Lecture 10 + 12- Headaches

Question 1

Types of headaches- dangerous

Answer 1

’ I never get headaches’- 10% risk

Thunderclap, fever, focal symptoms, persisting, progressing, provoked

Question 2

Thunderclap- assessment

Answer 2

Find out how long it took from onset to peak of headache- acute, severe, maximal at onset, 750/yr NI, 10% risk
>100 causes

Question 3

Fever- assessment

Answer 3

Systemic illness headache, paranasal sinusitis, meningitis (viral), meningitis (bacterial), encephalitis
Test for neck stiffness, patient lying flat
Aura? spreads, evolves, resolves

Question 4

Focal- assessment

Answer 4

Migraine aura: evolves and resolves- if persists usually needs investigated

Question 5

Persisting, new onset- considerations

Answer 5

CO poisoning e.g work(boiler/garage)- DEATH
Temporal arteritis- tender/systemic- BLINDNESS
IC HT- BMI, pulsatile tinnitus- BLINDNESS
Cervicogenic/hemicrania-unilateral? pain clinic
Paranasal sinusitis- URTI/dental pain- blindness?
Migraine, chronic onset- sensory sensitivity/allodynia

Question 6

Provoked- new onset

Answer 6

CSF Leak- orthostatic, epidural patch
Coital/exertional- onset/recurrence: SAH in first episode
Cluster headache- autonomic activation, often nocturnal- o2, verapamil, imigran
TGN- lancinating, triggered- tegretol (MS)
Hypnic headache- only wakens from sleep- caffeine, lithium

Question 7

Types of headaches- safe

Answer 7

Episodic- i keep getting headaches > migraine
Chronic- I’m always getting headaches > chronic migraine
Diagnosis- headache type + normal neuro exam = headache diagnosis

Question 8

Migraine- features

Answer 8

Sickening headaches that make you want to lie down?- in front of you it’s migraine (TMJ, Neck, myopia, family history all risk factors)
Sensory sensitivity- light noise smell movement touch nausea
Prodrome- depression/ anxiety, hunger thirst cravings, elation/energy, apathy/ somnolence, diarrhoea/polyuria
Vertigo, wordfinding, brainfog, tingling/heaviness- visual loss/flash/ ‘snow’

Question 9

Migraine-aura

Answer 9

20% get aura symptoms- cortical spreading depression
visual/ sensorimotor aura
Dysphasic, vertiginous
Basilar migraine- tLOC: average 20 minute duration

Question 10

Tension type headache

Answer 10

Bland, featureless- band/pressure/ tight in head
Hours/days/ weeks? location?
Nil provoking/exacerbating
Neck exam x5 risk, jaw x7 and eyes x2- most don’t consult ab tension headaches

Question 11

Icepick headache

Answer 11

neuralgic, brief, seconds and disappears- may linger (TTH), increase (migraine)- NSAIDS, NECK

Question 12

What may be further examined for in a headache neuro exam?

Answer 12

Meningism
Horner’s syndrome- loss of sympathetic innervation to eye- partial denervation of upper/lower eye lids- partial upper eyelid ptosis
Loss of sympathetic innervation of ciliary muscle- PS overactivity constricts pupil
Ipsilateral internal carotid artery dissection