Headache Flashcards
Mnemonic for remeering sinister causes of headache
Vascular
Infective
Visual threatening- GCA, apoplexy, cavernous sinous thrombosis, acute glaucoma
Intracranial pressure- SOL, HTN, cerebral oedema from trauma, hydrocephalus
Dissection- carotid
What needs to be considered with headache and LOC
SAH must be ruled out
If trauma could be haematoma
Infective causes can lead to this
What is implied by LOC following lucid interval
Extradural haematoma
What is implied by fluctuating LOC
Subdural haematoma
How would felt like hit in back of head indicate
SAH
What do seizures or focal neurology suggest about a headache
Intracranial or could be migraine aura
What does recurrent headaches suggest about overall pathology
Not that sinister
What is most common cause of amaurosis fugax
TIA
What to think when amaurosis fugax alongside headache
Any under VIVID
What to ask about if suspect GCA
Scalp tenderness
Jaw pain
Shoulder pain
If suspect carotid dissection what should ask about
Yoga
Neck chiropractic manipulation
What does headache worse when lying or bending over suggest
Raised ICP as no support on head
What does headache with morning nausea suggest
Raised ICP
What does headache worse when standing up suggest
Low ICP- very common after LP and will resolve after analgesia and time
What do constitutional Sx with headache suggest
TB
Malignancy
Chronic inflammation like temporal arteritis
What would be considered if PMH of immunosuppression such as HIV or recent transplant in headache Px
Increased risk of infection
What would history of TB in headache presentation suggest
Potential tuberculoma, abcess and toxoplasmosis
What would history of cancer and headache suggest
Metastases
What does tongue deviation suggest
12th nerve palsy
What can cause 12th nerve palsy
Carotid dissection
What is most likely cranial nerve palsy
6th as has longest route
What appears as convergent squint inwards or failure to abduct eye
6th nerve palsy
Common cause of 6th nerve palsy
Something compressing eye, can be from ICP
What does exopthalmos with headache suggest
Cavernous sinus thrombosis
What does a cloudy cornea suggest
Acute glaucoma
What does reduced visual acuity and headache indicate
Acute glaucoma and GCA
Non sinister headaches
Tension Migraine Sinusitis Medication overuse TMJ syndrome Trigeminal neuralgia Cluster headache
What are 2 types of headache
Primary and secondary
In primary if removed headache then would be no harmful pathology
Questions for non-sinister headaches
Suffer any headaches usually- migraine users susceptible to medication overuse
Triggers- migraines and tension types
How disabling?
Aura?
What does stress fatigue dehydration and hunger trigger
Tension headaches
How do tension headaches present
Feel like tight band around head Bilateral Can radiate to shoulders and neck No more than few hours Only disabling if for regular basis
What are migraine aura differentials
TIAs
Which sex are medication overuse headaches particularly prevalent in
Females
Presentation of sinusitis
Facial pain that worsens with movement
Associated with coryzal symptoms
Who does TMJ syndrome most commonly occur in
20-40
How does TMJ syndrome present
Get headache and dull ache in muscles of mastication that radiates to ears and jaw
What headache can lead to hearing click when move neck
TMJ
How does trigeminal neuralgia present
Stabbing pain that only comes about when patient touches or does anything involving face
What can separate trigeminal neuralgia from cluster and migraines
Trigeminal rarely wakes people up at night
Pain over eye differentials
Cluster
Migraine
GCA
When is only time you give preventative medication for migraines
If occur on a fortnightly basis
Examinations ordered for non-sinister headaches
Obs- rule out malignant HTN
Head and neck examination- muscle tenderness and stiffness
Focal neurology signs suggest something more sinister
Fundoscopy- ICP and HTN
What looking for SAH on CT
Blood in fissures and in CSF
Management of SAH if CT positive
Give Nimpodipine a CCB that reduces spasm of arteries preventing a stroke
Angio to find location of bleed and platinum coil to clot the bleed
How are visual problems described in migraines
Slow march where gradual worsening of visions and resolves in similar way
Other than TIA what else can cause positive signs sporadically
Epilepsy
Common epilepsy signs
Feeling sensation in her skin
Convulsions
Flashing lights seen
Most common brain tumour in children
Medulloblastoma of cerebellum- ataxia symptoms
IF brain tumour is strongly suggested what are steps to management
Do urgent MRI
Will treat with dexamethasone to reduce swelling and ease headache in mean time then will have surgery
What are examples of primary headache
Migraine
Cluster
Tension
RFs tension headache
Stress
Disturbed sleep
Management of tension headaches
Avoid triggers and make a headache diary
Simple analgesia
Beware of medication overuse headaches
First line management of migraines
Avoid triggers and make a headache diary
Simple analgesia
If simple analgesia doesnt work with migraines what is given
Triptans
If want to prevent migraines what is first line
Propanolol or topiramate
If Propanolol or topiramate dont work in preventing migraines what is given
Amitryptiline
What is topiramate
An anti-epileptic
What is amitriptyline
An antidepressant
When do cluster headaches normally happen
At night
Where is pain in cluster headache
Behind the eye
What can trigger cluster headaches
Alcohol or strong smells
Assocaited symptoms of cluster headache
Watery, red eye
Facial flushing
Nasal congestion
Signs on examination of cluster headache
Partial horners with ptosis and miosis
