headache history

Question 1

What are the cardinal symptoms of headaches?

Answer 1

headache 
syncope
seizures
falls
dizziness / vertigo 
visual disturbances 
altered sensation
aura

Question 2

History of subdural haemorrhage

Answer 2

recent head injury
gradual onset headache, either constant or fluctuating
fluctuating levels of consciousness, may have loss of consciousness at time of injury followed by lucid interval followed by subsequent deterioration
more common in elderly and alcoholics

Question 3

history of extradural haemorrhage

Answer 3

recent head injury
gradual onset headache, either constant or fluctuating
may have lucid interval
more common in young (dura mater less fixed to skull) and alcoholic

Question 4

history if intracerebral haemorrhage

Answer 4

sudden onset, severe headache
symptoms of raised ICP
focal neurology

Question 5

Subarachanoid history

Answer 5

sudden onset, severe headache
meningism
drowsiness / LOC
focal neurology

Question 6

meningitis history

Answer 6

fever
rash (non-blanching associated with meningococcal septicaemia)
meningism
nausea and vomiting
drowsiness / LOC

Question 7

What are the symptoms are meningism?

Answer 7

neck stiffness / photophobia

headache

Question 8

site of headache

Answer 8

generalised, occipital or temporal

bilateral or unilateral

Question 9

onset of headache

Answer 9

what doing?
recent head trauma or drug intake?
sudden or come on gradually?
how long to reach peak?

Question 10

aggravating and relieving factors

Answer 10

what done to relieve the headache?
simple analgesia helped
t

Question 11

What are common triggers for migraines?

Answer 11

cheese
chocolate
red wine

Question 12

Associated symptoms and systematic enquiry

Answer 12

neurological history - loss of consciousness, motor or sensory deficit, gait, disturbances in vision, speech, hearing, incontinence
meningism
fever
rashes
scalp tenderness when brushing hair or on chewing
nausea or vomiting
infective symptoms 
aura before onset of headache 
watery eyes of nasal congestion
use of glasses and last eye test

Question 13

past medical history

Answer 13

general health
hypertension 
kidney disease
TIAs or strokes 
migraines or tension headaches
similar episodes before?

Question 14

Drug history

Answer 14

regular medications
pain relief 
anticoagulants
OCP
over the counter
allergies

Question 15

Social history

Answer 15

smoking and alcohol history
occupation
recent stresses that contribute to symptoms
recent contact with meningitis

Question 16

immediate management of headache

Answer 16

ABCDE

analgesia and anti-emetics

Question 17

Investigations of suspected intracranial bleed

Answer 17

CT scan
negative does not rule out SAH
lumbar puncture at 12 hours to look for xanthochromia (yellow colour, indicative of Hb breakdown )
spectophotometry to detect bilirubin

Question 18

investigation of suspected intracranial infection

Answer 18

FBC, U&Es, glucose, coagulation screen, blood cultures and CRP
Lumbar puncture and blood cultures
Only CT in focal neurological signs and raised ICP suspected
CT scan must not delay administration of antibiotics

Question 19

Features of space occupying lesion

Answer 19

absence of clear diagnosis of headache
older age 
focal neurological symptoms and signs
headache on waking
vomiting without nausea

Question 20

Features of temporal arteritis

Answer 20

usually in patients over 60
frontal or occipital
jaw pain, scalp tenderness, visual disturbances
malaise and proximal muscle weakness

Question 21

Features of cluster headahce

Answer 21

localised around one eye and associated with autonomic features such as lacrimation and nasal congestion
occurs 15mins - 2 hours daily for 6-8 weeks then subsides for months

Question 22

Features of cervical spondylosis

Answer 22

headache associated with neck pain

worsens with neck movements

Question 23

Features of migraine

Answer 23

chronic or recurrent headache
may have prodrome or aura
trigger
OCP
photophobia and visual disturbance 
nausea and vomiting 
family history

Question 24

features of tension headache

Answer 24

band like dull headache, sometimes with sharp exacerbations
in scalp rather than cranium
last throughout day, worsening in the evening
may get tired or dizzy