Headache Flashcards
What key history would you obtain from a patient who complains of a headache?
Location (unilateral vs. bilateral) Quality Instensity Duration Timing (Does it disturb sleep?) Nausea Jaw claudicaiton Recent trauma Dental surgery Sinusitis symptoms Exacerbating (stress, fatigue, menses, exercise) Alleviating factors (rest, medicines) Past history of headache or family history of migraines
What key physical exam would you perform for a patient who complains of a headache?
Vital signs
Inspection and palpation of entire head
ENT inspection
Complete neurologic exam including fundoscopic exam
21 yo F presents with several episodes of throbbing left temporal pain that lasts for 2-3 hours. Prior to its onset, she sees flashes of light in her right visual field and feels weakness and numbness on the right side of her body for a few minutes. Headaches are often associated with nausea and vomiting. She has a family history of migraine. Differentials?
Migraine Tension headache Cluster headache Pseudotumor cerebri Trigeminal neuralgia CNS vasculitis Partial seizure Intracranial neoplasm
21 yo F presents with several episodes of throbbing left temporal pain that lasts for 2-3 hours. Prior to its onset, she sees flashes of light in her right visual field and feels weakness and numbness on the right side of her body for a few minutes. Headaches are often associated with nausea and vomiting. She has a family history of migraine. Differentials: migraine, tension headache, cluster headache, pseudotumor cerebri, trigeminal neuralgia, CNS vasculitis, partial seizure, intracranial neoplasm. Workup?
CBC ESR CT- head MRI - brain LP
26 yo M presents with terrible right temporal headaches associated with ipsilateral rhinorrhea and eye tearing and redness. Episodes have occurred at the same time every night for the past week and last for 45 minutes. Differentials?
Cluster headache Migraine Tension headache Sinusitis Pseudotumor cerebri Trigeminal neuralgia Intracranial neoplasm
26 yo M presents with terrible right temporal headaches associated with ipsilateral rhinorrhea and eye tearing and redness. Episodes have occurred at the same time every night for the past week and last for 45 minutes. Differentials: cluster headache, migraine, tension headache, sinusitis, pseudotumor cerebri, trigeminal neuralgia, intracranial neoplasm. Workup?
CBC ESR CT- head MRI - brain LP
65 yo F presents with severe, intermittent right temporal headache, fever, blurred vision in her right eye and pain in her jaw when chewing. Differentials?
Temporal arteritis (giant cell arteritis) Migraine Cluster headache Tension headache Meningitis Carotid artery dissection Pseudotumor cerebri Trigeminal neuralgia Intracranial neoplasm
65 yo F presents with severe, intermittent right temporal headache, fever, blurred vision in her right eye and pain in her jaw when chewing. Differentials: temporal arteritis (giant cell arteritis), migraine, cluster headache, tension headache, meningitis, carotid artery dissection, pseudotumor cerebri, trigeminal neuralgia,
intracranial neoplasm. Workup?
CBC ESR CRP Temporal artery biopsy Doppler U/S - carotid MRI - brain
30 yo F presents with frontal headache, fever and nasal discharge. There is pain on palpation of the frontal and maxillary sinuses. She has a history of sinusitis. Differentials?
Sinusitis Migraine Tension headache Meningitis Intracranial neoplasm
30 yo F presents with frontal headache, fever and nasal discharge. There is pain on palpation of the frontal and maxillary sinuses. She has a history of sinusitis. Differentials: sinusitis, migraine, tension headache, meningitis, intracranial neoplasm. Workup?
CBC
CT- sinus
LP
50 yo F presents with recurrent episodes of bilateral squeezing headaches that occur 3-4 times per week. She is experiencing significant stress in her life. Differentials?
Tension headache Migraine Depression Caffeine or analgesic withdrawal Hypertension Cluster headache Pseudotumor cerebri Intracranial neoplasm
50 yo F presents with recurrent episodes of bilateral squeezing headaches that occur 3-4 times per week. She is experiencing significant stress in her life. Differentials: tension headache, migraine, depression, caffeine or analgesic withdrawal, hypertension, cluster headache, pseudotumor cerebri, intracranial neoplasm. Workup
CBC, electrolytes
ESR
CT- head
LP
35 yo M present with sudden severe headache, vomiting, confusion, left hemiplegia, and nuchal rigidity. Differentials?
Subarachnoid hemorrhage Migraine Meningitis/encephalitis Intracranial hemorrhage Vertebral artery dissection Intracranial venous thrombosis Acute hypertension Intracranial neoplasm
35 yo M present with sudden severe headache, vomiting, confusion, left hemiplegia, and nuchal rigidity. Differentials: Subarachnoid hemorrhage, migraine, meningitis/encephalitis, intracranial hemorrhage, vertebral artery dissection, intracranial venous thrombosis, acute hypertension, intracranial neoplasm. Workup?
CT - head without contrast LP CBC PT/PTT MRI/MRA - brain
25 yo M presents with high fever, severe headache, confusion, photophobia, and nuchal rigidity. Kernig’s and Brudzinski’s signs are positive. Differentials?
Meningitis Migraine Subarachnoid hemorrhage Sinusitis/encephalitis Intracranial or epidural abscess
