Headache assessment 1 Flashcards
What are the symptoms for dangerous headaches?
- thunderclap
- fever
- focal symptoms
- persisting / progressing / provoked
- new onset
What are most recurrent/chronic headaches?
Migraines
What is a thunderclap headache?
- very sudden onset
- very painful headache
- can last between hours and days
- worrying prognosis is subarachnoid haemorrhage
What is the usual cause of sudden onset fever/focal headache?
- influenza
- headache comes along with lots of fevers
- worrying prognosis is bacterial meningitis
is bacterial or viral meningitis worse?
bacterial
viral is self-limiting
What is migraine aura?
- get migraines which last a few minutes
- spreads, evolves then resolves by itself
- will have focal disturbance
What is the worrying diagnosis of sudden onset persisting headache?
- CO poisoning (ask about there work and home)
- temporal arteritis (age over 50 and ESR over 50)
- intracranial hypertension (overweight women, daily headaches due to high pressure, often hear whoosing noise in head)
What are non-dangerous symptoms of sudden onset persisting headache?
- neck stiffness
- dental pain
What are the diagnoses of sudden onset provoked headache?
- CSF leak (only felt when standing)
- Cortisol / exertional (peak then go away, often benign)
- cluster headache (severe pain, runny nose, suddenly resolve, treatable with high O2)
- trigeminal headache (symptom of MS, intense pain, triggered by touching trigeminal nerve)
What headache type do patients with brain tumours usually present with?
- isolated headache
- tension headache
- along with focal neurology/epileptic seizures
- papilloedema (causing vomiting in mornings)
What are the types of safe headache?
- episodic migraine
- chronic migraines
What two things do you always need to do for a headache assessment?
- Headache history to get type
- normal neuro exam
- scans not usually required
How do you diagnose migraine?
- nausea
- pain severe enough to stop you wanting to do anything
- recurrent
- make you want to lie down
- pain is frontal
- normal neuro exam
What are the risk factors of migraines?
- neck stiffness
- myopia
- family history
- female more common
- tempomandibular joint dysfunction
What are the sensory symptoms of migraines?
- light
- noise
- smell
- movement
- touch
- nausea
What are the common prodromal symptoms of migraine?
- depression
- hunger/thirst
- elation/energy
- apathy
- diarrhoea
What can migraines cause?
- vertigo
- difficulty word-finding
- low concentration
- tingling / heaviness
- visual loss
What are the symptoms of migraine aura?
- cortical spreading depression (cause)
- visual aura
- sensory-motor aura
- dysphasic
- spreads, evolves then resolves by itself
What is chronic migraine?
pain doesn’t fully go away will have episodes which are more severe but migraine is constant
What will tension-type headaches present as?
- bland
- featureless
- tightness or weight in their head
- can last hours, days or weeks
- any location
- no provoking or exacerbating factors
What are the risk factors of tension headaches?
- neck stiffness
- visual acuity
- TMJ pain
How will ice-pick headache present?
- brief
- very localised to pin point
- disappears within seconds
- can linger
- may increase to migraine
What headaches warrant visiting A&E?
- thunderclap
- fever cant rule out meningitis
What are the types of new onset headache?
- thunderclap
- fever
- focal
- progressive
- persisting
