Headache Flashcards
Red flags of headache in associated conditions
Pregnancy/ postpregnancy status SLE Behcets disease Vasculitis Sarcoidosis Cancer
Rebound headaches result from sudden withdrawal from medication overuse, which is defined as…
> 10x/ mo (esp. ergots, triptans, opioids)
High-risk group for headaches
> 50 y/o, new/ worsening headache
Diagnosis for thunderclap headache
SAH unless proven otherwise
Most common cause of SAH
Aneurysmal rupture
Hereditary condition highly associated with intracranial aneurysm
Autosomal dominant polycystic kidney disease
What to check on a patient with headache and fever
Meningismus (stiff neck)
What to check on a patient with Horner’s syndrome
Visual acuity and visual fields
Differentials on headache w/ eye pain
Angle-closure glaucoma
Endophthalmitis
Scleritis
Features of cluster headache
Severe
Unilateral
Lasts for 15-180 mins
Circadian/ circannual pattern
Classic triad of patients with headache & CNS infection
Nuchal rigidity
Altered sensorium
Fever
PE finding of raised ICP
Papilledema
If LP is delayed and meningitis is suspected….
administer antibx w/o delay
Diagnosis for acute headache with vestibular symptoms
Cerebellar hemorrhage unless proven otherwise
Characteristic of headache for patients w/ brain tumor
Headache worsened by valsalva maneuver or awakening from sleep
Risk factors for cerebral venous thrombosis
Women
Peripartum period
Recent surgical hx
Hypercoagulable state
S/Sx of Posterior Reversible Encephalopathy Syndrome (PRES)
Severe headache Visual changes Seizures Encephalopathy in the setting of markedly elevated blood pressure elevation
2nd differential if SAH is ruled out
Reversible cerebral vasoconstriction syndrome
Hallmark of reversible cerebral vasoconstriction syndrome
Multiple areas of vasoconstriction on cerebral angiography found b/w 2-3 wks from onset, normal head CT
One thunderclap headache in the course of weeks of severe headache w/ or w/o seizures or focal neuro deficits
Reversible cerebral vasoconstriction syndrome
New-onset headache Age >50 ESR >50 Tenderness on palpation of temporal arteries Proximal muscle weakness Jaw claudication Transient visual loss TIA
Temporal arteritis (giant cell arteritis)
Chronic migraine
5 or more episodes per month over the past 3 mos
Antihistamine preferred for acute migraine attack
Diphenhydramine 25-50 mg IV
Migraine medication contraindicated in pregnant women
Triptans
