11 - Headache Flashcards
A 72-year-old patient presents with a headache. You palpate her scalp. What sign are you checking for?
Swollen temporal artery
What blood test should be arranged in any patient > 50 with a new headache, and why?
ESR (erythrocyte sedimentation rate) to check for temporal arteritis
A 72-year-old patient presents with a headache. You ask her to put her chin on her chest. What sign are you checking for?
Neck stiffness
Compare primary headaches and secondary headaches.
Primary: no underlying morbidity, benign
Secondary: underlying morbidity, benign or serious
What percentage of headaches are primary headaches?
90%
List 3 conditions leading to headaches with neck stiffness.
- Meningitis
- Raised intracranial pressure
- Subarachnoid haemorrhage
What type of headache worsens when lying down?
Raised intracranial pressure
How many types of headache are there?
Over 200
Presence of what would help you distinguish a benign headache from a serious one?
Red flag symptoms
List 6 possible examinations for a patient presenting with a headache.
- Blood pressure
- Optic fundi
- Temporal artery palpation
- Neurological examination
- Level of consciousness (Glasgow Coma Scale)
- Imaging
What scale would you use when examining a patient’s level of consciousness?
Glasgow Coma Scale
List 3 types of primary headache.
- Tension headache
- Migraine
- Cluster headache
Describe the pattern of attack for cluster headaches.
- Last 15 minutes to 3 hours
- Occur 1-8 times a day
- Last 4-12 weeks
Describe cluster headaches.
Sharp, recurrent headaches on that occur on one side of the head, often accompanied by watery eyes and a runny nose
List 2 associated symptoms for a cluster headache.
- Watery eyes
2. Runny nose
List 3 risk factors for a cluster headache.
- Men
- Smoker
- Over 20
Describe trigeminal neuralgia.
Severe, episodic facial pain caused by compression of the trigeminal nerve
List 2 mental illnesses that can trigger tension headaches.
- Anxiety
2. Depression
Compare the site of a tension headache and a migraine.
Tension headache: both sides of the head
Migraine: one side
A patient presents with a mild band-like headache and no other symptoms. What is the likely diagnosis?
Tension headache
Describe the intensity of a tension headache.
Mild to moderate
List 2 ways to manage a tension headache.
- Painkillers
2. Stress management techniques
What is the typical duration of a tension headache?
30 minutes to a few hours
Migraines typically start ___ middle age.
Before
Are migraines more common in women or men?
Women
What percentage of females are affected by migraines?
20%
What percentage of males are affected by migraines?
6%
What type of primary headache may have a family history component?
Migraine
What medication might aggravate migraines?
Oral contraceptive pills
How long would an untreated migraine typically last?
4 to 72 hours
Describe the quality of migraine pain.
Throbbing
What type of primary headache is worsened by movement?
Migraine
A patient presents with a migraine. What would be the result of examination?
Normal
Describe the intensity of migraine pain.
Moderate to severe
80% of migraine sufferers experience prodrome. What is prodrome?
General malaise and irritability indicating that a migraine will occur
What percentage of migraine patients experience aura?
20%
What is aura (re: migraines)?
VISUAL or SENSORY disturbances signalling a migraine
List 3 types of sensory aura precipitating a migraine.
- Tingling
- Numbness
- Speech impairment
List 4 types of visual aura precipitating a migraine.
- Scintillating scotoma
- Shimmering
- Temporal visual field loss
- Zigzag lines
List 5 potential symptoms of a migraine (in addition to a severe, throbbing headache).
- Sensitivity to stimuli (i.e., light/sound/smell/motion)
- Nausea
- Vomiting
- Dizziness
- Fatigue
Migraines increase sensitivity to which 4 stimuli?
- Light
- Sound
- Smell
- Motion
What is an antiemetic?
Drug that relieves nausea and vomiting
What is an analgesic?
Drug that relieves pain
A patient presents with a migraine. What antiemetic would you prescribe?
