Headache Flashcards
What is the acronym for remembering sinister caused of headache?
V: vascular I: infection V: vision threatening I: ICP raised D: dissection
What are the vascular sinister caused of a headache?
- subarachnoid haemorrhage (SAH)
- haematoma (subdural or extradural)
- cerebral venous sinus thrombosis
- cerebellar infarct
What are the infective reasons for a sinister cause of headache?
- Meningitis
2. Encephalitis
What are the vision threatening sinister reasons of a headche?
- temporal arteritis
- acute glaucoma
- cavernous sinus thrombosis
- pituitary apoplexy
- posterior leucoencephalopath
What are the raised ICP sinister causes of a headache?
- space occupying lesion (SOL; e.g. tumour, abscess, cyst)
- cerebral oedema (e.g. trauma, altitude)
- hydrocephalus
- malignant hypertension
- idiopathic intracranial hypertension
What are the dissection sinister reasons for a headache?
- Carotid dissection
How do you assess a headache?
SOCRATES
What are red flags to look for when assessing a headache?
- Decreased level of consciousness
- Sudden onset worst headache ever
- Seizure(s) or focal neurological deficit
- Absence of previous episodes
- Reduced visual acuity
- Persistent headache, worse when lying down
- Progressive, persistent headache
- Constitutional symptoms
- Past MHx
Why is decreased level of consciousness concerning with a headache?
1; SAH need exclusion
- if history of head injury could suggest subdural haematoma (fluctuating consciousness) or extradural haematoma (altered conciousness following a lucid interval)
- meningitis and encephalitis can affect consciousness
Why is sudden onset, worst headache ever worrying?
Suggest SAH with blood in CSF that is irritating the meninges
Why are seizure(s) or focal neurological deficet (e.g. limb weakness, speech difficulties) with a headache worrying?
- suggests intracranial pathology
- BUT migrainous aura can give neurological signs
Why is absence of previous episodes with a headache worrying?
- If recurrent usually less sinister
- If over 50 and new onset could be temporal arteritis
Why is reduced visual acuity with a headache worrying?
temporal arteritis is more common in older patients
What is Amaurosis fugax usually associated with?
usually due to TIA BUT rarely produce a headache
What do you ask if you are concerned about temporal arteritis?
- Jaw claudication
2. Scalp tenderness
If concerned about carotid or vertebral artery dissection what do you ask about?
minor neck trauma (yoga, chiropracter)
Why is a persistent headache worse when lying down with early morning nausea worrying/suggestive of?
- Suggests raised ICP
- Can be worse when lying down or even bending over
When is common to have headaches that are worse when standing up?
suggest reduced intracranial pressure and common after LP - not sinister
What could a progressive persistent headache sinister cause?
could be expansing SOL (e.g. tumour, abcess, cyst, haematoma)
What are some sinister constitutional symptoms with a headache?
- Weight loss
- night sweats and/or fever may suggest malignancy
- chronic infection (e.g. tb) or chronci inflammation (e.g. temporal arteritis)
What could be a sinister past medical history with a headache?
- history of malignancy that is known to metastasize to the brain (e.g. lung, breast)
- history of HIV or other immunosuppression (e.g. transplant patients) resulting in a higher risk of intracranial infection (e.g. toxoplasmosis, abcess, tb)
What investigations do you need to carry out to exclude sinister reasons?
- Basic obs
- Focal Neurological Signs
- Eye inspection
- Other special tests
What basic obs do you carry out to exclude sinister reasons for a headache?
- Altered consciousness: GCS
- Blood Pressure + pulse: check for malignant hypertension
- Temperature: fever and headache suggest intracranial infection
What would a focal limb deficit indicate?
intracranial pathology
What is 3rd nerve palsy?
- ptsosis
- mydriasis
- eye deviated down and out
What is a cause of 3rd nerve palsy?
- SAH due to ruptured aneurysm of the posterior communicating artery
- PCOM arterys are a cause of headache
What is 6th nerve palsy?
convergent squint and/or failure to abduct eye laterally
Why does 6th nerve palsy happen?
compressed either directly by a mass or indirectly by raised ICP