Headache 2-11: Acute Headache Flashcards
What is the most common reason that adults seek medical care
Headache
*accounts for 13 million visits each year
*5th most common reason for ED visit is
*2nd most common reason for neurologic consultation in the ED
What is the challenge to the initial evaluation of an acute headache?
To identify which patients are presenting with an uncommon but life-threatening condition
*1% of patients fall into this category
If a headache lessens in severity while on typical migraine therapies does that rule out critical conditions?
No
*critical conditions such as subarachnoid hemorrhage or meningitis
What is a sentinel headache
Happens before a subarachnoid hemorrhage (days or weeks)
1. Sudden
2. Intense
3. Persistent headache
How can an acute headache be classified as?
- Vascular events
- Infections
- Intracranial masses
What will aid in the diagnosis of a certain type of HA
Having the patient carefully describe the onset of headache
What is the typically description of a thunderclap headache
- Sudden onset headache
- Reaches maximal and severe intensity within seconds or a few minutes
*subarachnoid hemorrhage
What is the estimated prevalence of subarachnoid hemorrhage in patients with a thunderclap HA
45%
If there is a thunderclap Ha during the postpartum period that is precipitated by the valsalva maneuver or recumbent positioning what can that indicate
- Reversible cerebral vasoconstriction syndrome
- Irreversible cerebral venous sinus thrombosis
What warrants immediate neuro imaging/
A new HA in a patient older than 50 years or with HIV infection
If the patient has a history of HTN what should be done
Search for other features of malignant HTN
*appropriate to determine the urgency of control of HTN
What is HA and HTN associated with pregnancy due to?
Preeclampsia
What is a suggestive of phenochromocytoma
Episodic HA
1. HTN
2. Palpitations
3. Sweats
What is associated with an increased risk of cerebral venous thrombosis
- A history consistent with hypercoagulabitiy
What is the classic migraine patterns
1 scintillating scotoma followed by
2. Unilateral HA
3. Photophobia
4. N/V
* 3+ AND exacerbation by physical activity = migraine
* 1 or 2 = not migraine
Someone comes in with a HA what parts of the PE are you going to do?
- Vitals
- Neuro
- Vision (fundoscopic exam)
*if fever do Kernig and Brudzinksi
If the patient is older than 60 and they come in with a HA what should they be evaluated for?
Temporal artery tenderness
What can diminished visual acuity be suggestive of
- Glaucoma
- Temporal arteritis
- Optic neuritis
What can visual field defects be sings of
- Venous sinus thrombosis
- Tumor
- Aneurysm
What is Afferent pupillary defects due to
Intracranial masses or optic neuritis
What is ipsilateral ptosis and miosis suggestive of
Horner syndrome
What type of imaging study is sufficient to exclude intracranial HTN
Non contrast head CT
Does a normal neuro imaging study exclude subarachnoid hemorrhage
No
*follow with a LP
If a pateint has a high level of suspicion for subarachnoid hemorrhage what should a normal CT and lumbar puncture be followed by
CTA
