FN: Headache differential and investigation

Question 1

Acute headache differentials

Answer 1

VICIOUS
Vascular
Infection/Inflammation
compression
ICP
Ophthalamic
Unknown
systemic

Question 2

Chronic headache differentials

Answer 2

MCD TINGS
Migraine
Cluster headaches
Drugs
Tension headaches
ICP increased or decreased
Neuralgia (trigeminal)
Giant cell arteritis
Systemic

Question 3

Vascular headache causes

Answer 3

1. Haemorrhage: SAH, intracrainal, intracerebral
2. Infarction: esp. posterior circulation
3. Venous: Sinus/cortical thrombosis

Question 4

Infection/Inflammation

Answer 4

Meningitis
Encephalitis
Abscess

Question 5

Compression causes

Answer 5

Obstructive hydrocephalus: tumour

Pituitary enlargement: apoplexy

Question 6

ICP

Answer 6

Spontaneous intracranial hypotension

1. Acute dural CSF leak
2. Worse on standing initially

Question 7

Ophthalamic

Answer 7

Acute glaucoma

Question 8

Unknow causes

Answer 8

Situational: cough, exertion, coitus

Question 9

Systemic

Answer 9

HTN: Phaeo, PET
Infection: sinusitis, tonsillitis, atypical pneumonia
Toxins: CO

Question 10

Drug causes

Answer 10

analgesics
Caffeine
Vasodilators: Calcium antagonists, nitrates

Question 11

ICP changes

Answer 11

increased ICP: tumour, aneurysm, AVM, bening intracranial hypertension

Reduced ICP: spontaneous intracranial hypotension

Question 12

systemic causes of headache

Answer 12

Hypertension

Organ failure e.g. uraemia

Question 13

Investigations

Answer 13

Bloods
Urine
Micro
Radiology
Special: CSF

Question 14

Micro

Answer 14

Blood cultures
Serology: enterovirus (common cause of viral meningitis). HSV, HIV, syphilis, crypto

CSF

Question 15

Radiology

Answer 15

Non-contrast CT: SAH: blood in sulci, cisterns (white). 90% sensitivity in first 24h

MRI:
1. MRA: aneurysm
MRV: sinus thrombosis

Question 16

Special: CSF

Answer 16

Opening pressure (norm = 5-20cm H20)

• raised = SAH, meningitis
• reduced = Spontaneous intracranial hypotension

Xanthochromia: yellow appearance of CSF due to bilirubin. Detect by spectrophotometry

Question 17

Bacterial CSF
Appearance
Cells
Count
Glucose
Protein (g/L)

Answer 17

Turbid
PMN
100-1000
reduced (1.5)

Question 18

TB
Appearance
Cells
Count
Glucose
Protein (g/L)

Answer 18

Fibrin web
Lympho/mononuc
10-1000
reduced (

Question 19

Viral CSF
Appearance
Cells
Count
Glucose
Protein (g/L)

Answer 19

Clear
Lympho/mononuc
50-1000
>1/2 plasma
mild increase (