Headache Flashcards
Sinister causes of a headache
V - vascular I - infectious V - vision-threatening I - intracranial pressure D - dissection
Vascular diagnoses?
SAH
Sub/extradural haematoma
cerebral venous sinus thrombosis
cerebellar infarct
Infectious diagnoses?
Meningitis
Encephalitis
Vision-threatening diagnoses?
temporal arteritis acute glaucoma cavernous sinus thrombosis pituitary apoplexy posterior leucoencephalopathy
Intracranial pressure diagnoses?
SOL idiopathic intracranial HTN hydrocephalus malignant HTN cerebral oedema
Dissection diagnoses?
carotid dissection
Red flag symptoms
decreased consciousness sudden onset worst headache ever seizure (or focal neurological deficit) lack of previous episodes reduced visual acuity persistent worse when lying down/in the morning FLAWSV symptoms history of malignancy
Why would you check temperature?
check for fever to indicate intracranial infection
Why would you check BP
malignant HTN
Focal neurological signs
limb deficit third nerve palsy sixth nerve palsy twelfth nerve palsy Horners sydrome
What is the horners syndrome triad?
partial ptosis
anhydrosis
miosis
what does exophthalmos suggest?
cavernous sinus thrombosis
what does a cloudy cornea or fixed dilated or oval pupil?
acute glaucoma
what does optic disc appearance on a fundoscopy suggest?
raised ICP
what does scalp tenderness suggest?
temporal arteritis
symptoms of temporal arteritis
jaw claudication
headache
scalp tenderness
visual disturbances
pathophysiology of temporal arteritis
formation of immune inflammatory granulomas in the tunica media of medium/large arteries
management of temporal arteritis
blood test for raised ESR and CRP
high dose corticosteroids
temporal artery biopsy
diagnosis criteria of temporal arteritis
3 of the following:
onset of symptoms above 50 years old
new headache
ESR elevated >55mm/hr
clinically abnormal temporal artery - tender or non-pulsatile
biopsy reveals mononuclear cell infiltration or granuloma
differentials of non-sinister headaches
tension-type migraine sinusitis medication-overuse temporomandibular joint dysfunction trigeminal neuralgia cluster
tension-type
often bi-frontal
no other symptoms
usually lasts no more than a few hours
migraine
usually unilateral
associated with aura - sensitivity to sound/light/smell
can last between 4-72 hours
differential for epilepsy and TIAs
treatment for migraines
Triptans - sumatriptan
5HT receptor agonists - cerebral vasoconstriction and inhibition of trigeminal nerve transmission
sinusitis
facial pain that comes on over hours/days
in conjunction with coryzal symptoms (acute inflammation of the nasal mucus membranes)
headaches last several days - associated with time course of infection
medication overuse
very common
resemble cluster or tension-type
seen with migraine medications and analgesic overuse
remove medication for a while to treat
TMJ syndrome
most common in 20-40 year olds
dull ache in the muscles of mastication
trigeminal neuralgia
very rare mainly in women ages 60-70 unilateral stabbing, sharp facial pain attacks only last seconds but have many triggers attacks rarely occur during sleep
cluster
mainly affects men
onset of symptoms occurring in clusters of 6-12 weeks every 1-2 years at exactly the same time every day
pain is focused over one eye
very intense pain
red watery eye, rhinorrhea, horners syndrome
Sub-arachnoid haemorrhage
sudden onset, worst headache ever - possibly due to ruptured aneurysm
order CT scan to look for blood in CSF
nimodipine - CCB for management
cerebral angioplasty
Brain tumour
persistent headache in the occipital area fundoscopy reveals optic disc cupping MRI scan to locate dexamethasone to reduce inflammation surgery
main causes of SAH
rupture of arterial aneurysm (45%)
trauma (45%)
arteriovenous malformation (10%)
intracranial tumours
secondary metastatic (90%) Primary - axial (50%) extra-axial
