Head and Neck Flashcards
What are the 5 steps to a general approach with a patient?
- History
- Physical Exam
- Labs
- Imaging/Procedure
- Referral
Mild Traumatic Brain Injury
- 1’ or 2’
- signs/sxs
- PE
Primary head trauma
none/brief LOC, dilated pupils, breathing stops, flaccid muscles. recovers sec-min
neuro exam and CT scan
Severity grading for MTBI
Grade 1. confusion, no LOC, Sx 15
- > 15 min, no LOC
- LOC sec-min
Moderate diffuse TBI
- ssxs
- imaging
- Tx
- Prognosis
(primary)
unconscious up to an hour, slow recovery.
-lethargy, anxiety for days
-CT should be normal/scattered petechia
-hospitalize to watch for complications, rest, no alc/drugs
- complete recovery days to weeks if 40
red flags for moderate diffuse TBI
unconscious, altered mental status, convulsions, HA
Severe diffuse TBI
- ssxs
- tx
(primary)
categorized by pt Resonse- not injury
- severe brain edema, ischema, hemorrhages, deep unconsciousness
- resp. obstruction from vomiting
- brain stem damage- bilat pupillary fixation, slow response to light
- Tx- emergency hospitaliation
Post concussion syndrome
(primary)
when severe diffuse tbi lasts weeks to years
- HA, fatigue, anxiety…
primary/secondary HA
vascular/non-vascular HA
not caused by underlying dx/caused by underlying dx
quality is throbbing/pounding as triggers change artery size (migraine, tension, cluster) /// qop is steady/dull (tension, tmj, tumor, sinus inx)
LMNOPQRST
location mechanism new? onset provocation/palliation quality radiation severity timing
What are some red flags for headache history?
onset >50 inc frequency/seveity sudden onset pain to lower neck first/worst HA history of head trauma HIV/Cancer
What are some red flags for physical exam for headache?
fever, neck pain/rigidity, papilledema, focal neuro signs, signs of system illness
Migraine headache ssxs
primary, vascular
often familial, recurrent, vary in intensity/frequency, unilateral, associated with anorexia/nausea/vomiting, photophobia, aura
Migraine epidemiology
3:1 FEMALE to male
first often inc hildhood, inc in adolescence
2nd most common headache
Migraine- common factors/triggers
emotional/physical stress, hormones in women, hypoglycemia, sleep changes, weather changes, odors, lights, exercise, food intolerance/allergies, tryamine
Migraine without aura classification
at least 5+ attacks with
- HA 4-72hrs
- 2+: unilateral, pulsating, moderate/severe pain, worse with activity
- nausea/vomiting andor photo/phonophobia
migraine with aura classification
may be prodronial dx before, then at least 2 attacks with
- aura [visual scotoma or photopsia, sensory paresthesia, numbness, unilateral weakness, olfactry hallucinations]
- develops 5-20 min, lasts
work up for migraine- what 3 questions are asked to determine if the HA is migraine?
history, diary
- has the HA limited your activities for a day or more in the last 3 months?
- nauseated?
- light?
Tension type headache-
1’/2’ vasc/nonvasc?
epidemiology
triggers
primary, non-vascular
2: 1 FEMALE, all ages/mostly young adults
triggers: stress, mental tension, head/neck movement
Classifications:
- infrequent episodic TTH
- frequent episodic TTH
- chronic TTH
at leas 2 sxs:
IETTH: less than 1 day/mo
FETTH: 1-14 days/mo
Chronic: 15+days/mo
sxs: pain bilateral in head/neck, steady quality, mild/moderate intensity, not aggravated by physical activity
work up for tension type HA
assess triggers/stressors
PE neuro+MS exams normal
Cluster HA
- epidemiology
- triggers
primary, vascular
MALES, esp. younger
triggered by seasons, cig smoking..
Cluster HA diagnostic criteria
- episodic
- chronic
episode: at least 2 lasting 7days-1 year seperated by pain free >1mo
chronic: >1 yr w.o remission or
Cluster HA characteristics onset quality location duration frequency concominant symp
sudden onset, peaks 10-15min “alarm clock”
boring, constant “knife” qop
unilateral, same side. local at trigemial V1+2
10-30min - 3hr
1-3 or up to 8/day for 12 months
concom nausea, restlessness, agitation
work up for cluster HA
DDX
initial Dx- CT or MRI to rule out brain/pituitary path
DDX- paroxysmal hemicrania, trigenimal neuraliga, SUNCT syndrome
