ECR 11.29.12 Headach History and Diagnosis Flashcards
What are primary headaches (4)
Migraine
Tension Type (TTH)
Cluster
Other (benign cough headache)
What are secondary types of headaches
Infection
Hemorrhage
Increased ICP (intracranial P -DO NOT MISS)
Brain Tumor
What Questions should you ask when taking Headach History (5)
- Ask how many different types of headaches you have
- How long have you had it?
(if chronic, okay; if sudden worst ever–> CAT scan) - What do you think it’s due to?
- Where is it lcoated?
- What is it like?
What is temoporal pattern of Migraine
lasts 203 days
Episodic headaches
What is temporal pattern of Tension Headache
constant
~6 months
What is temporal pattern for cluster headache
painful stimulus ;
What is temporal pattern for Tumor/inracranial neoplasm
progressive with time
What are migraine triggers (7)
Phsyical exertion
Diet
Hormonal changes
Head Trauma
Stress and anxiety
Sleep deprivation or excess
Environmental factors
Why is pain localized to front of head (referred pain>
TRIGEMINAL N. above tentonum
If stretched–> Trigeminal N.
When do you have pain back of head
T9-T10
how deos IHS determine if its migraine?
> 5 attacks lasting 4-72h
What is timing of migrains (IHS)
> 5 attacks lasting 4-72 h
What are qualities of migraines (IHS)- need >2
Unilateral
Puslating
Moderate to severe intensity
Aggravation by routine physical activity
What are >1 needed for migraine (IHS)
nausea
photopobia and phonophobia
Rate /timing of Tension headache (IHS)
> 10 attacks lasting 30 mins-7 days
> 2 of the following 4 tension headaches (IHS)
Bilateral
Not pulsating
Mild or moderate intensity
Not aggravated by routing physical activityIs
Is nausea/vomiting ass. with tension headaches?
NO!
Is photophobia or phonoboia ass with headaches
only ONE or NEITHER
What is the attack profile of a cluster headache
unilateral orbital/temporal severe pain
Rapid onset (5-15 mins) Short duration (45-90 mins)
Agitation/restlessness (90%)
Migrainous syptoms (nausea, photophobia, phonobobia, aura)
Autonomic features
Rest doesn’t help, position doesn’t help
Pace in agitated/colicky staet
Worrisome headache RED FLAGS “SSNOOP”
Systemic symptoms (fever, weight loss)
or
SECONDRARY risk factors (HIB, Systemic cancer)
NEUROLOGIC SYMPTOMS or abnormal signs (confusion, impaired alertness, or consciousness)
ONSET- sudden, abrupt, or split-second
OLDER: new onset and progressive headache, esp.in middle-age >50 (giant cell arteritis)
PREVIOUS HEADACHE Hx: First headache or different (change in attack frequency, severeity, or clinical feature)
Acute Subdural Hematoma (pic)
Head injurty iwthout fraction of skull
Blood in subdural space, will be filled with density of CSF
Brain is shifted to opposite side
;ventricular system on the side of the hematoma is compressed
How can you treat Acute Subdual Hematoma (and what happens if you don’t treat it)
Burr hole in skull to relieve pressure
If not treated, patient may herniate
What is the timing of Acute Subdural Hematoma
Cresendao headache from days to weeks; generally in frontal region
Epidural hematoma
. But as the epidural hematoma grows, symptoms will develop, including severe headache, nausea and vomiting.
The term epidural hematoma means blood buildup between the dura mater and the skull; hematoma translates to blood mass.
Natasah Richardson
Intracerebral Hemorrhage
~10% f all strokes
Starts suddenly, then cresendo
first and worst headache
When exercising or lifting weight
Primary Headaches- Sudden onset headaches (4)
- Idiopathic thudnerclap headach (TCH)
- Sexual Headache
- Exertional Headache
- Cough Headache
Seocndary headaches- Sudden onset-
SAH Venous Sinus Thrombosis Pituitary Apoplexy Arterial Dissection Meningoencephalitis Acute Hydrocephalus Acute hypertension Spontaneous intracranial hypotension
What is SAH (subarachnoid hemorrhage)
Acute thunderclap as a prsentaitno of SAH
Rupture in aneurysm of anterior circle of willis
WHAT ARE CAUSES OF LOW PRESSURE HEADACHES
HANGOVER, dehydrateion
anxiety, fracture of dura’ spontaneous rupture of dura
