Headache Flashcards
Describe a headache with meningism
- acute
- severe
- felt over most of head
- neck stiffness
What should you exclude if a patient presents with an acute, sever headache felt over most of the head?
1) Meningitis (fever, photophobia, neck stiffness, purpuric rash, coma)
2) Encephalitis (fever, odd behaviour, fits or decreased consciousness)
3) subbarrachnoid haemorrhage (sudden onset, worst ever headache, occipital, stiff neck, decreased consiousness, focal signs)
What is your immediate management plan for a patient who presents with acute, sever headache felt over most of the head and neck stiffness?
- Urgent CT head
- if Ct +ve do Lumbar puncture to look for infection or blood products in CSF.
What could be the cause of a localised headache that becomes more generalized. Lasts around 2 weeks and is resistant to analgesia
Head Injury
Why do we do a CT head in a headache that lasts around 2 weeks and is not helped by analgesia?
The headache could be due to trauma.
Do CT to exclude subdural or extradural haemorrhage if drowsy
cause of subacute / sudden headache with papilloedema
venous sinus thrombosis
what is papilloedema
swelling of the optic disc
what are the symptoms of sinusitis?
dull, constant ache over frontal or maxillary sinuses with tenderness +/- postnasal drip.
- pain worse with bending over
where is ethmoid or sphenoid sinusitis pain felt ?
deep in the midline at the root of the nose
what could cause a low pressure headache?
what are the symptoms of a low pressure headache?
CSF leak
- a headache that becomes severe when the patient is upright and quickly disappears when the patient is lying flat.
- Thus, the headaches are typically absent first thing in the morning, and start or worsen shortly after getting out of bed.
- The pain is often worse at the back of the head, and may be accompanied by some neck discomfort and nausea.
An 80yr old presents with constant , aching pain that develops rapidly around one eye, radiating to forehead. She also has reduced vision, visual haloes, nausea and vomiting.
Acute glaucoma
( could also be cluster headache : pain around one eye , bloodshot + watery, miosis, ptosis, unilateral, affects same side, lasts for 4-12wks then pain free , recurrs)
What are the signs and symptoms of acute glaucoma?
signs:
- red, congested eye
- cloudy cornea
- dilated, non responsive pupil
- decreased visual acuity
Symptoms:
- sudden onset pain around one eye , radiated to forehead
- reduced vision
- visual haloes
- nausea/ vomiting
A 30 yr old man presents with rapid onset of excruciating pain around one eye that has become watery and bloodshot with lid swelling, lacrimation and facial flushing, as well as a constricted pupil. The pain is only on one side. It lasts 15-60mins and occurs once or twice a day. It is often at night. This has been going on for 4 weeks. He had a similar thing last year/.
Cluster headache
What are the symptoms of a cluster headache?
- sudden, severe pain around one eye
- pain is unilateral
- lasts 15 - 60 mins
- occurs once or twice a day
- often nocturnal
- lasts for 4 - 12 weeks
- few months / years main free
- pain recurrs on same side
- Pain debilitating
What is the treatment for cluster headaches?
- 100% Oxygen for 15min via non rebreathe mask
- sumatripan 6mg at onset
A 55 yr old man presents with:
- intense, stabbing pain that lasts seconds on one side of the face after shaving
- his face screws up with pain
Tigemminal neuralgic
What are the triggers of trigemminal neuralgic pain?
Usually affects mandibular or maxillary regions. Triggers: - washing face - shaving - eating - talking
Visual disturbances followed by unilateral throbbing headache within one hour?
migraine
Premenstrual episodic severe unilateral headache, with nausea / vomiting, photophobia
- migraine
What is a migrain prodrome?
precedes headache by hours/days :
- yawning,
- cravings
- mood change
- sleep change
What is a migraine aura?
- precedes headache by minutes / may persist during headache
- visual disturbances (choatic, distorting, jumbled lines,dots)
- parasthesia (numbness spreading from fingers to face)
- dysarthria (unclear articulation of speech)
- ataxia ( loss of balance)
- opthalmoplegia (eye muscles paralysed)
- Speech - dysphasia (difficulty putting word together)
A 56 yr old presents with a headache that has lasted a few weeks. The headache affects the front and side of his head
Exclude giant cell arteritis
ask about jaw pain and visula disturbances
Signs:
- thickened , tender, pulseless temporal arteries
- jaw claudication
- ESR >40mm/h
- prompt diagnosis and steroids to avoid blindness.
Describe the symptoms of a Tension headache?
- bilateral
- non pulsatile headache
- scalp muscle tenderness
- no vomiting
- no sensitivity to head movement
- stress relief / massage helps
What are the symptoms of a headache with raised intracranial pressure?
- worse on waking, lying, bending forward, coughing
- vomiting
- papilloedema
- seizures
- odd behaviour
What tests do you do for a headache that is worse on waking, lying, bending forwards, coughing?
CT head to exclude space occupying lesion (most likely headache caused by raised ICP)
**Only do Lumbar puncture after CT.
What is a common reason for episodic headache becoming chronic daily headache?
Medication overuse (painkiller rebound) headache
