Headache In The Elderly Article

Question 1

Acronym/pneumonic for red flag features.

Answer 1

SNOOP4
S - systemic symptoms
N - neurological symptoms
O - sudden onset
O - onset >50yrs.
P4 - progressive
Precipitated by valsalva
Postural aggravation
Papilloedema

Question 2

79 female
Sharp shooting bilateral headache
Intermittent episodes lasting less than few mins
Radiating to jaw, cheeks and neck
No reg meds.
No allergies
Unremarkable neurological exam.

Differential diagnosis?

Answer 2

GCA
Cerebral ischemia
Infection
ICH
Neoplasia
Cardiac cephalagia
Glaucoma
tension
Migraine
Trigem

Question 3

Further ix ? (4)

Answer 3

Plt
CRP
ESR
New headache - consider CT

Question 4

79 female
Sharp shooting bilateral headache
Intermittent episodes.
Radiating to jaw, cheeks and neck
No reg meds.
No allergies
Unremarkable neurological exam.

ESR 33. CRP 37. WCC 11

9 days alter presented with scalp sensitivity and jaw claudication ESR 66, CRP 125

Immediate management? (4)

Answer 4

Refer to rheum semi urgent
Prednisolone high dose 1mg/kg to 60mg max OD 2-4 weeks
USS temporal artery
Follow-up 5-7 days.

Question 5

Management of sight threatening? (2)

Answer 5

Urgent referral to ED/inpatient management
Methylpred 500-1000mcg/day for 3 days.

Question 6

Steroid regimen counselling (4)

Answer 6

Usually 2-3 years.
Avg 5000-6000mg/pt.
90% will have side effect.
Monoclonal antibiody can spare steroid.
Monitoring includes - FBC,HbA1c, lipids, BMD, BP, BMI
Annual eye exam - glaucoma
6-12 monthly falls risk and CVD risk Ax.
BMD 4 months, then 2-3 years. Annually if decreased.