Headache Flashcards
Sinister causes of headaches
VIVID acronym
Vascular Infection Vision-threatening Intracranial pressure Dissection
Sinister vascular causes of headache
SAH
Hematoma
Cerebral venous sinus thrombosis
Cerebellar infarct
Sinister infectious causes of headaches
Meningitis
Encephalitis
Sinister vision-threatening causes of headache
Temporal arteritis Acute glaucoma Pituitary apoplexy Posterior leucoencephalopathy Cavernous sinus thrombosis
Sinister intracranial pressure causes of headache
Abscess SOL Cerebral oedema Hydrocephalus Malignant hypertension
Sinister dissection causes of headache
Carotid dissection
Red flags for headache
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
What might decreased level of consciousness and headache suggest
SAH
What might decreased level of consciousness with head injury suggest
Subdural or extradural hematoma
Describe the type of decreased consciousness in subdural and extradural hematomas
Subdural: fluctuating consciousness
Extradural: altered consciousness following a lucid interval
What does sudden onset, worst headache suggest
SAH with blood in CSF irritating meninges
Which condition does a very severe headache with almost instantaneous onset suggest
SAH
Which red flag suggests intracranial pathology
Seizures or focal neurological deficits
Examples of neurological deficits
Limb weakness
Speech difficulties
Are recurrent headaches usually more or less sinister
Less sinister
Over what age does new onset headache suggest temporal arteitis
> 50 years old
Which condition normally causes transient blindness
Transient ischaemic attack
Causes of reduced visual acuity
Temporal arteritis
Carotid artery dissection
Acute glaucoma
RARELY transient ischaemic attack
Persiestent headache worse when lying down, and early morning nausea suggests
Raised ICP
When does headache due to raised ICP worsen
Lying down for prolonged times
Bending over
Headaches worse when standing up suggests
Reduced ICP, common after lumbar puncture but not sinister
Headaches, jaw claudication, and age>50 might indicate
Temporal arteritis
Signs to look for on clinical examination of headaches
Basic observations
Focal neurological signs
Eye inspection
Other (visual acuity, scalp tenderness, meningism)
Basic observations for headaches
Altered consciousness (GCS score)
Blood pressure
Pulse rate
Temperature
What can fever and headache together suggest
Meningitis or encephalitis
Focal neurological signs to look for in headaches
Focal limb deficit Third nerve palsy Sixth nerve palsy Tweflth nerve palsy Horner’s syndrome
What does focal limb deficit possibly suggest
Intracranial pathology
Signs of third nerve palsy
Ptosis
Mydriasis
Eye deviated down and out
Ruptured aneurysm in which artery leads to third nerve palsy
Posterior communicating artery
Signs of sixth nerve palsy
Convergent squint
Failure to abduct eye laterally
Which cranial nerve is most likely to get compressed
Sixth cranial nerve, because it is the longest. Can be compressed directly by mass or indirectly by raised ICP
Signs of twelfth nerve palsy
Tongue deviation
One possible cause of twelfth nerve palsy
Carotid artery dissection
Horner’s syndrome triad
Partial ptosis
Miosis
Anhydrosis
What is the autonomic nervous system’s relation to Horner’s Syndrome
Interruption of ipsilateral sympathetic pathway
What conditions can cause Horner’s Syndrome in conjunction with headaches
Carotid dissection
Cavernous sinus lesion
Signs to look for on eye inspection for headaches
Exophthalmos
Cloudy cornea
Fixed/dilated pupil
Optic disc appearance
What could exophthalmos and headache indicate
Retro-orbital process eg. cavernous sinus thrombosis
