Headache Flashcards
DDx for “primary” headaches
Tension
Migraine
Cluster
DDx for “vascular” headache
Temporal arteritis Subarachnoid hemorrhage Intracranial hemorrhage Subdural hematoma Aneurysm
DDx for “infectious” headache
Bacterial or Aseptic Meningitis
Abscess
Encephalitis
Iatrogenic and other medical causes of headaches
OCPs post -LP Post traumatic Fever Hypothyroidism
Migraine POUND criteria
Pulsatile Onset/duration 4-72 hrs Unilateral Nausea Disabling
Headache ‘red flags’
- “Worst headache of my life”
- Thunderclap
- Atypical aura (neuro function problems)
- Fever
- Nuchal rigidity
- Papilledema
- > 50 yrs old
- New onset in pregnancy
- New onset w serious chronic problem
- TTP over temporal artery
- Change in personality or mood w onset
“SNOOP” red flags
Systemic sx (fever, wt loss, secondary risk factors)
Neurologic sx (confusion, impaired alertness)
Onset (sudden, abrupt)
Older pt ( > 50)
Previous HA hx
Important hx questions
Time and mode of onset
Frequency, intensity, site, radiation of pain
Number HA per month
Aura?
Change in vision, sleep, exercise, weight, diet
Trauma?
Important PE to check
BP, HR Palpate head, neck, shoulder regions (meningitis, lymph, TTP) Fundoscopy papilledema Otoscopy Palpate neck and temporal artery Bruits in neck Spine and neck muscles (meningitis)
Neuro
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Gait
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Neuro exam
Mental status
CN exams
DTRs
Gait exam
Getting up from seated position w/o support
walk on toes, then heels
tandem gait
Romberg
Migraine without aura has at least 2 of the following
- Unilateral
- Moderate - severe
- Pulsatile
- Aggravated by movement
Migrainw without aura has one of the following
- Nausea
2. Photophobia
How many episodes must be reported to qualify as migraine without aura?
at least 5
Migraine with aura diagnostic criteria
HA preceded by > 1 neurologic sx:
Visual
- Scintillating scotoma
- Photophobia
Sensory
- Numbness
- Paresthesia
Other
- Weakness
- Aphasia
