Chapter 20 - Headache

Question 1

What is the pathophysiology of headaches?

Answer 1

• the brain parenchyma is insensitive to pain
• The pain sensitive areas: meninges, blood vessels, tissues lining the cavities within the skull,
• most of the pain associated with h/a is mediated through CNV (then transferred back to the nucleus)

Question 2

List 7 life threatening causes of headaches?

Answer 2

1) SAH
2) Meningitis
3) CO poisoning
4) Temporal arteritis
5) Acute angle closure glaucoma
6) Intracerebral hemorrhage
7) Cerebral venous sinus thrombosis

Question 3

List 9 red flags on history for headaches?

Answer 3

1) sudden onset
2) worst ever headache or never had a headache like this one
3) refractory symptoms despite treatment
4) headache onset during exertion
5) Hx of HIV or immunocompromised
6) altered mental status + headache
7) meningismus
8) unexplained fever
9) focal neurological findings

Question 4

When should you perform a CT before performing a LP?

Answer 4

1) Generally CT should precede LP when investigating headaches
2) LP should not delay antibiotic administration
3) LP can proceed CT in meningitis if the patient has a normal neurological exam and has no papilledema

Question 5

Describe 8 clinical findings suggestive of increased ICP

Answer 5

1) Persistent vomiting
2) Altered mental status
3) hypertension and bradycardia
4) bulging fontanelle
5) diffuse, severe headache
6) loss of venous pulsations in the eye
7) optic disc/papilledema
8) headache worse when lying down and worse in the morning

Question 6

List 7 non-life threatening causes of headaches

Answer 6

1) tension headache
2) cluster headache
3) cervical muscle strain
4) migraine
5) post-lumbar puncture headache
6) TMJ disease/dental disease
7) effort dependent/coital headaches