Headache Flashcards
What are the acute differentials for headache?
Vascular - Haemorrhage: SAH, intracranial bleed, sinus venous thrombosis
Infection / inflammation: Meningitis, Encephalitis, Abscess
Ophthalmic: Acute glaucoma
Situational: cough, exertion, coitus
What are the chronic causes of headaches?
Migraines Cluster headaches Drugs: Analgesics, caffeine, vasodilators Tension headaches Neuralgia (trigeminal) Raised ICP: tumours Giant cell arteritis Systemic: HTN (pheochromocytoma, pre-eclampsia)
What is the difference between primary or secondary headaches?
Primary: Due to the headache condition itself, not due to another cause e.g. migraine, tension, cluster
Secondary: Headache that is present because of another condition. e.g. headache in meningitis /sinusitis / SAH / medication overuse.
What things do you ask in the history if a patient resents with a headache?
SQITARS Causal factors / triggers PMHx: Problems related to headaches. DHx: analgesia / drugs with headaches as side effects Fix SHx: stress, eating, dehydration Red flags
What examinations do you do if a person presents with headache?
Obs
Neuro: Peripheral and cranial
Any other related system worried about.
What are the red flag symptoms fo a headache?
SNOOP
Systemic signs and disorders (meningitis)
Neurological symptoms (SOL, glaucoma)
Onset new or changed and patient >50yrs old (malignancy)
Onset in thunderclap presentation (vascular)
Papilloedema (raised ICP)
What are the symptoms of a headache caused by a space occupying lesion?
Gradual onset
Progressive
Associated neurology - change in vision
Features of increase ICP:
Early morning headache, N&V, Worse on coughing or bending.
Describe the symptoms of a migraine (SQITARS)
S - Unilateral, often frontal
Q - Sudden to gradual onset, Throbbing / pulsating
I - moderate
T - Between 4 and 72 hours. May be cyclical (triggered at Same time of month)
A - Photo/phonophobia
R - sleep make better, medication
S - +/- aura, N&V
Triggers: Food, sleep, stress
Often have family history
Not sure what causes - vascular or neuronal dysfunction?
Describe the symptoms of a tension headache (SQITARS)
S - bilateral, frontal (vertex-bitemporal) Q - Squeezing, non-pulsatile I - less severe (mild-moderate) T - Worse at end of the day A - stress, poor posture, lack of sleep R - to neck? S - mild nausea
What is a medication overuse headache?
Defined as headache present on at least 15 days per month.
Does not improve after OTC medication
Regular overuse greater than 3 month of:
Triptans or opioids on at least 10 days of the month.
Paracetamol or NSAIDs or aspirin on at least 15days of the month.
Resolves completely after 2 months following discontinuation of medication.
Will get worse before it gets better.
Describe the symptoms of a cluster headache (SQITARS)
S - around / behind one eye
Q - sharp, penetrating
I - Very severe and constant intensity
T - Rapid onset. Attack last 15mins-3hours, 1-2x a day, mostly nocturnal.
Clusters can last 2-12weeks and remission 3mo-3yrs
Can be chronic or episodic
A - head injury, alcohol, cigarette smoking
R - No radiation
S - Red, watery eye, nasal congestion
Triggers: alcohol, histamine, GTN, heat, exercise, solves, lack of sleep
Describe the symptoms of a trigeminal neuralgia (SQITARS)
S - unilateral, often over the eye
Q - stabbing, sharp, “electric shock”
I - severe
T - sudden onset, lasts a few seconds to two minutes
A - light touch to face, eating, cold winds, vibrations
R - radiated to eye, lips, nose and scalp
Preceding symptoms: tingling, numbness
More common with PHx of chronic pain
What are the most important things you need to know by end of the assessment of a headache?
How worried you are by the cause of the headache?
What do next?
Investigations? - headache diary, Imaging (CT / MRI)
Start treatment? -analgesia, triptans high flow oxygen
Specialist?
A&E?
