Head and Neck Flashcards
Headaches
Primary: Migraines, Tension, Cluster
Secondary: Congenital, Environmental, Iatrogenic, Infectious, inflammatory, Mechanical, Neoplastic, Psychological
Red Flags with headaches
SONAR
S - systemic (fever, wt loss)
O - older, >50
N - neuro (neuro symptosm, confusion, decreased alertness, change in LOC)
A - abrupt onset
R - Random changes (previous, first, different, change in frequency, severity or features)
Migraine
unilateral, 70% bifrontal rapid, reaches peak in 1-2 hrs throbbing aggravated by triggers lasts 4-72 hours N/V, photophobia, may have aura
Migraine Criteria
SULTANS S - Severe UL- UniLateral T- throbbing A- Activity worsens -------need 2 \++++ N- nausea S-Sensitivity to sound/light
Tension
bilateral, back of head steady pressure, nonthrobbing aggravated by muscle tension lasts 30 min - 7 days no nausea
Cluster
ALWAYS unilateral, eyes or temple
pain begins quickly, crescendo w/in minutes
deep,continuous, excruciating/explosive pain
up to 3 hours
ipsilateral lacrimation and redness of eyes
Common Secondary head aches
Sinusitis Meningitis Temporal Arteritis Trigeminal Neuralgia Acute Glaucoma Errors of Refraction Mild Traumatic brain injury/concussion Chronic subdural hematoma Space occupying lesion
Sinusitis
nucosal infection of eye, cheek, uni or bilateral
ache or throb
variable duration, recurring
local tenderness, congestion, discharge and fever
common with allergic rhinitis
Meningitis
generalized location stead and throbbing rapid onset, lasting days fever >38* with nuchal rigidity S. pneumonia or Neisseria Vaccinate teens
Temporal Arteritis (Giant cell arterititis)
chronic inflammation of cranial arteries w/ polymyalgia
near temporal/occipital
aching, throbbing, burning, severe pain
gradual/rapid, variable lasting weeks - months
tenderness of scalp
malaise, fatigue, anorexia, muscle ache, stiffness
visual loss or blindness
Trigeminal Neuralgia
compression of CN V, facial nerve cheeks, jaws, lips, or gums sharp jabs, "lightning" abrupt onset, comes and goes uncommon at night, not used exhaustion from pain triggered by chewing, talking, touch
Acute Glacuoma
sudden IOP pain around 1 eye steady aching, severe rapid onset associated with diminished vision
Errors of Refraction
pain with sustained contraction around both eyes, may be occipital steady aching onset gradual eyes feel fatigued and sandy improved with rest
mild traumatic brain injury/ concussion
HA immediate or delayed
related to cellular metabolic cascade and dec energy
intensifies with mental or physical exertion
10-14 days or months -years
cognitive impairment
Chronic subdural hematoma
bleeding into subdural space after trauma steady, aching gradual onset changes in personality, hemiparesis injury often forgotten
Space occupying lesion
displacement or traction on pain sensitive arteries, veins, or pressure on nerves
inc IOP
aching, steady, variable in intensity
brief duration, intermittent, and progressive
neruo symptoms, N/V
aggravated by coughing, sneezing, sudden movements
Dizziness
Vertigo
Presyncope
Disequilibrium
Psychiatric
Vertigo
spinning with nystagmus and ataxia, from peripheral vestibular dysfunction
may be lesion in central brain stem
Presyncope
near fainting, orthostatic Hypotension, vasovagal reflex
Disequilibrium
unsteadiness, especially in older pts
Psychiatric dizziness
anxiety, panic, hyperventilation, substance
Types of vertigo
Benign Positional Vestibular Neuronitis Meniere's disease Drug Toxicity Acoustic Neuroma Central Vertigo
Benign Positional Vertigo
sudden, roll on affected side
caused by dislodged otolith (inner ear)
transient, <1min
treat with Epley manuever
Vestibular neuronitis
sudden, caused by infection
last up to 2 weeks
N/V, nystagmus
Meniere’s Disease
idiopathic, possibly too much fluid sudden recurrent sensory hearing loss, tinnitis pressure/fullness N/V
Drug toxicity
insidious or acute
hearing may be impaired
may have tinnitis
N/V
Acoustic Neuroma
CN VIII compression
one sided hearing loss
may involve CN V and VII
tinnitis
Central Vertigo
sudden onset
variable duration
brainstem defects
Head Exam
inspect and palpate hair, scalp, skull
inspect face for symmetry, temporal arteries, TMJ, CN V, VII, mastoid
inspect for masses, bulges, pulsation
palpate for lymph, parotid, thyroid, trachea, carotids, CN XI (spinal accessory)
Lymph nodes
Preauricular Post auricular Occiptal Tonsilar Submandibular Submental Superficial Cervical Posterior cervical Deep cervical chain supraclavicular
Reactive lymph node
draining from regional infection
Concern for malignancy
if lymph nodes are hard, large, fixed, and non-tender
Parotid Gland
- enlarged in mumps, sarcoidosis, tumor, salivary stones, bacterial infection (suppurative parotitis)
- drains saliva into mouth through Stenson’s duct
Sarcoidosis
inflammatory disease, granuloma (immune deposits), common in lung, skin and eyes
Thyroid
inspect and palpate, if enlarged auscultate for bruit (inc blood flow)
Hypothyroidism
Hashimotos, sub-acute thyroiditis, iodine deficiency, drug induced
Hypothyroid symptoms
fatigue weight gain, anorexia dry coarse skin, cold intolerance swelling of face, hands and legs constipation weakness, muscle cramps, arthralgias, impaired memory/concentration
Hypothyroid Signs
Dry, coarse, cool skin with hair loss periorbital puffiness increased diastolic BP bradycardia mixed hearing loss, somnolence, peripheral neuropathy
Hyperthyroid
Grave’s disease
toxic multinodular goiter
toxic adenoma
exogenous thyroid hormone injestion
Hyperthyroid Symptoms
nervousness wt loss and inc appetite excessive sweating, heat intolerance palpitations frequent bowel movements tremor, proximal muscle weakness
Hyperthyroid Signs
warm, smooth, moist skin stare, lid lag, exophthalamos tachycardia, A-fib inc systolic BP hyperdynamic cardiac pulsation
