Headaches Flashcards
Define subarachnoid hemorrhage.
Subarachnoid hemorrhage is bleeding into the cerebrospinal fluid, usually due to leakage of an aneurysm or vascular malformation.
Define migraine.
Migraine is a syndrome characterized by intermittent pounding or throbbing headache, potentially preceded by an aura.
- It has frequent association with nausea, photophobia, phonophobia and exertional worsening.
What is a tension headache?
Tension-type headache is a recurrent headache with a bilateral, squeezing and pressing sensation that usually does not prevent normal activity and does not significantly worsen with exertion.
What is a cluster headache?
Cluster headache is a recurrent, severe headache, which is unilateral and periorbital and often associated with autonomic symptoms of tearing and nasal congestion.
What is temporal arteritis?
Temporal arteritis is a condition of inflammation of major cranial blood vessels. It can result in blindness or stroke depending on the vessels involved.
Define paresthesia.
Paresthesia is an abnormal sensation that is not due to an external stimulus.
What are bad signs/symptoms in the headache patient (and what might it signify)?
- Sudden onset and worst headache of life - subarachnoid hemorrhage
- Sudden onset headache with focal neurologic deficit - intracerebral hemorrhage
- New or different headache in older patient - giant cell (temporal) arteritis
- Headache that awakens from sound sleep - increased intracranial pressure
- Escalating headache that is always in the same location - focal lesion such as tumor, abscess or hemorrhage
- Headache associated with a focal neurological deficit - focal lesion
- Headache with recent head trauma, systemic disease, fever, malignant hypertension
- Positional or exertional headache - obstruction of CSF flow
What does subarachnoid hemorrhage indicate and how can you rule it out?
- It is usually due to aneurysm or arteriovenous malformation.
- LP may be the only way to rule this out and angiogram is the definitive test for identification of the specific cause.
How can you rule out intracerebral hemorrhage?
Imaging (particularly CT scan) can identify.
How can you test for giant cell (temporal) arteritis?
- ESR is almost always high.
- Biopsy is the only way to diagnose it definitively.
How can you examine for intracranial pressure?
- Looking for venous pulsations or papilledema in the eye grounds.
- Otherwise, the only way to determine pressure is by lumbar puncture
What are possible causes of increased intracranial pressure?
- Mass lesions (tumor, abscess)
- Disruptions of resorption of CSF (meningitis, subarachnoid hemorrhage)
- Sagittal sinus thrombosis
- Pseudotumor cerebri
What are the symptoms of common migraine?
- Migraine headache is usually moderate to severe intensity (several hours- days)
- Usually pounding
- Unilateral
- Nausea, vomiting, light and sound sensitivity.
- It is worse with exertion
- The headache may be provoked by food, drink, stress, erratic schedules, lights/glare, smells, part of menstrual cycle, etc.
How do you recognize classic migraine?
- Classic migraine has an aura before headache begins
- This aura is usually visual or paresthesia, although it may result in actual loss of function on some occasions (numbness, weakness, aphasia, etc).
- The aura often includes positive phenomena (lights, bright spots, lines, tingling/prickling)
How do you recognize tension-type headache?
These headaches are usually pressing or squeezing pain of mild to moderate intensity, with few associated symptoms and no warning.
- The headaches are not worsened by exertion.
