headache and migraine Flashcards
History of presenting complaint?
Where is it?
Distribution
What is it?
Timing
Onset
Time course
Insidiously progressive
Intermittent
Vitamin D
So What?
Synthesis
Anatomical (1 or more)
Syndromal (IPD)
Aetiological
/Associated features of acute cephalgia
Associated features
Visual/Vestibular/Paraesthesiae/Autonomic
Meningism
Nausea/Vomiting
Neck stiffness
Photophobia
Seizure
Focal neurological features
Associated features of headaches?
Associated features (cont)
Aggravating factors
Light/Sound/Movement
Straining
Circumstances
Intercourse
Posture
Time of day
Syndromic presentations
Visual loss on stooping with pulsatile tinnitus
Jaw Claudication/Scalp tenderness
Abrupt onset with meningism
Postural headache
Coital
Screening examination?
Gait
Pupils
Fields
Fundoscopy
Eye movements
Facial sensation
Mouth
“AAH”/tongue bulk/cough
Neck flexion
Arms/Legs
Wasting
Tone
Outstretched hands
Pyramidal power testing
DTRs and plantars
Co-ordination
Finger nose/ Heel shin
Sensation
JPS/Vib/LT/PP distally
clinical characteristics of a migraine?
+/- Aura
Scintillations/fortification spectra/photopsia
Onset to peak
Seconds/minutes/hours
Duration
< 24 hrs
Frequency
Monthly (hormonal)
Character
Throbbing
Distribution
Unilateral
Associated features of migraines?
Associated features
Nausea
Photo-/phono- phobia
Aggravation with movement
P/N, clumsy, aphasic
Able to sleep?
Triggers
FHx
Migraine treatments?
Acute therapies
Analgesia
Anti-emetics
Triptans
Prophylaxis
Pizotifen
Tricyclic antidepressants
Beta blockers
Anticonvulsants
syndromes secondary to headaches?
Red Flag syndromes
Space occupation (SOL)
Sub arachnoid haemorrhage
Meningitis
Venous sinus thrombosis
Idiopathic intracranial hypertension
Giant cell/Temporal arteritis
space occupying lesion?
Subacute headache
Days/months
Morning headache
Aggravated by Valsalva manoeuvre
Coughing/sneezing
stooping/straining
Diplopia
VIth nerve
N/V
Focal +/- secondarily generalised seizure
Urgent
brain imaging
+/- Dexamethasone
+/- Mannitol
Referral to Neurosurgeon
Sub arachnoid haemorrhage symptoms?
Abrupt onset
Instantaneous
Thunderclap
Worst ever headache
Prostration
Meningism
Photophobia
Neck stiffness
N/V
Resuscitate
Airways
Breathing
Circulation
Urgent
Imaging
Lumbar puncture
Neurosurgical review
Nimodipine
Neurological obs/ICU
Meningitis?
Subacute onset
Minutes-hours
Meningism
Photophobia
Neck stiffness/rigidity
N/V
Febrile
+/- Rash-non-blanching
Shocked
Confused/Coma
Managemnet of meningitis?
Resuscitate
Airways
Breathing
Circulation
Blood Cultures
Throat swab
Urgent
Imaging
Lumbar puncture
Treatment with broad spectrum antibiotics
Close neurological observation/ICU
Venour Sinus Thrombosis?
Young fertile female
Pregnancy
Thrombophilia
Venous thrombo-embolism
Acute onset headache
Global
Associated features
N/V
Seizure/Coma
Papilloedema
Raised CSF opening pressure
Venous sinus thombosis management?
Thrombolysis
Iv unfractionated Heparin
+/- interventional thrombolysis
Control of raised intracranial pressure
Control of seizures
Close neurological observations/ICU
Idiopathis intracrainail hypertneion?
Young fertile female
Pregnancy
Subacute headache
Global
Associated features
N/V
Stooping blindness/blurring
Pulsatile tinnitus
Papilloedema
Impaired Visual fields
Enlarged blind spot
Peripheral constriction
Raised CSF opening pressure
