16. Headache Flashcards
What are the pain sensitive areas of the brain?
Meninges’s
Arteries, and veins.
Various tissues lining the cavities within the skull
Which cranial nerve mediates thought of headache
Cranial nerve five
Name eight causes of emergent headache
Carbon monoxide poisoning, meningitis/encephalitis/abscess, temporal arthritis, glaucoma, increased, intracranial, pressure, cerebral Venus, sinus thrombosis, reversible, cerebral, vasoconstriction syndrome, intracranial, hemorrhage, including subarachnoid, subdural, epidural
Who is at risk for meningitis/encephalitis/abscess
History of sinus or ear infection, or recent surgical procedure, immuno compromised, general debilitation with decreased immunologic function, acute viral illness of any type, extremes of age, impacted living conditions, including military, or college dorms, lack of primary immunization
What are risk factors for carbon monoxide poisoning?
Breathing in an enclosed confined space with engine, exhaust or ventilation of heating equipment, multiple household members with same symptoms, wintertime and working around machinery or equipment, producing carbon monoxide
Temporal arthritis risk factors
Age greater than 50 females greater than males.
History of other collagen, vascular disease, including lupus.
Previous chronic meningitis
Previous chronic illness, including TB, parasitic or fungal infection
Risk factors for acute angle closure glaucoma
Not associated specifically with any usual or customary headache pattern.
History of previous glaucoma
Age greater than 30
History of pain in increasing in a dark environment
Risk factor is for increased intracranial pressure
History of previous benign, intracranial, hypertension
Presence of cerebral spinal fluid shunt.
History of congenital brain or skull abnormalities
Female gender.
Obesity
Risk factors for cerebral Venus, sinus thrombosis
Female gender.
Pregnancy, peripartum, hormone replacement therapy, or OCP.
Prothrombotic conditions
Risk factors for reversible cerebral vasoconstriction syndrome
Episodic sudden severe pain with or without focal Neuro deficits or seizure.
Recurrent episodes over period up to several weeks.
Exposure to adrenergic or serotonergic drugs.
Postpartum state
Risk factors for SAH
Sudden and severe pain “worst headache of life”
Acute severe pain after intercourse or exertion.
History of SAH or cerebral aneurysm.
History of polycystic kidney disease
Family, history of SAH.
Hypertension, severe.
Previous vascular lesions and other areas of the body
Young and middle age
What type of haematoma is associated with anisocoria
Epidural
List 10 differential diagnosis of headache causes in the CNS neurologic or vessels
SAH, carotid dissection, Venus, sinus thrombosis, shunt failure, traction, headache, tumor, mass, subdural, hematoma, reversible, cerebral, vasoconstriction syndrome, migraine, vascular headache, trigeminal, neuralgia, post traumatic, i.e. concussion, post LP headache
List two causes of headache that are considered toxic/metabolic or environmental
Carbon monoxide poisoning.
Mountain sickness
What type of headache falls under the collagen vascular disease category?
Temporal arthritis
What four ocular or ENT causes can cause headache
Glaucoma
Sinusitis
Dental problems.
TMJ disease
What muscular skeletal causes can cause headache
Tension headache
Cervical strain
What type of headaches fall under the allergy diagnosis?
Cluster
Name four headache causes that fall under infectious disease
Meningitis.
Encephalitis
Brain abscess.
Headaches, man, neurologic source
What type of headache falls under the pulmonary or oxygen criteria?
Anoxic headache
What type of cardiovascular cause can cause a headache?
Hypertensive crisis
What are four miscellaneous causes under the category of unspecified, causing headaches?
Preeclampsia
Idiopathic, intracranial, hypertension
Effort, dependent, or coil headache
Medication, overuse or rebound
Keith physical exam categories for assessment of headache
General appearance.
Vital signs
HEENT
Neurologic
What timing is sufficient to rule out cerebral venous thrombosis
MRV or t venogram
How many hours since the onset of headache has been shown to be sufficient to exclude the diagnosis of SAH when using a third generation CT scan scanner?
Six hours
What two diagnosis in particular are useful for using an LP
Concern for SAH greater than six hours
IIH with an opening pressure and CSF analysis
What tests are helpful for diagnosing temporal arthritis?
Yes, SR or CRP
Which two kinds of headaches or causes of headaches might an ECG be helpful with
SAH
Increased intracranial pressure.
I.e. nonspecific ST/T wave changes
What is the inclusion criteria for the Ottawa subarachnoid haemorrhage rule?
Patient’s age 15 and over, non-traumatic headache, peak intensity within one hour onset
Ottawa subarachnoid haemorrhage rule: exclusion criteria
New neurologic deficits, prior aneurysm, prior SAH, known intracranial mass, recurrent chronic headaches
Ottawa subarachnoid rule, which of the following must all be negative in order to rule out (six)
Age greater than 40 years
neck, pain or stiffness.
Witness loss of consciousness.
Headache during exertion.
Thunderclap headache with immediate peak pain.
Limited neck flexion
What type of symptoms might carbon monoxide poisoning present with?
Gradual, subtle, non-focal throbbing wax and wane
Recommendations for in Eric treatment of headache example primary
Oral NSAIDs, including 500 mg naproxen
Medical clopamide 10 mg
Can treat with sumatriptan 6 mg
Intramuscular or IV and said including Coac 15 mg
Recommendations for in Eric treatment of headache example primary
Oral NSAIDs, including 500 mg naproxen
Medical clopamide 10 mg
Can treat with sumatriptan 6 mg
Intramuscular or IV and said including Coac 15 mg
A CT NegGram is relatively contraindicated in what condition due to not been shown to be safe
Pregnancy
