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