraine sinusitis medication overuse headache TMJ dysfunction syndrome trigeminal neuralgia cluster headache
What are characteristics of a tension type headache?
It is bifrontal and more common in women
What are characteristics of trigeminal neuralgia?
More common over 60s, unilateral sharp facial pain, lasts seconds
What are the characteristics of a migraine?
Unilateral, aura, more common in women, sensitive to light
What are the features of sinusitis?
Constitutional symptoms and facial pain
What are the features of a cluster headache?
Unilateral pain over one eye, more common in men, causes patients to wake up at night, occurs in clusters every few weeks
