1. Headache Flashcards
What are the sinister causes of a headache?
VIVID
- Vascular
- infection
- vision-threatening
- raised intracranial pressure
- dissection
What are the vascular causes of a headache?
- Subarachnoid haemorrhage
- hematoma
- cerebral venous sinus thrombosis
- cerebellar infarct
What are the infective causes of a headache?
- Meningitis
- encephalitis
What are the vision-threatening causes of a headache?
- Temporal arteritis
- acute glaucoma
- cavernous sinus thrombosis
- pituitary apoplexy
- posterior leukoencephalopathy
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 ever
- seizure
- no previous episodes
- headaches worse when lying down along with morning vomitting
- progressive persistent headache
- constitutional symptoms
- reduced visual acuity
- past medical history
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 (SAH)
What does a persistent headache, worse when lying down with early morning nausea suggest?
Raised intracranial pressure
- intracranial pressures rise when we lie down
What might a progressive persistent headache suggest?
Expanding space occupying lesion
eg. tumour, abscess, cyst or hematoma
What are constitutional symptoms?
- weight loss
- night sweats
- fever
might suggest malignancy, chronic infection or inflammation
what does sudden onset worst headache ever suggest?
- this is inline with SAH
- as blood in the CSF irritates the meninges
- very severe headache with instantaneous onset is inline with SAH
what basic observations to look out for?
- altered consciousness (GCS score)
- blood pressure and pulse (malignant hypertension)
- Temperature (fever and headache suggests intracranial infection )
what focal neurological signs to look out for?
- focal limb deficit
- third nerve palsy
- sixth nerve palsy
- twelfth nerve palsy
- horners syndrome
What might a focal limb deficit suggest with a headache?
- Intracranial pathology is more likely
- (migrainous aura)
What signs are seen in a third nerve palsy?
- Ptosis (drooping eyelid)
- mydriasis (dilated pupil)
- 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 signs are seen in twelfth nerve palsy?
- tongue deviation
What are signs of horner’s syndrome?
- Partial ptosis (drooping eyelid)
- anydrosis (lack of sweating)
- miosis ( pinpoint pupil)
features to look at in eye inspection?
- exophthalmos - cavernous sinus thrombosis
- cloudy cornea - acute glaucoma
- optic disc appearance on fundoscopy - raised ICP
What does scalp tenderness suggest?
Classically seen in temporal arteritis
what might stiff neck or photophobia suggest?
management of temporal arteritis?
- elevated erythrocyte sedimentation rate
- C-reactive protein
management is to reduce the immune regulated inflammation to prevent more visual loss
- high dose corticosteroids
temporal artery biopsy could be done later on to confirm
criteria to diagnose temporal arteritis?
- age of onset of symptoms is greater than 50
- new headache
- ESR>50
- clinically abnormal temporal artery (tender/non pulsatile)
- biopsy of temporal artery shows mononuclear infiltration
What are the causes of non sinister headache?
- tension type headache
- migraine
- cluster headache
- sinusitis (secondary)
- medication overuse headache (secondary)
- TMJ dysfunction syndrome (secondary)
- trigeminal neuralgia (secondary)
questions to categorise non-sinister headaches?
- different types of headaches or just one type?
- are there any triggers?
- how disabling are the headaches?
- does the patient get an aura before headaches?
What are the characteristics of a migraine?
- Unilateral
- aura
- more common in women
- sensitive to light and nausea
- pulsatile pain
- last between 4-72 hours
What are the characteristics of a tension-type headache?
- very common
- It is bifrontal like a band
- more common in women
- few hours and not disabling
- no other features
What are the characteristics of trigeminal neuralgia?
- More common over 60s
- unilateral sharp facial pain
- lasts seconds
- triggered by eating, laughing, talking
What are the features of sinusitis?
- Constitutional symptoms and facial pain
- worse with movements
- lasts several days with infection
features of medication overuse headache?
- seen with migraine medication and analgesics
- resemble migraine/tension-type headaches
- treatment is withdrawal from analgesic use
What are the features of a cluster headache?
- Unilateral pain over one ey
- more common in men
- causes patients to wake up at night
- occurs in clusters every few weeks
- headaches are very disabling
characteristics of TMJ syndrome headache?
- most common in individuals 20-40 years old
- headache and dull ache in muscles of mastication
- click or grinding noise when they move their jaw
