Headache history

Question 1

What are the differentials diagnosis for acute, new onset headache?

Answer 1

1. Meningitis
2. Low CSF pressure
3. Subarachnoid haemorrhage
4. Intracranial haemorrhage
5. Head injury
6. Acute closed angle glaucoma

Question 2

What are the differentials diagnosis for subacute onset headache?

Answer 2

1. Raised intracranial pressure
2. Encephalitis
3. Temporal arteritis

Question 3

What are the differentials diagnosis for chronic and recurrent headache?

Answer 3

1. Tension headache
2. Migraine
3. Cluster headache
4. Cervical root headache
5. Eye strain
6. Drug side-effect

Question 4

What headache is worse on waking up?

Answer 4

Raised intracranial pressure

CT or MRI scan 1

Question 5

How would you manage raised intracranial pressure?

Answer 5

Dexamethasone or mannitol

Question 6

What are the key characteristics of a tension-type headache?

Answer 6

Generalised bilateral mild-moderate headache

Bandlike, progresses as the day goes on and aggravated by eye movement

Give analgesics

Question 7

What are the key characteristics of a migraine?

Answer 7

Unilateral throbbing headache

Vomiting, aura

Family history

Question 8

What are the key characteristics of cluster headache?

Answer 8

Episodic, typically nightly pain in one eye for weeks

Nasal stuffiness on same side. Localised around one eye

Occurs for 15 minutes to 2 hours daily for 6-8 weeks

Question 9

What are the key characteristics of a subarachnoid headache?

Answer 9

Sudden, severe headache (thunderclap)

Neck sickness, photophobia

Drowsiness, loss of consciousness

Question 10

What are the key characteristics of a subdural haemorrhage?

Answer 10

Recent head injury

Gradual onset

Fluctuating levels of consciousness, potential lucid interval

Common in elderly

Question 11

What are the key characteristics of a extradural haemorrhage?

Answer 11

Recent head injury

Gradual onset headache. Potential loss of consciousness and lucid interval

More common in the young

Question 12

What are the key characteristics of a intracerebral haemorrhage?

Answer 12

Sudden onset, severe headache

Often worse on waking up due to increased intracranial pressure

Focal neurological signs

Question 13

What foods can trigger migraine?

Answer 13

Cheese, chocolate, wine

Question 14

What are the key characteristics of temporal arteritis headache?

Answer 14

Usually in patients over 60

Frontal or occipital

Jaw pain, scalp tenderness, visual disturbances

Malaise and proximal muscle weakness

Question 15

What are the key characteristics of cervical spondylosis headache?

Answer 15

Headache associated with neck pain and neck movement

Question 16

What other cardinals symptom would you consider?

Answer 16

Syncope
Seizures
Falls
Dizziness
Visual disturbances 
Altered sensation
Aura

Question 17

What would you do if you suggested intracranial infection?

Answer 17

FBC, U&E, glucose, coagulation screen, blood cultures and CRP

Lumbar puncture, cultures

Question 18

What would you do if you suggested intracranial bleed?

Answer 18

CT scan