Headaches Flashcards
What are age red flags for HA?
<5 yo or >50 yo with new or worsening HA
What are onset red flags for HA?
- Sudden onset or thunderclap (cerebral aneurysm rupture)
- Sudden onset with exertion (SAH or arterial dissection)
If a HA presents with a sudden onset during valsalva, what are you concerned about?
Intracranial abnormality such as space occupying lesion
A patient has a fever and a HA. What should you ask about?
- Onset in relation to HA onset
- Severity
- Suspicion for CNS infection
Why would you ask about ill contacts when assessing a patient with a HA?
- Infectious etiology
- CO poisoning
- Toxin exposure
Toxin/CO would likely see a group of people with same symptoms
A patient uses analgesics frequently and is presenting with a HA. What should be in your differential?
Rebound HA, >10 times analgesic use/month
What medications would clue you into etiologies of a HA?
- Analgesia overuse
- Anticoagulants, antiplatelet agents –> possible hemorrhage?
- Chronic steroids, immunomodulators –> risk of infection
- Antibiotics –> recent use may decrease symptoms due to partial treatment
What social history can impact HA?
- Substance use with cocaine, amphetamine, methamphetamine –> increased risk of hemorrhage, reversible cerebral vasoconstriction syndrome
- Alcohol use –> increase risk of hemorrhage due to falls, violence, coag disorders with chronic use
What family history could help in diagnosing HA?
- FMHx of aneurysm or sudden death in 1st degree relative
- FMHx of migraine
What is a persistent HA despite an adequately controlled fever a red flag for?
A CNS infection
What makes a high likelihood of meningitis?
- HA
- Fever
- Neck stiffness
- AMS
If there is elevated BP, AMS, and neurologic dysfunction, what should you consider?
- Hypertensive emergency
- Preeclampsia/eclampsia
If there is tenderness over the temporal artery, what condition should you be suspicious of?
Temporal arteritis
You see papilledema on fundoscopic exam with a HA. What condition should you be thinking of?
Acute angle closure glaucoma and increased ICP
A patient has a history of OM and has a HA. What complication can arise?
Brain abscess
A patient has a history of sinusitis and now has a HA. What complication is possible?
Sinusitis invasion of IC space
If a patient has meningismus, what is that indicative of?
- Infection or hemorrhage
What neurologic exams should be done on a patient with a headache?
- Mental status
- CN exam
- Motor- extremity weakness, pronator drift
- DTR- assess asymmetry or babinski
- Gait
- Coordination testing
What symptoms are clinical red flags for HA?
- AMS
- Seizure
- Fever
- Neuro symptoms
- Visual changes
What associated conditions are red flags?
- Pregnancy or postpregnancy status
- SLE
- Behcet’s disease
- Vasculitis
- Sarcoidosis
- Cancer
What labs can be ordered if a patient is at high risk of a serious etiology of HA?
- CBC, blood cultures- suspected infection
- CMP
- Coag panel- suspected bleed or need for LP
- ESR/CRP- suspected temporal arteritis
- hCG- females of reproductive age
What are indications for imaging and what image would be most often used?
- Abnormal neurologic examination to include altered mental status, cognitive impairment, or focal deficit
- New, severe headache of sudden onset
- HIV-positive patients with presentation of new headache
- Concern for increased ICP in patient requiring LP
Non-contrast CT
What would cause you to be concerned for increased ICP in a patient requiring a LP?
- Immunocompromised
- Hx of CNS disease (mass lesion, stroke, focal infection)
- New onset seizures (within 1 week of presentation)
- Papilledema
- Altered LOC
- Focal neurologic deficits
When would a lumbar puncture be indicated?
- Differential including meningitis
- Encephalitis
- Intracranial hypotension
- Pseudotumor cerebri
- Subarachnoid hemorrhage