Headache 1

Question 1

Potentially serious causes of acute HA

Answer 1

meningitis - stiff neck and fever
subarachnoid haemorrhage - sudden onset of HA with altered consciousness
temporal arteritis - unilateral tenderness over temple with a high ESR (erythrocyte sedimentation rate - tells you how much inflam. in the body)
raised intracranial pressure - papilledema (optic disc swelling), HA worse on waking - need to look for intracranial lesion)

Question 2

What are the important causes of chronic recurrent HAs?

M V P………

Answer 2

history over months and years
muscle contraction HA (tension) - very common
vascular HA. eg; migraine
post traumatic headache
potentially long duration of symptoms following injury
some cases HAs get worse - lethargy, irritability, difficulty concentrating, dizziness
patient whose symptoms develop weeks after minor head injury (could be subdural haematoma)

Question 3

Signs & symptoms of intracranial disease

Answer 3

Recent substantial change in:
HA frequency
HA severity
HA intensity
Progressive worsening of HA despite app. therapy
Progressive development of neurological signs or symp.

Question 4

Evidence of raised intracranial pressure

Answer 4

onset of HA with exertion, cough or sex
drowsiness
vomiting
bradycardia
papilledema

Question 5

How do you diagnose meningeal irritation?

Answer 5

Neck stiffness, use the….
Slump Test
1 - Neck drop, arms behind back, palm side up
2 - leg extended
3 - punch in stomach
4 - dorsiflexion of foot
Positive Brudzinski sign - passive neck flexion in pt. with extended limbs causes invol. hip flexion
Positive Kernig sign - same position as supine hamstring test, hamstring pain means positive sign

Question 6

Grounds for a referral for a HA

Answer 6

HA more than 24 hours WO respite
a new HA in a HA free patient
a sudden change in a chronic HA
HA worse on waking
persistent localised pain
HA progressively worsening
HA aggravated by - exertion, bending, stooping,coughing

Question 7

Red Flags - HA

Answer 7

progressive neurological deficit over 50 years
personality change under 10 years at onset
disturbance of memory progressive over weeks
convulsions wakes pt. at night
projectile vomiting thunderclap HA
papilledema - optic disc swelling
neck stiffness & fever accompanied by systemic illness
unequal pupil size new onset in pt. with cancer history
nystygmus localised pain in definate area, eg-eye
sudden change in consciousness
persistent HA asso. with Valsalva man. - intracranial pressure

Question 8

Discuss the components that constitute a cervicogenic HA

Answer 8

must arise from cervical complex - C0-C3, can be one or all
single most common symptom from having a neck trauma
manual therapies & exercise is preferred method of trmt.
usually unilateral
if bilateral one side is worse
when it returns will be same side as last time
site of pain - opthalamic division of trigeminocervical nucleus, begins in neck, spreads to occiput, sub occ, frontal,
Pain is typically moderate & fluctuates, does NOT have features like dizziness, nausea, visual disturbances
can happen at any age
no regular pattern
common with trauma, DJD & sedentary lifestyle
doen’t respond to analgesics