Head Pain Flashcards
List tentative diagnoses of non-emergencies presenting with ocular pain;
cornea: abrasion, FB, RCE, EKC, dry eye, trichiasis, dystrophy, etc.
Scleritis, a red, painful eye
List tentative diagnoses of non-emergencies presenting with peri-ocular pain
near point stress orbital mass eyelid mass sinusitis Neuralgia H zoster
Near point stress - diagnosis
a reliable trigger for the symptom?
Tend to affect both eyes. Most other ocular conditions more likely to involve just one eye
Headaches tend to be frontal
Headaches tend to be worse at the end of the day
gritty,” “burning” feeling in the eyes
generalized “eye strain”
“Redness” but not very red
Also: general fatigue, tiredness, need to take frequent breaks
orbital mass-diagnosis
Seeing it or feeling it by touch or asymmetrical resistance to retropulsion makes the dx
Chalazion / hordeolum
Orbital mass lesion - need imaging
sinusitis-diagnosis
Pain usually at the sinus Tender to pressure over the sinus Associated with rhinorrhea, nasal congestion, recent cold Failure to transilluminate the sinus Sinus xray
List the distinguishing characteristics of TACs
The pain is neuralgiform (ice pick pain)
The pain is accompanied by autonomic hyper- or hypo-activity
List tentative diagnoses of non-emergencies presenting with cranial pain; specific primary Headache Syndromes
Migraine
Tension-type
TACs
Chronic daily
3 major groups of HA
Primary (4 sub-groups)
Secondary (8 sub-groups)
Cranial neuralgias & “other” (2 sub-groups)
Trigeminal Autonomic Cephalalgias (TAC) encompasses;
Cluster
paroxysmal hemicrania
SUNCT
What distinguishes the TACs from primary trigeminal neuralgia?
autonomic
Cluster
Males»females (9:1), esp large men
Onset age 20-40
During HA, they pace the floor.
Being still makes the pain worse.
Migraine
migraine is a recurrent and episodic type of HA,1 per year to 5 per week,
Fairly common
Females > males by about 2:1
Often runs in families
Onset: often start in childhood or late teens
Duration: typically 24 hours
Migraine -Description of the Pain
Unilateral (esp. temple and around eyes)
Pulsating or Throbbing
Severe (to moderate)
Exacerbated by routine physical activity
Migraine associations
gastrointestinal upset, nausea
photophobia / phonophobia
Migraine with aura
Just like any other migraine, but the HA is preceded fairly reliably by an aura,
DURATION: 30 (10 to 60) minutes!
Transient ischemic attack (TIA): 3 to 10 minutes
flashes of RD: 5 to 30 seconds
Visual migraine auras
Fortification spectrum
Typically on opposite side of head from HA
Tension-type
Duration: 0.5 hours to 7 days , but
Typical duration is 2 to 16 hours
Steady “pressing” or “vice-like” pain
Severity: mild to moderate, worse @ end of day
Bilateral, typically: wide-spread location
Triggers: stress, fatigue, not eating
Tension-type were once called
“muscle-contraction” headaches
Possibly related to tension or isometric contraction in the neck &/or scalp muscles
Daily-persistent
Typically present upon awakening or
begin during the MORNING.
Duration: 1 hour to all day, typically around 4 - 6 hours, but less than 24 hours
Gradually get worse or better
Description: dull, steady, bilateral (like tension)
Pseudotumor cerebri
“benign intracranial hypertension.”
Onset of headache: gradual
Location of headache: generalized, bilateral
Description of headache: dull, steady
Accompanied by:
blurry vision, (because of papilledema)
visual “obscurations” 2° papilledema (cloud passing front of vision, confused with TIA)
Diplopia 2° CN6 palsy
Opening” cerebrospinal fluid pressure >200
Pseudotumor differential
The diagnosis of pseudotumor cerebri can only be made if there has been a lumbar puncture accompanied by a measurement of the opening pressure.
space occupying lesion
Brain tumor (1 of the 2 ‘B’ words)
Aneurysm
Epidural or Subdural hematoma
Brain tumor
Focal neurological signs or seizures usual presenting indication (not HA)
Onset: subacute or chronic
When advanced (very high ICP): nausea, vomiting, impaired mental status
Look for: papilledema, CN6 palsy, SVP
Subdural hematoma
Slow (weeks to months) onset of sx, after blunt trauma or a fall.
HA, if present, starts as mild, but…
HA and focal neuro si gradually escalate
Often first si (signs) = change in mental status,
Usually not associated with papilledema
Must be imaged
elevated intracranial pressure
Headache is due to elevated intracranial pressure
Location: global or diffuse
Made worse by: valsalva maneuver
Ruling out elevated ICP
Look for:
papilledema,
CN6 palsy,
SVP
list diagnosis of emergencies presenting with cranial pain
Anuerysm
Subarachnoid hemorrhag
Meningitis/Encephalitis
GCA
