Headache Flashcards
What could fever, photophobia or neck stiffness be indicative of?
Menignitis
Encephalitis
What could new neurological symptoms be indicative of?
Haemorrhage
Malignancy
Stroke
What could dizziness be indicative of?
Stroke
What could visual disturbance be indicative of?
Temporal arteritis
Glaucoma
What could sudden onset occipital headache be indicative of?
Subarachnoid haemorrhage
What could headache worsening on coughing or straining be indicative of?
Raised ICP
What could postural headache worse on standing, lying or bending over be indicative of?
Raised ICP
What could vomiting with headache be indicative of?
Raised ICP
Carbon monoxide posoning
What could headache with history of trauma be indicative of?
Intracranial haemorrhage
What could headache be indicative of during pregnancy?
Pre-eclampsia
What could headache with papilloedema be indicative of?
Raised ICP
What is a secondary headache?
Similar presentation to tension headache but with a clear cause
Causes of secondary headache
Underlying medical conditions e.g. infection, obstructive sleep apnoea or pre-eclampsia
Alcohol
Head injury
Carbon monoxide poisoning
Symptoms of migraine
Unilateral throbbing headache preceded by an aura, such as visual or sensory (paraesthesia spreading from fingers to face) symptoms
4-72hrs
Photophobia & phonophobia
Diagnosis of migraine
Presence of aura confirms diagnosis
When no aura, following criteria required:
At least 5 headaches lasting 4-72 hours with nausea/vomiting or photo/phonophobia
AND 2 of:
Unilateral headache
Pulsating character
Impaired or worsened by daily activities
Management of migraine
Avoid triggers
Prophylaxis with propanolol or topiramate
Symptoms of tension headache
Bilateral, non-pulsatile headaches
Tight band around head
May be associated scalp muscle tenderness
Management of tension headache
WHO pain ladder
Symptoms of cluster headache
Recurrent attacks of sudden-onset unilateral periorbital pain
Watery and bloodshot eye, lacrimation, rhinorrhoea, miosis, ptosis, lid swelling, and facial flushing
Last 15 minutes to 3 hours, occur once or twice a day, over a period of 4-12 weeks
Followed by a pain-free period of months before the next cluster begins
Management of cluster headache
Avoid triggers
Prophylaxis with verapamil
Management of cluster headache acute attack
100% oxygen via non-rebreathable mask
Subcutaneous or nasal triptan
Management of migraine acute attack
Triptan (+ paracetamol or NSAID)
Symptoms of trigeminal neuralgia
Recurrent short episodes of severe stabbing pain, affecting one side of the face, in the trigeminal nerve distribution
Pain may be triggered by touching the face, eating, or talking
Investigations in trigeminal neuralgia
MRI to exclude secondary causes e.g. tumour/aneurysm
Management of trigeminal neuralgia
Carbamazepine first-line
Surgery: microvascular decompression
Symptoms of raised ICP
Headaches which are worse in the morning and upon bending over, and improve after vomiting and lying down
May be associated with neurological deficits due to compression of cranial structures by a space-occupying lesion, such as a tumour or haemorrhage
Diagnosis of raised ICP
CT head
Management of raised ICP
Treat underlying cause e.g. surgery and chemo for cancel, clot evacuation for haemorrhage
Sinusitis symptoms
Inflammation in the ethmoidal, maxillary, frontal or sphenoidal sinuses
Facial pain behind nose, forehead and eyes
Often tenderness over affected sinus
Usually resolves within 2-3 weeks
Management of sinusitis
Nasal irrigation with saline can be helpful
Prolonged symptoms can be treated with steroid nasal spray
Antibiotics are occasionally required
Occipital, sudden onset, high intensity headache
Subarachnoid haemorrhage
What is meningism a red flag symptom for?
Haemorrhage
Meningitis
Present on waking, worse on laying down, social neurological signs, higher cortical dysfunction, autonomic instability, papilloedema
Raised ICP
SOL
What are visual changes and red eye red flag symptoms for?
Acute glaucoma
Surgical 3rd nerve palsy
Temporal with associated changes
GCA
