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Clinical Reasoning > Headaches > Flashcards

Headaches Flashcards

1
Q

What condition would you be concerned about in a pt who presents with visual loss?

A

Giant cell arteritis, acute angle closure glaucoma

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2
Q

What condition would you be concerned about in a pt with prolonged visual aura?

A

Arteriovenous malformation (AVM)

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3
Q

What condition would you be concerned about in someone with disequilibrium?

A

CVA, brain tumor

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4
Q

Confusion or lethargy?

A

Meningitis, encephalitis, brain tumor, brain abscess

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5
Q

New-onset seizure?

A

infection, brain tumor

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6
Q

Fever?

A

Meningitis, encephalitis, brain abscess

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7
Q

Speech changes?

A

Expressive or receptive aphasia (brain tumor)

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8
Q

History of malignancy?

A

Brain tumor, metastasis

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9
Q

History of HIV?

A

CNS lymphoma, toxoplasmosis, cryptococcal meningitis

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10
Q

History of neurosurgery or CNS shunt?

A

Hydrocephalus, meningitis

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11
Q

Eye pain?

A

Acute angle closure glaucoma

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12
Q

Thunderclap headache?

A

Subarachnoid hemorrhage

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13
Q

New onset after age 50?

A

brain tumor, CVA, giant cell arteritis

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14
Q

Progressive headache over weeks to months?

A

Brain tumor

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15
Q

Diplopia?

A

Brain tumor, CVA, AVM

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16
Q

Hemiparesis?

A

CVA, brain tumor, brain abscess

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17
Q

Aphasia?

A

CVA, brain tumor, brain abscess

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18
Q

Headache worse at work?

A

Carbon monoxide poisoning

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19
Q

Nausea?

A

Brain tumor, hydrocephalus, carbon monoxide poisoning

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20
Q

Neck stiffness?

A

Meningitis

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21
Q

Onset of headache with exertion, cough, or sexual activity?

A

Subarachnoid hemorrhage (SAH)

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22
Q

Unilateral in 60 to 70 percent, bifrontal or global in 30 percent

A

Migraine

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23
Q

Bilateral location

A

Tension

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24
Q

Always unilateral

A

Cluster headache (usually begins around eye or temple)

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25
Q

Gradual or abrupt onset, crescendo pattern, pulsating, aggravated by physical activity

A

migraine

26
Q

pressure or tightness that waxes and wanes

A

tension

27
Q

pain begins quickly. Deep, continuous, excruciating pain. Described as “hot poker” through the eye

A

Cluster

28
Q

Patient may remain active or need to rest

A

Tension

29
Q

Patient remains active, pacing around

A

Cluster

30
Q

Duration is 4-72 hours

A

Migraine

31
Q

Duration is 30 minutes to 3 hours

A

Cluster

32
Q

Associated symptoms: N/V, photo/phonophobia, may have aura

A

migraine

33
Q

Associated symptoms: Ipsilateral lacrimation and redness of the eye, stuffy/runny nose, sweating, pallor, Horner’s symptoms, sensitivity to alcohol.

A

Cluster headache

34
Q

Focal neurologic symptoms are rare

A

Cluster headache

35
Q

Women > men

A

migraines

36
Q

Women = men

A

Tension

37
Q

Men > women

A

Cluster

38
Q

More common in smokers

A

Cluster

39
Q

POUND: P

A

pulsatile quality

40
Q

POUND: O

A

4-72 hOurs

41
Q

POUND: U

A

Unilateral location

42
Q

POUND: N

A

Nausea or vomiting

43
Q

POUND: D

A

Disabling intensity

44
Q

What should you consider if your patient is pregnant?

A

Benign intracranial hypertension (Pseudotumor cerebri), venous sinus thrombosis, and new-onset migraine

45
Q

Chronic nasal stuffiness or chronic URI with headache suggests what?

A

Sinusitis (but can also be s/s of migraine)

46
Q

Impaired vision or seeing “holes” around light suggests what?

A

Glaucoma (present within one hour with unilateral pain suspect sub acute angle closure glaucoma)

47
Q

Visual field defects suggests what?

A

Presence of lesions in the optic chiasm

48
Q

Bitemporal hemianopsia suggests what?

A

pituitary mass

49
Q

Blurring of vision on forward bending of the head, and headaches with early morning awakening that improve with sitting up and double vision suggests what?

A

Increased intracranial pressure

50
Q

Headaches that are relieved by recumbency and exacerbated with upright position suggests what?

A

Low CSF pressure or CSF leak. Recent lumbar puncture?

51
Q

Sudden, severe, unilateral vision loss suggests what?

A

Presence of optic neurosis

52
Q

Headache, fatigue, generalized aches and pains, and night sweats, blurred vision, jaw claudication in patients older than 55 suggests what?

A

Temporal arteritis! Check SED rate/ESR STAT!!!

53
Q

Intermittant headaches with high blood pressure and symptoms of palpitations are suggestive of what?

A

Pheochromocytoma (Adrenal tumor)

54
Q

Important things to check on PE:

A

Vitals, auscultate for bruits in neck and temporal arteries, assess spine and neck muscles, FULL neurologic exam (especially pt’s ability to get up from a seated position w/o support, walking on tiptoes and heels, cranial nerve exam, fundoscopy and otoscopy, tandem gait, romberg test, assess symmetry on motor, sensory, reflexes, cerebellar tests), and Mental status exam

55
Q

Neck stiffness and resistance to passive neck flexion (meningismus) suggests what?

A

Meningitis

56
Q

Papilledema suggests what?

A

Presence of mass in the brain, intracranial HTN, encephalitis, or meningitis

57
Q

Focal neurologic signs suggests what?

A

Intracranial mass, AV malformation, or collagen vascular disease

58
Q

If a bleed is suspected, what imaging study is done?

A

CT

59
Q

In emergency situations, what imaging study is done?

A

CT (Fast!)

60
Q

What imaging study is done if a mass is suspected?

A

MRI

61
Q

What imagine study is done if suspect a stroke?

A

MRI

62
Q

When is a lumbar puncture indicated?

A
  1. Clinical suspicion of subarachnoid headache with normal CT
  2. Suspicion for infection or inflammatory etiology

Clinical Reasoning (3 decks)

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