Acute Headache Flashcards
What are the common differentials?
Migraine Tension Headache Cluster Headache Temporal (Giant cell) arteritis Glaucoma Meningitis Subdural heamatoma Subarachnoid bleeds Venous sinus thrombus Space-occupying lesion
Migraine? (5)
Recurrent, severe headache which is usually unilateral and throbbing in nature
May be be associated with aura, nausea and photosensitivity
Aggravated by, or causes avoidance of, routine activities of daily living.
Patients often describe ‘going to bed’.
In women may be associated with menstruation
Tension Headache? (2)
Recurrent, non-disabling, BILATERAL headache, often described as a ‘tight-band’
Gradual onset
Not aggravated by routine activities of daily living
Cluster headache? (5)
Pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours with clusters typically lasting 4-12 weeks
Intense pain around one eye (recurrent attacks ‘always’ affect same side)
Patient is restless during an attack
Accompanied by redness, lacrimation, lid swelling
More common in men and smokers
Temporal arteritis? (5)
Key investigation?
Rx?
Typically patient > 60 yrs old
Usually rapid onset (e.g. <1 month) of unilateral headache
Jaw claudication (65%)
Tender, palpable temporal artery
Can result in blindness if delay in treatment
Raised ESR & CRP (occasionally)
High-dose prednisolone
Glaucoma? (Generally) (5)
Rx?
Increased IOP Red eye Unilateral Cloudy cornea Blurred vision
Let the person lie flat with their face up and head not supported by pillows, as this may relieve some of the pressure on the angle.
If the drugs are available, give: pilocarpine eye drops, one drop of 2% in blue eyes or 4% in brown eyes; acetazolamide 500 mg orally to reduce production of aqueous humour (provided that there are no contraindications); analgesia; and an anti-emetic, if required.
Refer to an ophthalmologist anyone with suspected intermittent angle closure or chronic angle closure glaucoma (or its precursors — primary angle closure suspect [PACS], or chronic primary angle closure [PAC]).
Meningitis:
Causes?
Investigations?
Mx if meningococcal suspected at GP?
Mx of initial empirical therapy > 50 yrs?
Mx of meningococcal suspected at hospital?
Mx of pneuomococcal meningitis at hospital?
Mx of haemophilias influenza at hospital?
Mx of listeria at hospital?
Meningococcus (10%)
Pneumococcus (25%)
H.influenza
Listeria
FBC, U&E’s, CRP, coagulation screen, blood culture, blood glucose, PCR
LP (if no signs of increased ICP)
If meningococcal disease suspected (e.g. at GP) - IM Benzylpenicillin
IV cefotaxime + amoxicillin
IV Benzylpenecillin or cefotaxime
IV cefotaxime
IV cefotaxime
IV amoxicillin + gentamicin
Subdural haemorrhage/heamatoma? (5)
most commonly secondary to trauma
initial injury minor and forgotten
headache
classically fluctuating conscious level
raised ICP
NOTE: “EXTRADURAL” –> Lucid intervals
Subarachnoid haemorrhage:
Causes? (4)
Investigations? (2)
Mx? (2)
85% are due to rupture of berry aneurysms (polycystic kidney disease, Ehlers-Danlos syndrome and coarctation of the aorta)
AV malformation
Trauma
Tumours
CT: negative in 5%
LP: done after 12 hrs (allows time for xanthochromia to build up - yellow CSF)
neurosurgery
post-operative nimodipine (e.g. 60 mg/4hrly)
Venous sinus occlusion/thrombus:
Risk factors? (4)
Presentation?
lateral sinus?
cavernous sinus?
jugular bulb?
Investigations? (2)
Mx?
Prothrombotic states (pregnancy)
Infection
Malignancy
Dehydration
Headache (sudden onset & severe) Seizures Stroke syndrome N&V raised ICP papilloedema
headache
cranial nerve palsies
CN IX - XI palsies
FBC, U&E’s, CRP, clotting screen
CT/MRI
Analgesia
Treat seizures
Reduce ICP
Anticoagulation - heparin then warfarin
Space-occupying lesion:
Presentation? (2)
Headache always located on the same side
Dull, aching headache: made worse lying down or straining
