Headache Flashcards
Key history in headache
Onset (acute vs. chronic)
Location (unilateral vs. bilateral)
Quality (dull vs. stabbing)
Intensity (“Is it the worst headache of your life?”) Duration
Timing (Does it disturb sleep?)
Other neurological symptoms (visual stigmata, weakness, numbness, photophobia, neck stiffness)
Nausea or vomiting
Jaw claudication
History of trauma
Dental surgery
Sinusitis symptoms
Exacerbating and alleviating factors
Personal and family history of migraine
Key physical exam in headache
Inspect and palpate entire head
ENT inspection
Complete neurological exam, including fundoscopic exam
21 yo F with episodic, throbbing, L temporal pain lasting 2-3 hours
+ visual aura
+ unilateral weakness and numbness
+ N/V
+ FHx of migraine
Complicated migraine
Tension HA
Cluster HA
Pseudotumor cerebri
CBC, ESR, CT-head, MRI-brain, LP-CSF analysis
26 yo M with severe R temporal pain
+ ipsilateral rhinorrhea, eye tearing, redness
+ Occur nightly at same time over last week
Cluster HA
Migraine
Tension HA
CBC, CT-head, MRI-brain, LP-CSF analysis, ESR
65 yo F with severe, intermittent R temporal HA
+ blurred vision in R eye
+ pain in jaw when chewing
Temporal arteritis (giant cell arteritis)
Migraine
Cluster HA
ESR, CBC, CRP, temporal artery biopsy, Doppler US - carotid, MRI - brain, LP-CSF analysis
30 yo F with frontal HA
+ fever
+ nasal discharge
+ pain on palpation at frontal and maxillary sinuses
+ history of allergies
Sinusitis
Migraine
Tension HA
CBC, XR - sinus, CT - sinus, LP-CSF analysis
50 yo F with recurrent episodes of bilateral squeezing HA at end of work day
+ life stressors
+ decreased caffeine intake
Tension HA
Migraine
Depression
Caffeine withdrawal
CBC, electrolytes, ESR, CT - head, LP-CSF analysis
35 yo M with sudden, severe HA
+ vomiting
+ confusion
+ L hemiplegia
+ nugal rigidity
Subarachnoid hemorrhage
Migraine
Meningitis/encephalitis
Noncontrast CT-head, LP-CSF analysis, CBC, PT/PTT/INR, urine toxicology
25 yo M with severe HA
+ high fever
+ confusion
+ photophobia
+ nuchal rigidity
Meningitis
Migraine
Subarachnoid hemorrhage
CBC, CT-head, MRI-brain, LP-CSF analysis (cell count, protein, glucose, Gram stain, PCR for specific pathogens, culture)
18 yo obese F with pulsatile HA
+ vomiting
+ blurred vision
+ taking OCPs
Pseudotumor cerebri
Tension HA
Migraine
Urine hCG, CBC, CT-head, LP - opening pressure and CSF analysis
57 yo M with daily pain in R cheek over last month
+ “electric” and stabbing sensations
+ occurs while shaving
Trigeminal neuralgia
Tension HA
Migraine
CBC, ESR, MRI-brain
