1. Headache

Question 1

What are the sinister causes of a headache?

Answer 1

VIVID
Vascular
Infection
Vision threatening
Raised intracranial pressure
Dissection

Question 2

What are the 4 vascular causes of a headache?

Answer 2

Subarachnoid haemorrhage
Haematoma
Cerebral venous sinus thrombosis
Cerebellar infarct

Question 3

What are the 2 infective causes of a headache?

Answer 3

Meningitis + encephalitis

Question 4

What are 5 vision threatening causes of a headache?

Answer 4

Temporal arteritis
Acute glaucoma
Cavernous sinus thrombosis
Pituitary apoplexy
Posterior leucoencephalopathy

Question 5

What are the 5 causes of a raised intracranial pressure?

Answer 5

Space occupying lesion
Cerebral oedema
Hydrocephalus
Malignant hypertension
Idiopathic intracranial hypertension

Question 6

What are the 9 red flags to look out for in someone with a headache?

Answer 6

Decreased level of consciousness
Sudden onset worst headache
Seizure/ focal neurological defecit
No previous episodes
Reduced visual acuity
Headaches worse when lying down
Progressive persistent headache
Constitutional symptoms
PMH (malignancy/ immunosuppression)

Question 7

What might a decreased level of consciousness suggest in someone with a headache?

Answer 7

SAH
Subdural haematoma: fluctuating consciousness
Extradural haematoma: altered consciousness post- lucid interval
Infection

Question 8

What does a persistent headache, worse when lying down with early morning nausea suggest?

Answer 8

Raised intracranial pressure

Question 9

What might a progressive persistent headache suggest?

Answer 9

Expanding space occupying lesion

Question 10

What are constitutional symptoms?

Answer 10

Weight loss
Night sweats
Fever

Question 11

What might a seizure or focal limb deficit suggest with a headache?

Answer 11

Intracranial pathology is more likely

Question 12

What signs are seen in a 3rd nerve palsy? What is the headache associated cause of this?

Answer 12

Ptosis
Mydriasis
Eye deviated down + out
SAH due to ruptured PCOM aneurysm

Question 13

What signs are seen in a 6th nerve palsy? What is the headache associated cause of this?

Answer 13

Convergent squint +/ or failure to abduct eye laterally

Mass or raised intracranial pressure

Question 14

What are signs of horner’s syndrome? What is the headache associated cause of this?

Answer 14

Partial ptosis
Anydrosis
Miosis
Carotid artery dissection
Cavernous sinus lesion

Question 15

What does scalp tenderness and jaw claudication suggest?

Answer 15

Temporal arteritis

Question 16

What are 7 causes of non sinister headache?

Answer 16

Tension type headache
Migraine
Sinusitis
Medication overuse headache
TMJ dysfunction syndrome
Trigeminal neuralgia
Cluster headache

Question 17

What are characteristics of a tension type headache?

Answer 17

Bifrontal

More common in women

Question 18

What are characteristics of trigeminal neuralgia?

Answer 18

More common >60s

Unilateral sharp facial pain, lasts seconds

Question 19

What are the characteristics of a migraine?

Answer 19

Unilateral
Aura
More common in women
Sensitive to light

Question 20

What are the features of sinusitis?

Answer 20

Constitutional symptoms + facial pain

Question 21

What are the features of a cluster headache?

Answer 21

Unilateral pain over 1 eye
More common in men
Causes patients to wake up at night
Occurs in clusters every few weeks

Question 22

What may you suspect if a patient over the age of 50 presents with a new onset headache?

Answer 22

Temporal arteritis

Question 23

If you are concerned about carotid or cerebral artery dissection, what may you ask about?

Answer 23

Minor neck trauma

Question 24

What signs are seen in a 12th nerve palsy? What is the headache associated cause of this?

Answer 24

Tongue deviation

Carotid artery dissection