Depression Flashcards
What are the red flags of headache?
- New severe or unexpected headache.
- progressive or persistent headache or headache that has changed dramatically
- Associated features such as fever, impaired consciousness, seizure, neck stiffness, papillodema, new onset neurological deficit, atypical aura, dizziness, visual disturbances and vomiting.
- contacts with similar symptoms
- precipitating factors such as head trauma, headache triggered by a valsalva manoeuvre, headache that worsens on standing or lying down.
- comorbidities such as immunosuppression and malignancy
- current or recent pregnancy
What are the causes of a new severe or unexpected headache?
- Sudden-onset severe headache reaching maximum intensity within 5 minutes may indicate serious causes such as intracranial haemorrhage, venous sinus thrombosis, hypertensive encephalopathy and vertebral artery dissection.
- New onset headache in a person aged over 50 years may indicate a serious cause such as giant cell arteritis or space occupying lesion.
What are the causes of progressive or persistent headaches?
Mass lesion
Subdural haematoma
Which conditions would cause headaches, fever, Impaired consciousness, seizure, neck pain/stiffness and photophobia?
Meningitis
Encephalitis
Which conditions would cause headache and papilloedema?
Space occupying lesions
Cerebral venous sinus thrombosis
Benign intracranial HTN
Which conditions causes new-onset neurological deficit and headache?
Cerebrovascular event
Malignancy
SOL
Subacute or chronic subdural haematoma
Which conditions would cause atypical aura and headaches ?
Cerebrovascular event
Which condition would cause dizziness and headaches?
Ischaemic or haemorrhagic stroke
Which conditions cause visual disturbances and headaches?
Migraine
Acute closure glaucoma
Temporal arteritis
Which conditions cause vomiting with headaches?
Migraine
Mass lesion
Brain abscess
Carbon monoxide poisoning
Why is it important to ask about contacts with similar symptoms when assessing headaches?
Consider serious causes such as carbon monoxide poisoning if household contacts have similar symptoms.
What are worrying precipitating factors of headaches?
Preceding recent (usually within the past 3 months) head trauma — consider serious causes such as subacute or chronic subdural hematoma.
• Headache triggered by a Valsalva manoeuvre (such as coughing, sneezing, bending or exertion [physical or sexual]) — consider serious causes such as Chiari 1 malformation or a posterior fossa lesion.
• Headache that worsens on standing — consider a CSF leak.
• Headache that worsens on lying down — consider a space-occupying lesion or cerebral venous sinus thrombosis.
What is a worrying condition that causes headaches in pregnancy?
Pre-eclampsia
Why is it important to ask about PMH when assessing headaches?
- Compromised immunity (for example due to HIV or immunosuppressive drugs) — consider serious causes such as cerebral infection or malignancy.
- Current or past malignancy — consider serious causes such as cerebral metastases.
What is depression?
• Depressive disorders are typically characterised by persistent low mood, loss of interest and enjoyment, neurovegetative disturbance, and reduced energy, causing varying levels of social and occupational dysfunction.
What are depression symptoms?
Depressed mood (DSM-5) Anhedonia (DSM-5) Functional impairment (DSM-5) Weight changes Libido changes Sleep disturbance Psychomotor problems Low energy Excessive guilt Poor concentration Suicidal ideation Medical illness excluded Bipolar disorder excluded