Differentials for acute presentation - Headache Flashcards
What are life-threatening causes of a headache?
- Subarachnoid haemorrhage
- Meningitis/encephalitis
- SOL
- Temporal arteritis
- Pre-eclampsia
How would you explore the symptom of an acute headache?
- SOCRATES
- Meningeal symptoms - rash, fever, neck stiffness, photophobia
- Temporal arteritis - temporal headache, jaw claudication
- Glaucoma - visual problems, red eyes, halos around lights
What would you ask about on systems review in someone with an acute headache?
- How patient feels
- Fever
- Fits/falls/LOC
- Limb weakness
- Altered sensations
- Vision
What would you ask about in the drug history of someone with an acute headache?
- Anticoagulants
- Steroids
- Analgesia
What would you ask about in family history for someone with an acute headache?
- Previous headache problems
- Berry aneurysms
What would you look for on examination in someone with an acute headache?
- GCS
- Signs of photophobia/rash/neck stiffness
- Eyes - pupils, redness, vision
- Sinuses + temporal artery
- Kernigs / Brudzinski’s sign
- Full neuro exam
- Cranial nerves
- FUndoscopy - papilloedema/haemorrhages
What bloods would you consider doing in someone with an acute headache?
- FBC
- CRP
- U+E’s
- ESR
- Blood cultures
- Meningococcal PCR
What imaging would you consider doing in someone with a headache?
CT head
What specific tests would you consider doing in someone with an acute headache?
LP
What are primary causes of an acute headache?
- Migraine
- Cephalgias - Cluster headache, SUNCT, paroxysmal hemicrania
- Tension headache
- Trigeminal neuralgia
What are secondary intracranial causes of acute headache?
- Meningitis
- Temproal arteritis
- Subarachnoid haemorrhage
- Raised ICP
- Venous sinus throbosis
- Intracerebral haemorrhage
- Encephalitis
- Cerebral abscess
- Tumour
- Pituitary apoplexy
- Subdural haematoma
- Extradural haematoma
What are secondary extracranial causes of an acute headache?
- Acute closed angle glaucoma
- Sinusitis
- Hypertensive encephalopathy
- Pre-eclampsia
- Carotid/vertebral artery dissection
- Drugs/Withdrawal
- Carbon monoxide poisoning
- Post-trauma
- Paget’s disease
- Hypoxia
- Cervical spondylosis
- Otitis media
- Dental problems
What structured approach would you take to deciding what investigations to do in someone with an acute headache?
- Bloods/Bedside
- Orifices
- X-ray/Imaging
- ECG
- Specific
What are red flag features of a headache?
- Thunderclap/recent trauma - intracranial bleed
- Postural/valsalva induced - Raised ICP
- Onset > 50 years, other malignancy - SOL
- Rash/fever/neck stiffness - meningitis
- Visual problems/jaw claudication/scalp tenderness - temporal arteritis
- Blurring/red eye/halos - Glaucoma
