Headache Flashcards
What red flag condition(s) are you worried about with an acute severe headache or a headache thats changed from a previous pattern?
Subarachnoid hemorrhage
What red flag condition(s) are you worried about with a new onset headache in an adult over 50?
Subarachnoid hemorrhage
What red flag condition(s) are you worried about with a headache on exertion or progressive in nature?
Mass lesion
What red flag condition(s) are you worried about with a headache accompanied by fever?
Systemic infection
CNS infection
Collagen vascular disease
What red flag condition(s) are you worried about with a headache with new neurologic signs?
Infection
Mass lesion
Subdural hematoma
Metabolic imbalance
CV disease
Inc intracranial pressure
MS
Lyme
Glaucoma
Arthritis
Focal brain disease
Subarachnoid hemorrhage
Tx for tension headaches
Stress reduction
Peppermint oil
NSAIDs
Caffeine
Tx for migraines
Triptans
Feverfew/butterbur tincture for prevention
Hormonal: chaste tree, seed cycling
Cluster headache tx
Triptans
CCBs
Melatonin
Stress reduction
Avoiding smoking/alcohol
Name the headache ddx:
Bilateral
Bandlike
Hx anxiety, stress, depression
Neck tightness
Tension-type headache
Name the headache ddx:
Progressive
Unilateral
Nausea/vomiting
Can be visual changes
Photophobia
Phonophobia
Migraine
Name the headache ddx:
Throbbing
Constant pain
Muscle tightness
FHx of migraine
mixed headache
Name the headache ddx:
Abrupt
Unilateral
Periorbital pain
Nighttime onset
Rhinorrhea
Nasal stuffiness
Sweating
Ptosis
Conjunctival injection
Cluster headaches
Name the headache ddx:
Sudden onset
Related to physical exertion, valsalva, or coitus
Benign exertional headache
Benign exertional headache work up
CT to differentiate from subarachnoid hemorrhage
Name the headache ddx:
Frontal, upper molar, or periorbital pain
Cough
Rhinorrhea
No fever/low fever
Pain on palpation of sinuses
Purulent nasal/postnasal dc
Sinusitis
work up sinusitis
Radiographs (waters view)
Name the headache ddx:
Ear pain
Pain with swallowing
Otitis media
Name the headache ddx:
Severe headache
Chills
Myalgias
Stiff neck
Fever
Photophobia
Petechial rash
Pos Kernig/Brudzinski
Meningitis
Meningitis work up
Lumbar puncture
Name the headache ddx:
> 55
Bursts of sharp pain over face
Trigeminal neuralgia
Name the headache ddx:
Acute onset pain with EOM
Followed by blurred vision
Dec visual acuity
Dec papillary reflex
Hypermedia of optic disc
Pain with EOMs
Optic neuritis
Name the headache ddx:
Hx of trauma
Occipital pain
Muscle stiffness
Pain with neck motion
Cervical spine disorders
Name the headache ddx:
> 50
Sharp, localized temporal pain
Malaise
Anorexia
Hx poly myalgia rheumatica
Fever
Wt loss
Temporal arteritis
Temporal arteritis work up
ESR - immediate referral
Name the headache ddx:
Throbbing headache
Mild dyspnea
Nausea
Vomiting
Change in mental status
Lethargy
LOC
Carbon monoxide poisoning
Name the headache ddx:
Hx diabetes/meds/etoh
Generalized headache
Dizziness
General sense of unwell
Pallor, sweating, weak
Severe hypoglycemia
Name the headache ddx:
Sudden onset
Progressive
Worse by coughing or exercise
Worse in morning
Hx trauma (possible)
Papilledema
Vomiting
Asymmetrical reflexes
Sensory/Neuro deficit
Intracranial tumor
Intracranial tumor workup
CT scan
Name the headache ddx:
Progressive headache
Vomiting
Irritability
Rapid enlargement of head
Hydrocephalis
Hydrocephalis workup
CT and referral
Name the headache ddx:
Hx head trauma, bleeding disorders, child abuse
Adult >35
Sudden onset
“Worst headache ever”
Often over eye
Transient LOC
Unequal pupils
Photophobia
Neuro changes
Seizure
Subdural hematoma
Subdural hematoma workup
CT scan and neuro surgeon referral
Name the headache ddx:
Teens, menopausal women
Hx Vit A or tetracycline ingestion
Progressive headache
Papilledema
Pseudotumor cerebri
Pseudotumor cerebri workup
CT and referral
Name the headache ddx:
Hx chronic ear infection or cyanotic heart disease
Fever
Seizures
Focal neuro deficits
Brain abscess
Brain abscess workup
MRI
Name the headache ddx:
> 50
AIDS
Anticoagulation meds
HTN
Abnormal neuro findings
Intracranial hemorrhage
Intracranial hemorrhage workup
ER for CT, MRI, possibly surgery
what PEs would you do for headache?
General observation (A&Ox3)
Vitals
Palpate and percuss scalp, face, neck, temporal arteries, sinuses
EENT exam (eyes regardless, ears/nose/throat only if sx align)
CN exam
Neck ROM
Brudsinski/kernig
MRS
Balance/Gait
