1. Headache Flashcards
What are the sinister causes of a headache?
VIVID Vascular Infection Vision threatening Raised intracranial pressure Dissection
What are the 4 vascular causes of a headache?
Subarachnoid haemorrhage
Haematoma
Cerebral venous sinus thrombosis
Cerebellar infarct
What are the 2 infective causes of a headache?
Meningitis + encephalitis
What are 5 vision threatening causes of a headache?
Temporal arteritis Acute glaucoma Cavernous sinus thrombosis Pituitary apoplexy Posterior leucoencephalopathy
What are the 5 causes of a raised intracranial pressure?
Space occupying lesion Cerebral oedema Hydrocephalus Malignant hypertension Idiopathic intracranial hypertension
What are the 9 red flags to look out for in someone with a headache?
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)
What might a decreased level of consciousness suggest in someone with a headache?
SAH
Subdural haematoma: fluctuating consciousness
Extradural haematoma: altered consciousness post- lucid interval
Infection
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 seizure or focal limb deficit suggest with a headache?
Intracranial pathology is more likely
What signs are seen in a 3rd nerve palsy? What is the headache associated cause of this?
Ptosis
Mydriasis
Eye deviated down + out
SAH due to ruptured PCOM aneurysm
What signs are seen in a 6th nerve palsy? What is the headache associated cause of this?
Convergent squint +/ or failure to abduct eye laterally
Mass or raised intracranial pressure
What are signs of horner’s syndrome? What is the headache associated cause of this?
Partial ptosis Anydrosis Miosis Carotid artery dissection Cavernous sinus lesion
What does scalp tenderness and jaw claudication suggest?
Temporal arteritis
What are 7 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?
Bifrontal
More common in women
What are characteristics of trigeminal neuralgia?
More common >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 + facial pain
What are the features of a cluster headache?
Unilateral pain over 1 eye
More common in men
Causes patients to wake up at night
Occurs in clusters every few weeks
What may you suspect if a patient over the age of 50 presents with a new onset headache?
Temporal arteritis
If you are concerned about carotid or cerebral artery dissection, what may you ask about?
Minor neck trauma
What signs are seen in a 12th nerve palsy? What is the headache associated cause of this?
Tongue deviation
Carotid artery dissection
