Headache Flashcards
1
Q
Worry features of a headache
A
- ↓ GCS
- Sudden onset
- severe
- recurrent vomiting
- photophobia
- rash/neck stiffness
- focal neurology
- seizure
- papilloedema
- ↑↓HR, ↑↓BP
2
Q
Emergency causes of headache
A
intracranial haemorrhage (subarachnoid, subdural, extradural) meningitis/encephalitis ↑ICP Temporal arteriris acute glaucoma hypertensive crisis
3
Q
Common
A
dehydration tension infection migraine extra cranial (sinuses, eyes, ears, teeth) trauma post-LP post- nitrates
4
Q
Any others
A
cluster
postcoital
hypoglcyaemic
hyponatraemia
5
Q
Questions to ask in Pc Hx
A
SOCRATES change with coughing, leaning forward N&V visual changes (before & currently) trauma seizures rash, neck pain sweating
6
Q
Dhx
A
Nitrates, analgesia, antihypertensives
7
Q
What to look out for in examination
A
Fluid status
Meningism: neck stiffness, photophobia, kernels, non-blanching rash (whole body)
red eye
visual disturbance, papilloedema
focal neurology
temporal artery tenderness & pulsatility
tenderness of sinuses
evidence of recent trauma
dental hygiene & ear dischage
8
Q
What to do if: new onset focal neurology
A
reassess -meningitis - encephalitis - ↑ ICP consider Abx: call senior
9
Q
Sudden onset severe constant headache
A
consider subarachnoid
15l/O2
Lie flat
Call senior
10
Q
Unwell & deranged obs
A
consider meningitis or sepsis 15l/min O2 IV fluids Discuss Abx Senior
11
Q
Red, painful eye, ↓Acuity
A
acute glaucoma
urgent ophthalmology referral
12
Q
when to CT head
A
- GCS < 13 on presentation
- GCS < 15 after 2 hours of assessment
- Suspected open/depression skull fracture
- any sign of basal skull fracture
- post-traumatic seizure
- focal neurological deficit
- more than 1 episode of vomiting since head injury
- patient has ↑risk of bleeding: anticoagulants, dual anti platelets, coagulopathy
- Amnesia or LOC
