Headache Flashcards
List 8 important DDx for headache
Tension-type
Migraine
SAH
Meningitis/encephalitis
Subdural haematoma
Space-occupying lesion
GCA
Glaucoma
Describe the characteristics of a tension-type headache
Bilateral “band-like” pressure
Gradual onset
Common, associated with stress
Describe the characteristics of migraine
Unilateral
Gradual onset
May be associated with nausea and accompanying or preceding visual or sensory aura
Describe the characteristics of headache due to SAH
Severe
Sudden onset
“Warning headache” beforehand
+ive FHx
Describe the characteristics of headache due to meningitis/encephalitis
May be associated with fever, neck stiffness or photophobia
List the typical clinical vignette seen in subdural haematoma
Age
Alcoholics
Anticoagulants
Describe the characteristics of headache due to a space-occupying lesion
Morning headaches
May be associated with new-onset seizures and other neurological deficits
What clinical features also accompany GCA?
Unilateral headache
Visual disturbances
Jaw and tongue claudication
Describe the characteristics of headache due to GCA
Unilateral
Usually in over 50s
May be accompanied by visual disturbance and jaw and tongue claudication
Describe the characteristics of headache due to glaucoma
Unilateral with visual disturbance
How does SAH present clinically?
Sudden onset, severe headache (not previously experienced, sometimes with preceding sentinel headache)
Reduced conscious state with decline (30% present deeply comatose or with sudden death)
Meningism (headache, neck stiffness, photophobia, fever, vomiting), due to blood in the subarachnoid space
Focal neurological signs
What are the possible mechanisms of focal neurological signs in SAH and what signs are commonly seen?
Intracerebral component of bleeding may cause frontal or temporal haematoma and related signs
Local pressure effects of aneurysm (particularly of PCommA) may cause 3rd nerve palsy
Cerebral vasospasm may cause symptoms and signs 2-7 days post-initial presentation
List 5 DDx for severe, sudden onset headache
Meningitis
Intracerebral haematoma (HTNive or amyloid haematoma, trauma)
Migraine or cluster headache
Headache with orgasm
Reversible cerebral vasospasm
What are the 3 most common causes of SAH? List 5 rarer causes
Most common: ruptured cerebral aneurysm, undiscovered/unknown or ruptured AV malformation
Rarer: spinal AV malformation, arterial dissection, tumour, bleeding diathesis
What should be done if a normal CT is produced in a case of suspected SAH? What are the expected findings?
LP
Bloodstained CSF that does not clear on 3 consecutive collection tubes, and xanthochromia