Headache: Differential Diagnosis Flashcards
1
Q
‘Red flags’ - First and worst headache:
A
- SAH
2
Q
‘Red flags’ - Thunderclap headache:
A
- SAH
3
Q
‘Red flags’ - Unilateral headache and eye pain:
A
- Cluster H/A
- Acute glaucoma
4
Q
‘Red flags’ - Unilateral headache and ipsilateral symptoms:
A
- Migraine
- Tumour
- Vascular
5
Q
‘Red flags’ - Cough-initiated headache:
A
- Raised ICP
- Venous thrombosis
6
Q
‘Red flags’ - Worse in the morning or bending forward:
A
- Raised ICP
- Venous thrombosis
7
Q
‘Red flags’ - Persisting headache ± scalp tenderness in over-50s:
A
- GCA
8
Q
‘Red flags’ - Headache with fever or neck stiffness:
A
- Meningitis
9
Q
Two other vital questions to ask:
A
- Where have you been? (malaria)
- Might you be pregnant? (pre-eclampsia; especially if proteinuria and BP)
10
Q
No signs on examination - Diff Dx:
A
- Tension headache
- Migraine
- Cluster headache
- Post-traumatic
- Drugs - nitrates, calcium-channel antagonists
- Carbon monoxide poisoning or anoxia
- Subarachnoid haemorrhage
11
Q
Signs of meningism - Diff Dx:
A
- Meningitis - may not have fever or rash
- Subarachnoid haemorrhage - examination may be normal
12
Q
Decreased conscious level or localizing signs - Diff Dx:
A
- Stroke
- Tumour
- SAH
- Encephalitis/meningitis
- TB meningitis
- Subdural haematoma
- Cerebral abscess
- Venous sinus occlusion (focal neurological deficits)
13
Q
Papilloedema - Diff Dx:
A
- Tumour
- Venous sinus occlusion (focal neurological deficits)
- Malignant (accelerated phase) hypertension
- Idiopathic intracranial hypertension
- Any CNS infection, if prolonged (eg > 2 wks) eg TB meningitis
14
Q
Giant cell arteritis features:
A
- Raised ESR
- Tender scalp over temporal arteries
15
Q
Acute glaucoma features:
A
- Painful red eye - get pressures checked urgently
16
Q
Vertebral artery dissection features:
A
- Neck pain
- Cerebellar/ medullary signs
