Headaches Flashcards
What do these red flag headache signs indicate?
First and worst headache, thunderclap.
Subarachnoid haemorrhage
What do these red flag headache signs indicate?
Unilateral and eye pain.
Cluster headache or glaucoma
What do these red flag headache signs indicate?
Cough initiated headache, worse in the morning/bending forwards.
Raised ICP
What does this red flag headache sign indicate?
Scalp tenderness
Giant cell arteritis
What do these red flag headache signs indicate?
Fever, neck stiffness.
Meningitis
What are the types of primary headache (90%)?
Tension, migraine, cluster.
What are the causes of secondary headaches (10%)?
SAH, meningitis, glaucoma, raised ICP, sinusitis, GCA, extra-dural haematoma.
What should you focus on in an examination involving a headache?
- Systemically unwell? Tachycardia? BP? Fever? Rashes?
- Reduced GCS?
- Temporal artery pulsation/tenderness?
- Focal neurology?
- Fundoscopy - papilloedema?
What is this a presentation of?
Bilateral, dull, tight/pressing, gradual onset headache. Patient can continue with normal activities but it is made worse by stress.
Tension headache
What is this a presentation of?
Recurrent severe headaches lasting several hours to a few days, waxing and waning in nature, photophobia, phonophobia, nausea, vomiting, some focal neurology. Intense, throbbing, unilateral.
Migraine
What are some common triggers of migraines?
Chocolate, hangover, orgasm, cheese, OCP, lie-in, alcohol, travel, exercise, stress.
At what age do patients normally present with their first migraine?
<40 years old
What is this a presentation of?
Severe, unilateral, retro-orbital headache. Restlessness, agitation, ipsilateral lacrimation, nasal stuffiness, rhinorrhoea. 15-980 minute attacks, occur frequently and repeatedly.
Cluster headache
What is the ratio of men:women affected by cluster headaches?
5:1 (more common in men)
What is the treatment for a cluster headache?
High flow oxygen via non-rebreather mask for 15 minutes plus sumatriptan SC at onset.
What drug is used for the prevention of cluster headaches?
Verapamil
What is this a presentation of?
Sudden onset headache, reaches maximal intensity within a few seconds, occipital, very severe. Distress and photophobia common. Neck stiffness within hours. Vomiting.
Subarachnoid haemorrhage
What is the potential presentation of a large subarachnoid haemorrhage?
Drop in GCS, seizure, or focal neurological signs.
What is this a presentation of?
Headache, fever, meningism. Onset over hours.
Meningitis
What is this a presentation of? Localised headache (temporal/occipital), scalp tenderness, jaw claudication, visual loss, malaise, night sweats, fever, weight loss, amaurosis fugax. Eye is not painful.
Giant cell arteritis
What is the treatment for giant cell arteritis?
ESR almost always raised, start prednisolone first then urgent referral for temporal artery biopsy.
What is this a presentation of?
Overweight young woman, COCP. Headache, worse in the morning and on lying flat/coughing/straining, gradual and dull. Nausea, vomiting, papilloedema.
Raised ICP
What is this a presentation of?
Long-sighted, middle-aged/elderly patient. Peri-orbital pain, nausea, vomiting, reduced vision, halos around lights.
Acute angle closure glaucoma
What is this a presentation of?
Patient just started paracetamol/opiate/triptans, episodic headache becoming chronic daily headache.
Medication overuse headache
