Headache

Question 1

Sinister causes of headaches

Answer 1

VIVID acronym

Vascular
Infection
Vision-threatening
Intracranial pressure
Dissection

Question 2

Sinister vascular causes of headache

Answer 2

SAH
Hematoma
Cerebral venous sinus thrombosis
Cerebellar infarct

Question 3

Sinister infectious causes of headaches

Answer 3

Meningitis

Encephalitis

Question 4

Sinister vision-threatening causes of headache

Answer 4

Temporal arteritis
Acute glaucoma
Pituitary apoplexy
Posterior leucoencephalopathy
Cavernous sinus thrombosis

Question 5

Sinister intracranial pressure causes of headache

Answer 5

Abscess
SOL
Cerebral oedema
Hydrocephalus
Malignant hypertension

Question 6

Sinister dissection causes of headache

Answer 6

Carotid dissection

Question 7

Red flags for headache

Answer 7

Decreased consciousness
Sudden onset, worst headache ever
Seizure or focal neurological deficit
Absence of previous headaches
Reduced visual acuity
Persistent headache, worse when lying down
Persistent, progressive headache
Constitutional symptoms

Question 8

What might decreased level of consciousness and headache suggest

Answer 8

SAH

Question 9

What might decreased level of consciousness with head injury suggest

Answer 9

Subdural or extradural hematoma

Question 10

Describe the type of decreased consciousness in subdural and extradural hematomas

Answer 10

Subdural: fluctuating consciousness
Extradural: altered consciousness following a lucid interval

Question 11

What does sudden onset, worst headache suggest

Answer 11

SAH with blood in CSF irritating meninges

Question 12

Which condition does a very severe headache with almost instantaneous onset suggest

Answer 12

SAH

Question 13

Which red flag suggests intracranial pathology

Answer 13

Seizures or focal neurological deficits

Question 14

Examples of neurological deficits

Answer 14

Limb weakness

Speech difficulties

Question 15

Are recurrent headaches usually more or less sinister

Answer 15

Less sinister

Question 16

Over what age does new onset headache suggest temporal arteitis

Answer 16

> 50 years old

Question 17

Which condition normally causes transient blindness

Answer 17

Transient ischaemic attack

Question 18

Causes of reduced visual acuity

Answer 18

Temporal arteritis
Carotid artery dissection
Acute glaucoma

RARELY transient ischaemic attack

Question 19

Persiestent headache worse when lying down, and early morning nausea suggests

Answer 19

Raised ICP

Question 20

When does headache due to raised ICP worsen

Answer 20

Lying down for prolonged times

Bending over

Question 21

Headaches worse when standing up suggests

Answer 21

Reduced ICP, common after lumbar puncture but not sinister

Question 22

Headaches, jaw claudication, and age>50 might indicate

Answer 22

Temporal arteritis

Question 23

Signs to look for on clinical examination of headaches

Answer 23

Basic observations
Focal neurological signs
Eye inspection
Other (visual acuity, scalp tenderness, meningism)

Question 24

Basic observations for headaches

Answer 24

Altered consciousness (GCS score)
Blood pressure
Pulse rate
Temperature

Question 25

What can fever and headache together suggest

Answer 25

Meningitis or encephalitis

Question 26

Focal neurological signs to look for in headaches

Answer 26

``` Focal limb deficit Third nerve palsy Sixth nerve palsy Tweflth nerve palsy Horner’s syndrome ```

Question 27

What does focal limb deficit possibly suggest

Answer 27

Intracranial pathology

Question 28

Signs of third nerve palsy

Answer 28

Ptosis Mydriasis Eye deviated down and out

Question 29

Ruptured aneurysm in which artery leads to third nerve palsy

Answer 29

Posterior communicating artery

Question 30

Signs of sixth nerve palsy

Answer 30

Convergent squint | Failure to abduct eye laterally

Question 31

Which cranial nerve is most likely to get compressed

Answer 31

Sixth cranial nerve, because it is the longest. Can be compressed directly by mass or indirectly by raised ICP

Question 32

Signs of twelfth nerve palsy

Answer 32

Tongue deviation

Question 33

One possible cause of twelfth nerve palsy

Answer 33

Carotid artery dissection

Question 34

Horner’s syndrome triad

Answer 34

Partial ptosis Miosis Anhydrosis

Question 35

What is the autonomic nervous system’s relation to Horner’s Syndrome

Answer 35

Interruption of ipsilateral sympathetic pathway

Question 36

What conditions can cause Horner’s Syndrome in conjunction with headaches

Answer 36

Carotid dissection | Cavernous sinus lesion

Question 37

Signs to look for on eye inspection for headaches

Answer 37

Exophthalmos Cloudy cornea Fixed/dilated pupil Optic disc appearance

Question 38

What could exophthalmos and headache indicate

Answer 38

Retro-orbital process eg. cavernous sinus thrombosis