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Clinical Problem Solving > 11 - Headache > Flashcards

11 - Headache Flashcards

1
Q

A 72-year-old patient presents with a headache. You palpate her scalp. What sign are you checking for?

A

Swollen temporal artery

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2
Q

What blood test should be arranged in any patient > 50 with a new headache, and why?

A

ESR (erythrocyte sedimentation rate) to check for temporal arteritis

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3
Q

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?

A

Neck stiffness

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4
Q

Compare primary headaches and secondary headaches.

A

Primary: no underlying morbidity, benign
Secondary: underlying morbidity, benign or serious

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5
Q

What percentage of headaches are primary headaches?

A

90%

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6
Q

List 3 conditions leading to headaches with neck stiffness.

A
  1. Meningitis
  2. Raised intracranial pressure
  3. Subarachnoid haemorrhage
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7
Q

What type of headache worsens when lying down?

A

Raised intracranial pressure

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8
Q

How many types of headache are there?

A

Over 200

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9
Q

Presence of what would help you distinguish a benign headache from a serious one?

A

Red flag symptoms

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10
Q

List 6 possible examinations for a patient presenting with a headache.

A
  1. Blood pressure
  2. Optic fundi
  3. Temporal artery palpation
  4. Neurological examination
  5. Level of consciousness (Glasgow Coma Scale)
  6. Imaging
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11
Q

What scale would you use when examining a patient’s level of consciousness?

A

Glasgow Coma Scale

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12
Q

List 3 types of primary headache.

A
  1. Tension headache
  2. Migraine
  3. Cluster headache
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13
Q

Describe the pattern of attack for cluster headaches.

A
  • Last 15 minutes to 3 hours
  • Occur 1-8 times a day
  • Last 4-12 weeks
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14
Q

Describe cluster headaches.

A

Sharp, recurrent headaches on that occur on one side of the head, often accompanied by watery eyes and a runny nose

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15
Q

List 2 associated symptoms for a cluster headache.

A
  1. Watery eyes

2. Runny nose

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16
Q

List 3 risk factors for a cluster headache.

A
  1. Men
  2. Smoker
  3. Over 20
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17
Q

Describe trigeminal neuralgia.

A

Severe, episodic facial pain caused by compression of the trigeminal nerve

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18
Q

List 2 mental illnesses that can trigger tension headaches.

A
  1. Anxiety

2. Depression

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19
Q

Compare the site of a tension headache and a migraine.

A

Tension headache: both sides of the head

Migraine: one side

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20
Q

A patient presents with a mild band-like headache and no other symptoms. What is the likely diagnosis?

A

Tension headache

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21
Q

Describe the intensity of a tension headache.

A

Mild to moderate

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22
Q

List 2 ways to manage a tension headache.

A
  1. Painkillers

2. Stress management techniques

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23
Q

What is the typical duration of a tension headache?

A

30 minutes to a few hours

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24
Q

Migraines typically start ___ middle age.

A

Before

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25
Q

Are migraines more common in women or men?

A

Women

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26
Q

What percentage of females are affected by migraines?

A

20%

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27
Q

What percentage of males are affected by migraines?

A

6%

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28
Q

What type of primary headache may have a family history component?

A

Migraine

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29
Q

What medication might aggravate migraines?

A

Oral contraceptive pills

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30
Q

How long would an untreated migraine typically last?

A

4 to 72 hours

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31
Q

Describe the quality of migraine pain.

A

Throbbing

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32
Q

What type of primary headache is worsened by movement?

A

Migraine

33
Q

A patient presents with a migraine. What would be the result of examination?

A

Normal

34
Q

Describe the intensity of migraine pain.

A

Moderate to severe

35
Q

80% of migraine sufferers experience prodrome. What is prodrome?

A

General malaise and irritability indicating that a migraine will occur

36
Q

What percentage of migraine patients experience aura?

A

20%

37
Q

What is aura (re: migraines)?

A

VISUAL or SENSORY disturbances signalling a migraine

38
Q

List 3 types of sensory aura precipitating a migraine.

A
  1. Tingling
  2. Numbness
  3. Speech impairment
39
Q

List 4 types of visual aura precipitating a migraine.

A
  1. Scintillating scotoma
  2. Shimmering
  3. Temporal visual field loss
  4. Zigzag lines
40
Q

List 5 potential symptoms of a migraine (in addition to a severe, throbbing headache).

A
  1. Sensitivity to stimuli (i.e., light/sound/smell/motion)
  2. Nausea
  3. Vomiting
  4. Dizziness
  5. Fatigue
41
Q

Migraines increase sensitivity to which 4 stimuli?

