Clinical Headache Assessment Flashcards
What are the three main types of headache a patient can present with?
New onset, recurrent, chronic
What are the concerning signs that a headache is dangerous?
Thunderclap
Fever
Focal symptoms
Persisting/progressing/provoked
What key question should you ask if someone comes in with a new onset headache?
From the start of the headache until it reached its peak - how long did it take?
Thunderclap comes on in few seconds (maximal at onset)
What does a headache with fever indicate?
Paranasal sinusitis
Meningitis - viral
Meningitis - bacterial
Encephalitis
What could be the cause of a persisting, new onset headache?
CO poisoning - work/boiler/garage
Temporal Arteritis - tender/systemic
Intracranial hypertension - BMI/pulsatile tinnitus
Cervicogenic/hemicrania - NSAID responsive, unilateral
Paranasal sinusitis - URTI/dental pain
Migraine, chronic onset (sensory sensitivity, allodynia) - if all else fails
What could be the diagnosis of a provoked, new onset headache?
CSF leak - orthostatic
Coital/exertional - onset during orgasm or intense exercise/recurrence
Cluster headache - autonomic activation, often nocturnal
Trigeminal neuralgia - lancinating, triggered
Hypnic headache - only wakens from sleep
How can brain tumours present?
Only small % present with isolated headache
- sounds like tension-type headache
- focal neurology/epileptic seizures
- papilloedema
- raised intracranial pressure
How is a new onset headache assessed?
History - new/onset/persist/provoked Targeted exam Decide if A+E/OPC/imaging ESR/CRP, FBP, TSH, U+E, LFT, Cortisol Treat with NSAID/paracetamol/decongest/physio Temporise 8 week rule
What are the safe types of headaches?
Episodic - migraine
Chronic - chronic migraine
What might a patient with migraine complain of?
Sickening headaches that make them want to lie down
- sensory sensitivity (light, noise, smell, movement, touch, nausea)
- prodrome (depression/anxiety, hunger/thirst/cravings, elation/energy, apathy/drowsiness, diarrhoea/polyuria)