Metoclopramide
Drugs belonging to the triptan class (e.g., sumatriptan) would be prescribed for which ailment?
Migraines
List 2 drugs that could prevent migraines.
- Propranolol
2. Amitriptyline
Compare a hemorrhage and a hematoma.
Hemorrhage: bleeding
Hematoma: collection of blood outside the vessels
The acronym VINDICATE is a mnemonic for the differential diagnosis of secondary headache. What does it stand for?
Vascular Infection Neoplasia Drugs Inflammatory Congenital Autoimmune Trauma Endocrine
Define aneurysm.
A balloon-like bulge in a weak blood vessel
What is the most common cause of a subarachnoid hemorrhage?
Ruptured brain aneurysm
What is the most common site for a subarachnoid hemorrhage?
Back of the head
Name an infection that could induce a secondary headache.
Meningitis
Name a neoplasm that could induce a secondary headache.
Brain tumour
Name a drug that could induce a secondary headache.
Codeine
A patient presents with a headache. You suspect meningitis. List 5 additional symptoms you might have encountered.
- Fever
- Neck stiffness
- Rash
- Vomiting
- Seizure
Compare the underlying pathology of aseptic meningitis and meningococcal meningitis.
Aseptic: VIRAL
Meningococcal: BACTERIAL
You suspect meningitis. What investigation do you carry out?
Lumbar puncture
What is a lumbar puncture?
Collection of CSF with a needle for diagnostic testing
What is an abscess?
Buildup of puss
List 3 causes of raised intracranial pressure.
- Hemorrhage
- Abscess
- Tumour
What is focal weakness?
Impaired CNS function in a specific region of the body
A patient presents with a headache, vomiting, and seizures. You suspect raised intracranial pressure. List 5 additional symptoms you may have encountered.
- Focal weakness
- Neck stiffness
- Papilledema
- Drowsiness
- Behavioural changes
What is papilledema?
Swelling of the optic nerve caused by raised intracranial pressure
What percentage of malignant tumours are brain tumours?
1%
What is the most common benign brain tumour?
Meningioma
What is the most common cause of malignant brain tumours?
Metastases
What is the immediate mortality rate for a patient presenting with a subarachnoid hemorrhage?
10-15%
Patients with a subarachnoid hemorrhage would present with a thunderclap headache. What is a thunderclap headache?
Headache with a sudden, severe onset
What percentage of strokes in the UK comprise of a subarachnoid hemorrhage?
5%
How might a subarachnoid hemorrhage lead to neck stiffness?
Bleeding irritates the meninges, which cover the CNS (including the neck)
List 2 investigations that could confirm a subarachnoid hemorrhage.
- Lumbar puncture
2. CT scan
How would you treat a subarachnoid hemorrhage?
Neurosurgery
What is subdural hematoma?
Blood in the subdural space following rupture of a vein
What is the most common cause of subdural hematoma?
Trauma
A patient fell two weeks ago. Over the past few days, they have complained of a headache. You suspect subdural hematoma. List 5 other symptoms you may have encountered.
- Disorientation
- Confusion
- Memory loss
- Drowsiness
- Seizures
Compare the onset of a subarachnoid hemorrhage and subdural hematoma.
Subarachnoid hemorrhage: sudden
Subdural hematoma: days of weeks after trauma
Compare the treatment for a subarachnoid hemorrhage and a subdural hematoma.
Subarachnoid hemorrhage: surgical
Subdural hematoma: surgical OR conservative
Which age group is most susceptible to temporal arteritis?
50+
The acronym SNOOPTHAT can be used to identify headache red flags. Briefly describe what each letter stands for.
Systemic – fever, weight loss, fatigue, rash
Neurological – confusion, unconsciousness, personality changes, seizure
Onset – thunderclap (i.e., sudden, severe)
Older – 50+
Pattern – first headache, different from previous headaches
Timing – early morning
Hurling – vomiting WITHOUT nausea
Aggravating – worsened by coughing, exercise, or lying down
Trauma – within past 90 days