Headache Flashcards
What are the DDx for acute, sudden onset headache?
- Meningitis
- Low CSF pressure
- Subarachnoid haemorrhage
- Intracranial haemorrhage
- Head injury with cerebral contusion
- Acute closed angle glaucoma
- Sinusitis
- Tension headache
- Bilateral migraine
What are the DDx for subacute onset headache?
- Raised ICP due to tumour, hydrocephalus, cerebral abscess, etc
- Encephalitis
- Temporal/giant cell or cranial arteritis
What are the DDx for chronic, recurrent headaches?
- Tension headache
- Migraine
- Cluster headache
- Cervical root headache
- Eye strain
- Drug side effect
List the 10 neuro screen questions.
- Have you had any weakness anywhere?
- Have you had numbness, tingling, pain or change of sensation anywhere?
- Any double vision or other visual change?
- Any hearing problems?
- Any problems with speech or swallowing?
- Any headaches?
- Any neck or back pain?
- Any collapse or LoC?
- Any dizziness unsteadiness or incoordination?
- Bladder or bowel or erectile dysfunction?
What are the three different types of peripheral neuropathies?
- length dependent - glove and stocking
- sensory neuropathies: arms and legs at onset
- entrapment neuropathies: most common are:
- carpal tunnel syndrome
- ulnar neuropathies
- common fibular nerve compression
What is a radiculopathy?
lesion at or near nerve root (most common from compression of nerve roots exiting spinal canal)
What is the common presentation of carpal tunnel syndrome?
Pain in the arm, usually distal to the elbow, which wakes people at night
Temporarily improved by shaking the hand
NB: numbness in radial side of hand is not common
What are the 5 main causes of neuropathic pain and sensory loss?
- peripheral neuropathy
- radiculopathy
- plexopathy
- myelopathy
- brain disorder
What is the most common cause of headache?
Respiratory infection
What is the most cause cause of chronic recurrent headaches?
Tension-type headache
Combination headache
Migraine
Transformed migraine
What is a combination headache?
Constant pain lasting for many days, with a mix of components such as tension, depression, cervical dysfunction, vascular headache and drug dependence
Serious headache DDx that cannot be missed
- CV:
- subarachnoid haemorrhage*: sudden onset, severe, warning headache, family history
- intracranial haemorrhage
- carotid or vertebral artery dissection
- temporal arteritis
- cerebral venous thrombosis - Neoplastic: morning headaches, seizures, neurological deficit
- Cerebral tumour
- Pituitary tumour - Infection:
- Meningitis (esp fungal)*: fever, neck stiffness
- Encephalitis: fever, neck stiffness
- Intracranial abscess - Glaucoma: unilateral headache with visual disturbance
- Haematoma: extradural/ subdural: slow bleed that may not cause Sx for hours/days; elderly; at risk a. alcoholics b. anticoagulants
- Benign intracranial HTN
- Giant cell arteritis: unilateral, over 50, visual disturbance (curtain coming down one eye), constitutional malaise, jaw claudication (i.e. during chewing, pain in masseter muscle due to inflam infiltrate in intra/extra cranial arteries
- > ischaemia)
What are the causes of an acute thunderclap headache?
- Enlarging aneurysm
- SAH - pain is typically occipital, localised first then generalised, persistent headache
- Meningitis - consider if headache is generalised, especially in the presence of malaise, fever, neck stiffness
- Venous sinus thrombosis
- Primary sex-related headache: 20-30 minutes duration,
Headaches tend to ____ with age, therefore headaches developing in the elderly could be caused by _________.
decrease
temporal arteritis
Key questions during Hx for headache
- Can you describe your headaches?
- How often do you ge tthem?
- Can you point to exactly where in the head you get them?
- Do you have any pain in the back of your head or neck?
- What time in the day do you get the pain?
- Do you notice any other symptoms when you have the headache?
- Do you feel nauseated and do you vomit?
- Do you experience any unusual sensations in your eyes, such as flashing lights?
- Do you get dizzy, weak or have any strange sensations?
- Does light hurt your eyes?
- Do you get blurred vision?
- Do you notice watering or redness of one or both your eyes?
- Are you under a lot of stress or tension?
- Does your nose run when you get the headache?
- What tablets do you take?
- Do you get a high temp, sweats or shivers?
- Have you had a heavy cold recently?
- Have you ever had trouble with your sinuses?
- Have you had a knock on your head recently?
- What do you think causes your headaches?
