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Lower Back pain > Headache in General Practise > Flashcards

Headache in General Practise Flashcards

1
Q

How do you diagnose headaches in primary care?

A
  • Good history taking
  • Exam the pt well - esp neurologically
  • Check for red flags
  • Avoid over investigation
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2
Q

What are the 4 C’s of socrates in history taking?

A

Circumstances
Character
Causes
Co symptoms

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3
Q

What are the questions would you ask in circumstances ?

A

How long you suffered?
How long it lasted ?
How often ?
How constant ?
Episodic ? When ?
Any pattern ?
Have they changed ?

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4
Q

What are the questions would you ask in character ?

A

The nature
Site & severity
Pain ? throbbing, stabbing, global, one-sided, neck , back/front of head, band like, facial ?

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5
Q

What are the questions would you ask in causes ?

A

is there anything that trigger ?
Aggravate or relieving factors ?
Periods

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6
Q

What are the co-symptoms ?

A

Nausea
Vomiting
Visual
Photophobia
Neurological ?

Is there any different types of headaches between headache

also make sure to ask for ICE

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7
Q

Classify the headaches accordingly to chronically ?

A

Acute new headache

Acute recurrent headache

Subacute headache

Chronic headache

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8
Q

What are the causes of acute new headache ?

A

Meningitis
Subarachnoid haemorrhage
Viral UTI
Sinusitis
Dental problems
Tropical illness e.g malaria

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9
Q

What are the causes of acute recurrent headache ?

A

Migrane
Cluster headache
Exertional headache
Trigeminal headache
glaucoma

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10
Q

What causes subacute headache ?

A

Temporal artheritis

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11
Q

What causes chronic headache ?

A

Tension type
Cervicogenic
Medication overuse
Raised intracranial pressure

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12
Q

What would you ask in PMH/Surgical history?

A

Sinus problems
Dental problem
Migrane
Hypertention / Intracranial bleeding
Recent head injury
Malignancy
HIV
Depression /Mental illness

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13
Q

What would you ask in Social history?

A

Job
Recent travel
drugs
alcohol
Home situation
Stress with work, bills, relationship
Family problems, children, parents , illness

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14
Q

How would you keep a headache diary?

A

If the cause is not known yet then keep a headache diary

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15
Q

What would you record on Headache diary ?

A

Frequency, duration, severity
associated symptoms
Medication used
possible precipitations
Relationship to periods

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16
Q

What are the red flags in headache?

A

Fever , purpuric rash, meningism ?
- Meningitis

Thunderclap headache
- Subarachnoid headache

Worsening over few weeks or change in chronic headache - SOL

Headache with change in posture, coughing, sneezing, exercise - vomiting ? Increased Intracranial Pressure

17
Q

Furthermore red flags ?

A

Are they new onset + h/o , cancer, HIV, immunosuppressant - infection /met

Recent head injury (<3cm ) - Bleed

Any changes in personality, cognition, new neurological defecit - SOL

18
Q

What are the Atypical aura in migraine?

A

Motor weakness
double vision
unilateral vision symptoms
Poor balance
Reduced consciousness

19
Q

What do you look during Inspection of the examination ?

A

Neuro signs

Rash ? purpura , the glass test

In eyes - look for red, pupils PERLA, Cornea and photophobia

injury

Mood

20
Q

What do you look during palpation of the examination ?

A

The temporal area

Tender Scalp

Sinuses for tenderness

Examine the neck to exclude neck pain as a factor

21
Q

What would you look for in Neuro examination ?

A

Include Fundi ( papilledema )

Visual acuity

Gait

cranial nerves/ full neuro exam

22
Q

What would be your investigation ?

A

Not needed in GP

-If the cause is acute- they’re admitted

-if the cause is serious - they’re referred

-Temporal arteritis - ESR raised

23
Q

What more investigations would you consider for pts with lethargic, pallor and jaundice?

A

FBC

U & E

TFT

LFT

24
Q

What is tension type of headache ?

A
  • 2 % prevelance
  • 2 F : 1M
  • Pts that present with stress/anxiety
  • FH of 40%
  • often comes during the day
    and gets worse at the end of the day
  • It lasts few hrs

-it does not disturb sleep

-it also doesn’t affect physical activity

25
Q

What is the management for Tension headache?

A
  • Aspirin ( but not for under 16s)

or NSAIDS +/- Paracetamol

  • Reassurance
  • Explanation
  • NOT OPIODS
26
Q

What is Migraine ?

A

15% of prevalence

3F :1M

Disturbance of cerebral flow which lead to

Headache
- ( 4-72 hrs debilitating)
- Nausea/vomiting, sensitivity to light/noise

With aura
- 5- 60 mints visual symptoms - flickering lights, spot lines, loss of vision
- Sensory symptoms include - numbness and parasthesis
- speech symptoms include - FULLY REVERSIBLE

27
Q

What are the triggers of the MIgrane ?

A
  • Stress/ anxiety
  • Environment ( nose, flickering light, perfume, cold
  • Foods eg caffeine
  • Lack of sleep
  • Periods

Severity can be assessed by the migrane, disability assessment score - MIDAS

28
Q

What is the management of Migrane ?

A

Acute Migrane

  • treated with triptan , +/- nsaid ,paracetamol

Prophylaxis Migrane

  • treated with Propranolol/ Toparimate
29
Q

What is Cluster Headache ?

A

1 in 1000 people

6M: 1F

Severe pain comes unilaterally and around one eye

Ptosis, miosis, red watery eye, stuffy nose,

May wake you up at night sometimes or after alcohol

It lasts usually one hour

Cluster attacks over days/ weeks months then periods of remission

30
Q

What is the management of cluster headache ?

A

Refer to neurology with 1st attack to confirm the diagnosis/ scanning

31
Q

What is the treatment of acute cluster headache?

A

100 % O2 , 12 L minimum with non - rebreather mask and reservoir bag

Triptan

32
Q

What is the prophylaxis of cluster headache ?

A
  • Verapamil or prednisolone
  • specialist advice
33
Q

What is Temporal arthritis ?

A

Chronic vascular disease

Age > 50 years

Inflammation in the wall ( medium size and large arteries - branches of carotids )

overlap with polymyalgia rheumatica

34
Q

What type of headache would you experience with temporal arthritis ?

A

Unilateral temporal, can be diffuse or bilateral

35
Q

What would you find on examination for temporal arthritis ?

A

Temporal artery tenderness on palpation

36
Q

What is the Investigation of Temporal arthritis ?

A

ESR >50 USUALLY HIGHER ( 2- 8.7% can be normal)

Biopsy temporal artery - vasculitis,

Lower Back pain (2 decks)

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