Case 3: Work up for headache Flashcards
Understand the clinical approach to a headache
Define migraine
Disorder of recurrent attacks; headache= unilateral, throbbig pain that is pulsatile. Look for aura, nausea or vomiting.
What are common triggers for migraines?
menstruation; stress, visal stimuli, nitrates, fasting
define tension-type headache
Unilateral or bilateral, non-throbbing headache without associated features
Define cluster headache
Belongs to a group of trigeminal autonomic cephalgias–> KEYUnilateral, sever headache with autonomic symptoms
Lasts <80mins
Describe the 2 stages in the approach to a headache history?
- Rule out serious underlying pathology
2. Determine the type of Primary headache using History
What are the danger signs for a headache? (SNOOP)
Systemic symptoms
Neurological symptoms (confusion, impaired consciousness)
Onset is new/sudden
Other associated conditions (trauma, toxin)
Previous headache history with different type of headache
What should we screen for on headache history?
Vascular, infecto, metabolic disturbances or systemic problems
What is the significance of a visual field defect
Lesion of the optic pathway
What is the significance of sudden severe unilateral vision loss
Optic neuritis
What is th significance of confusion, blurred vision and lack of concetration
Raied ICP
What is the significance of a morning headache?
COPD, OSA, raised ICP
What is the significance of a thunderclap headache
SAH
What is the significance of hornet’s syndrome + neck pain?
Cervical artery dissection
What is the significance of fever, altered mental status and nuchal rigidity?
Meningitis/encephalitis
What is the significance of orbital symptoms
Glaucoma,infeciton, tumor
