8. Céphalée /Headache Flashcards
Red flags (SNOOPPPPS)
Systemic - fever, weight loss, HTN, myalgias, scalp tenderness
Neuro - confusion, decreased LOC, papilledema, visual field defect, CN asymmetry, extremity drift/weakness, reflex asymmetry, seizure
Onset - Sudden
Older - New onset or progressive >50yo
Pattern change/progressive - Different or new
Papilledema
Postural aggravation
Precipitated by valsalva (cough, sneeze)
Secondary risk factors- HIV, malignancy, trauma, early morning/nocturnal
ddx - primary headache (4) secondary (3) intra vs extra cranial
1
migraine
tension
cluster
if more than 15d for 3 mo (chronic tension or migraine vs overuse vs hemicrania continua)
2
infx - meningitis, sinus, mastoid, dental
hyperTA 0 pre-eclampsia
CO
3 Intracranial
VASCULAR
Subarachnoid (thunderclap)
Temporal arteritis
Venous Sinus Thrombosis
SDH (worsening over time)
Cervical artery dissection (TIA/neuro deficit in young)
Nonvascular:
Increased/decreased (eg. CSF leak) ICP, Tumor, Chiari malformation (Valsalva)
4 Extracranial
Eye disorder (refractory errors, glaucoma)
Carotid dissection
TMJ - Temporomandibular joint dysfunction
When to do an LP
if symptoms of secondary cause
Valsalva/exercise
Systemic illness (fever/rash/neck stiffness/meningismus)
Neuro sign (papilledema/seizure)
when to do a CT
red flags SNOOPPPPS
Risk of intracranial pathology
Tests if suspecting temporal arteritis
ESR / CRP
confirm with bx
R/O subarachnoid hemorrhage (SAH)
Ottawa SAH Rule (100% sensitive, 15% specific - if negative helpful to rule out, excluded neuro deficits, brain tumors, chronic recurrent headache)
Age≥40
Neck Pain/Stiffness
LOC
Onset during Exertion
Thunderclap
Limited Neck Flexion on exam
If CT negative for SAH what to do
LP = Elevated opening pressure
elevated RBC count that does not significantly diminish, Xanthochromia (hemoglobin degradation if blood in CSF >2h)
If diagnosed SAH, proceed to angiography to rule out aneurysmal
