12.1.1 Headache Flashcards
Discuss an approach to the undifferentiated paediatric and adult patient who presents to primary health care with headaches. At the end of this lecture, you will be able to effectively utilize all clinical information to formulate a differential diagnosis for these patients, identify the most likely diagnosis, and rule out critical diagnoses that must not be missed.
1
Q
Common primary care causes of headaches
A
Tension type headache
- stress,anxiety,depression
-Lack of sleep, fatigue
- Poor posture
Migraine
- Stress
- fluctuation in hormone leves: can be caused by oral contraceptives or menstruation.
- Certain types of food: those containing tyramines or nitrates such as processed meat, chocolate,cheese
Cluster
- Alcohol
2
Q
Common red flags in patients with headaches
A
SNOOP15
1. Systemic symptoms (e.g., fever, signs of meningitis, myalgia, malaise)
- Intracranial infections
-Nonvascular intracranial disorders
- Neoplasm in history
- Neoplasms of the brain and metastasis - Neurological deficits/dysfunction (e.g., altered mental status, seizures)
- Neoplasms
-ischemic stroke
- SAH
- ICH - Onset of headache is sudden or abrupt
- Subarachnoid haemorrhage - Older age at onset (> 50 years)
- Giant cellarteritis
-Cranial or cervical vascular disorders
-Neoplasms - Pattern changes of headache or recent onset
- Neoplasms
- Headache attributed to vasular or nno vascular intracranial disorders - Positional headache
- Intracranial hypertension or hypotension.
* Precipitated by sneezing, coughing
, or exercise
* Papilledema and other signs of increased ICP
* Progressive headache and atypical features
* Pregnancy or postpartum period
* Pain of the eye
with autonomic features and visual deficits
* Posttraumatic onset
* Pathology of the immune system
(especially due to HIV
* Painkiller overuse or new drug at onset of headache
3
Q
Things to note: epidemiology(USA)
A
- Regarding lifetime prevalence > 90%, female predominance except for cluster headaches.
- Most common forms of headaches:
Tension:40-80%
Migraine: 10%
4
Q
Things to note: epidemiology(SA)
A
- Headaches are common but look at them with upper respiratory tract infection.
5
Q
Approach to headaches in primary care
A
- Check vital signs.
- Perform focused history and examination.
- If red flags are present:
Obtain brain imaging (either CT or MRI brain with and/or without contrast) based on the red flag symptoms. [1]
Perform further targeted diagnostics (see below). - If no red flags are present and suspicion for life-threatening causes is low:
Perform a detailed history and clinical exam.
Consider whether further diagnostic testing is necessary. - Provide supportive care.
- Identify and treat the underlying cause.
