headaches Flashcards
What are the signs that make you think a headache is secondary and not primary?
- Reaches full intensity rapidly
- Is associated with neurological symptoms
- Progressive in duration and intensity
- Is increased by Valsalva maneuver
- Is worse upon standing
- initially develops after the age of 50
What cause of headache typically presents with an onset of minutes? Of hours to days? Of weeks to months? of months to years?
What are the causes of headaches that wake you up from sleep?
- Brain abscess headache
- Brain tumor headache
- Idiopathic intracranial hypertension
What are the similarities betwee a brain tumor headache and a brain abscess headache? Differences?
Similarities
- Wakes you up from sleep
- Increases upon Valsalva maneuver and exertion
- Nausea and vomiting
- focal neurological complaints
- Change in prior headache pattern
- Other clinical manifestations (patients with brain tumors have more symptoms that just a headache)
Differences
- brain abscess can be accompanied by fever (but in only 1/2 of cases) and seizures
What are the risk factors for Idiopathic Intracranial Hypertension?
Female gender
Child-bearing age
menstrual irregularities
Obesity/significant weight gain
What are the physical exam findings in a patient with idiopathic intracranial hypertension?
- pulsatile tinnitus and noises in head
- diplopia from a CN VI palsy
- transient visual obscurations
- papilledema
- photopsia (perceived flashes of light)
- nausea and vomiting (because of increased ICP)
- radiculopathies
- elevated opening pressure in lumbar puncture
- normal imaging studies (that’s why it is idiopathic!)
What medications and treatments are available for idiopathic intracranial hypertension?
carbonic anhydrase inhibitors (acetazolamide or topiramate)
weight loss
What are the types of headaches are associated with moving focal symptoms?
stroke (62 year old male, with the abrupt onset of numbness in his face, spreading down his left arm over 10 minutes, then receding over the next 10 minutes and rapidly resolving)
migraine (32 year old woman, with tingling in her left thumb, then her entire left hand, then extending to her mouth over 5 minutes. As the tingling resolved, it was replaced by numbness of the hand, extending from her face extending down the left arm. All of this resolved in 25 minutes)
sensory seizures (A 60 y.o. male with no prior history of migraine began experiencing episodes of spreading right body numbness beginning in the right leg then extending to the arm, lasting for 15 minutes. Normal exam)
Notice that strokes and seizures present very similarly! That is why you always have to keep seizure on the differential if you are thinking stroke
What is the cause of the “worst headache of my life”? A “thunderclap” headache?
Both subarachnoid hemorrhage (ruptured Berry aneurysms) but the differential for a thunderclap headache is very long - need to rule out a lot of other things
What are the symptoms of a carotid dissection?
- ipsilateral headache
- pain on ipsilateral face and neck
- ipsilateral Horner’s syndrome
What are the symptoms of a cluster headache?
- intense, super painful, boring, unilateral pain
- ipsilateral eye is watery
- miosis and ptosis of ipsilateral eye
- Can be episodic or chronic
- Episodic cluster headaches follow a circadian rhythm but chronic does not
- Patients rock or move when headache hits (in contrast to migraines where patients lie down and keep as still as possible)
What are the symptoms of giant cell (temporal) arteritis?
- throbbing
- in temporal area but can be occipital
- fever, malaise
- scalp tenderness
- jaw or tongue claudication
- myalgias and muscle stiffness of the neck
- Associated with polymyalgia rheumatica
- elevated inflammatory markers
- treat with steroids
- can present with infarction of just about any organ
What is cardiac cephalgia?
pain from angina that is referred to the face and head
What are orthostatic/low pressure headaches most commonly cause by?
lumbar puncture or anything that causes hypoCSF/cranial hypotension
What molecule would indicate that there is a CSF leak in the patient’s nasal discharge?
beta-2 transferrin