A
  1. Light
  2. Sound
  3. Smell
  4. Motion
42
Q

What is an antiemetic?

A

Drug that relieves nausea and vomiting

43
Q

What is an analgesic?

A

Drug that relieves pain

44
Q

A patient presents with a migraine. What antiemetic would you prescribe?

A

Metoclopramide

45
Q

Drugs belonging to the triptan class (e.g., sumatriptan) would be prescribed for which ailment?

A

Migraines

46
Q

List 2 drugs that could prevent migraines.

A
  1. Propranolol

2. Amitriptyline

47
Q

Compare a hemorrhage and a hematoma.

A

Hemorrhage: bleeding
Hematoma: collection of blood outside the vessels

48
Q

The acronym VINDICATE is a mnemonic for the differential diagnosis of secondary headache. What does it stand for?

A 
Vascular
Infection
Neoplasia
Drugs
Inflammatory 
Congenital 
Autoimmune
Trauma
Endocrine
49
Q

Define aneurysm.

A

A balloon-like bulge in a weak blood vessel

50
Q

What is the most common cause of a subarachnoid hemorrhage?

A

Ruptured brain aneurysm

51
Q

What is the most common site for a subarachnoid hemorrhage?

A

Back of the head

52
Q

Name an infection that could induce a secondary headache.

A

Meningitis

53
Q

Name a neoplasm that could induce a secondary headache.

A

Brain tumour

54
Q

Name a drug that could induce a secondary headache.

A

Codeine

55
Q

A patient presents with a headache. You suspect meningitis. List 5 additional symptoms you might have encountered.

A
  1. Fever
  2. Neck stiffness
  3. Rash
  4. Vomiting
  5. Seizure
56
Q

Compare the underlying pathology of aseptic meningitis and meningococcal meningitis.

A

Aseptic: VIRAL
Meningococcal: BACTERIAL

57
Q

You suspect meningitis. What investigation do you carry out?

A

Lumbar puncture

58
Q

What is a lumbar puncture?

A

Collection of CSF with a needle for diagnostic testing

59
Q

What is an abscess?

A

Buildup of puss

60
Q

List 3 causes of raised intracranial pressure.

A
  1. Hemorrhage
  2. Abscess
  3. Tumour
61
Q

What is focal weakness?

A

Impaired CNS function in a specific region of the body

62
Q

A patient presents with a headache, vomiting, and seizures. You suspect raised intracranial pressure. List 5 additional symptoms you may have encountered.

A
  1. Focal weakness
  2. Neck stiffness
  3. Papilledema
  4. Drowsiness
  5. Behavioural changes
63
Q

What is papilledema?

A

Swelling of the optic nerve caused by raised intracranial pressure

64
Q

What percentage of malignant tumours are brain tumours?

A

1%

65
Q

What is the most common benign brain tumour?

A

Meningioma

66
Q

What is the most common cause of malignant brain tumours?

A

Metastases

67
Q

What is the immediate mortality rate for a patient presenting with a subarachnoid hemorrhage?

A

10-15%

68
Q

Patients with a subarachnoid hemorrhage would present with a thunderclap headache. What is a thunderclap headache?

A

Headache with a sudden, severe onset

69
Q

What percentage of strokes in the UK comprise of a subarachnoid hemorrhage?

A

5%

70
Q

How might a subarachnoid hemorrhage lead to neck stiffness?

A

Bleeding irritates the meninges, which cover the CNS (including the neck)

71
Q

List 2 investigations that could confirm a subarachnoid hemorrhage.

A
  1. Lumbar puncture

2. CT scan

72
Q

How would you treat a subarachnoid hemorrhage?

A

Neurosurgery

73
Q

What is subdural hematoma?

A

Blood in the subdural space following rupture of a vein

74
Q

What is the most common cause of subdural hematoma?

A

Trauma

75
Q

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.

A
  1. Disorientation
  2. Confusion
  3. Memory loss
  4. Drowsiness
  5. Seizures
76
Q

Compare the onset of a subarachnoid hemorrhage and subdural hematoma.

A

Subarachnoid hemorrhage: sudden

Subdural hematoma: days of weeks after trauma

77
Q

Compare the treatment for a subarachnoid hemorrhage and a subdural hematoma.

A

Subarachnoid hemorrhage: surgical

Subdural hematoma: surgical OR conservative

78
Q

Which age group is most susceptible to temporal arteritis?

A

50+

79
Q

The acronym SNOOPTHAT can be used to identify headache red flags. Briefly describe what each letter stands for.

A

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

Clinical Problem Solving (10 decks)

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