LGD1 Other Headaches Flashcards
When should you think secondary headache?
headache reaches full intensity rapidly, abnormal neuro signs, progressive in intensity/duration over time, worse with standing, develops after age 50
What are 3 types of headaches you get while sleeping?
- brain tumor headache
- brain abscess headache
- idiopathic intracranial hypertension
What are type of headache with moving focal symptoms?
- headache with stroke
What type of headache that explodes?
subarachnoid hemorrhage
or: untruptured aneurysm, dissection,
What type of headache wtih autonomic features?
cluster headache
What type of headache that is worse with exertion?
giant cell arteritis
cardiac cephalgia
coital headache
cough headache
What type of headache with position?
orthostatic/low pressure headache
postural orthostatic tachycardia syndrome [POTS]
WHy type of headache that stabs?
trigeminal neuralgia
What is clinical presentation of migraine?
POUND
- pulsating
- one day duration [4-72 hrs]
- unilateral
- nausea [+ aura, vomit, photophobia, phonophobia, neck pain]
- disabling
women more than men
excaerbated by light, noise, activity
What is clinical presentation of tension headache?
pressing, bilateral headache
lats > 30 min, can be constant
no photophobia/phonophobia/aura, rare nausea
What is clinical presentation of cluster headache?
unilateral, repetitive brief headaches
excruciating periorbital pain with lacrimation [tears], rhinorhea, horners
more common in men
lasts ~ 15 min
How do you differentiate cluster headache from trigeminal neuralgia?
trigeminal neuralgia = repetitive shooting pain in distribution CN 5 that lats < 1 min
cluster = > 15 min usually
What is time signature of headache? if min? if hours/days? if wks/mos? if mos/years?
min = vascular hours/days = infectious weeks/mos = inflammatory/neoplasm mos/yrs = primary headache
Patient is a 61-year-old woman with a 6-week history of headache. Pain would wake her up and lessen as the day progressed. Straining at stool increased the pain. At times, when she sat up, she experienced a transient loss of vision.
What should you think?
headache from brain tumor
What is clinical presentation of brain tumor headache?
worse in the morning, change from prior headache pattern
location = diffuse
other symptoms: transient vision loss, increased ICP [pain with straining], N/V
abnormal neuro exam
can be similar to tension headache
What is clinical presentation of headache from brain abscess?
same as with tumor + a fever in half
impaired sensorium, focal complaints, seizure
22 year old female, new frontal headaches which increase with straining and are awakening her out of sleep. Menstruation has become abnormal.
What should you think?
idiopathic intracranial hypertension?
What is clinical presentation idiopathic intracranial hypertension?
diffuse swelling of brain and increased ICP = same type of headache as brain tumor but without clinical consequences of tumor compressing adjacent structures
brain tumor headache + visual complaints, cranial bruits, noises in head, N/V, radiculopathies
confirm by normal imaging studies
Who usually gets idiopathic intracranial hypertension?
women who are obese and of childbearing age usually
What are laboratory tests for idiopathic intracranial hypertension
normal imaging studies
MRI: flattened post globes, protruding optic nerve heads
normal CSF except for increased pressure
82 year old woman who has been awakened at 3am and 5am nightly for 2 months with a bilateral pounding headache. Normal neurological examination.
What should you think?
hypnic headache syndrome
What is hypnic headache syndrome
rare disorder age onset = 40-84 bilateral throbbing headache recurs 1-3 times nightly no associated symptoms
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 to involve the left side of his lip, then rapidly resolving. 5 minutes later he developed a throbbing headache in his right temple lasting 5 minutes.
What should you think?
stroke headache
What is clinical presentation of stroke headache?
most frequent in strokes of posterior circulation
can be abrupt or gradual
severity not related to size of infarction
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, after which she developed a moderately severe throbbing headache involving her entire head and associated with photophobia and phonophobia and lasting a day.
What should you think?
? stroke?
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 and leg, lasting for 15 minutes, followed by left-sided pulsatile headache. His exam is normal
What should you think?
? stroke?
Patient is a 37-year-old woman who had abrupt onset of a severe occipital headache with mild nausea. Had transient diplopia, which resolved before she arrived at the hospital. Headache remained constant without any photophobia but with moderate nausea. Her neurological examination was normal and her headache and nausea responded well to sumatriptan; she was discharged
What should you think?
SAH headache
What is clinical presentation of SAH headache?
- sudden onset severe headache “worst headache of life”
- diffuse location
- associated with mild nausea, seizure, diplopia [seizure and diplopia not seen in thunderclap]
- no photophobia, phonophobia
- if suspect –> do non-contract CT –> if negative do LP; do angiography to find aneurysm
What are some causes of thunderclap headache?
- aneurysm/non-aneurysmal SAH
- un-ruptured aneurysm
- cerebral sinus thrombosis
- dissection
- acute intracranial hypotension
- sexual/exertion headache
Patient is a 23-year-old man. For the past 6 weeks has been awakened at 3 AM by pain in his right cheek and upper molars. No head pain
Pain very severe, lasting 45 minutes. Deep, not triggered by superficial cutaneous stimuli. One attack lasted 6 hours, but most shorter. A clear liquid has been coming out of his right nostril
What should you think?
cluster headache
What is episodic vs chronic cluster headache?
episodic: bouts of headache last 1-4 mos, typically follow circadian pattern
chronic: absence of circadian pattern
Patient is a 45-year-old woman with a 1-month history of pain in her left ear while chewing
A click is noted over the left ear with jaw opening
What should you think?
giant cell artery headache
Patient is a 70-year-old man with pain in his jaw while chewing. Has pain in his scalp, particularly when weather is cold. Shoulders ache, but known to have arthritis of his neck. A CTT scan of his brain is normal.
What should you think?
giant cell arteritis headache
What is clincal presenation of headache due to giant cell arteritis?
- location = bilateral temporal region, jaw, scalp
- generalized thrombing, jaw claudication, polymyalgia rheumatica, fever, malaise, scalp tenderness, painful dysphagia, muscle stiffness of neck/shoulders, occasional visual loss
- onset ~ 70 yo
Patient is a 75-year-old woman with a 6-month history of bilateral jaw pain upon chewing
Otherwise feels well. No history of bruxism and no clicks or pain over TMJs. ESR is normal.
What should you think?
cardia cephalgia = anginal pains referred to head
What are lab findings in giant cell arteritis?
mean ESR 91 [very high]
What is clinical presentation of cardiac cephalgia?
usually associated with chest discomfort
headaches occur with exertion, typically subside with rest
commonly involve: forehead, occiput, jaw
does not respond to triptans/ergots; give nitroglycerin
gradual onset
Patient is a 42-year-old man. Has had severe headaches of abrupt onset with orgasm for the past month . Pain in right temple, throbbing, and associated with nausea and photophobia lasting 2 hours. Afraid to have sex. A few headaches occurred without orgasm; patient very concerned
coital exertional headache
What are clinical symptoms of coital exertional headache?
explosive, throbbing
lasts for hours
confustional state or symptoms of ischemia
38 year old male developed the sudden onset of an acute left sided throbbing headache associated with pains in the left side of his face, worse with neck movement. There was no history of trauma. He had an upper respiratory infection which was resolving. Examination revealed a Horner’s syndrome on the left side.
What should you think?
spontaneous carotid artery dissection
What is presentation of spontaneous carotid artery dissection headache?
young and middle age
risk: trauma, family history of aneurysm, resp infection
neck pain, facial pain, horenrs
30 year old male who developed a generalized headache when erect the day after a golf game. After 2 days, they were no longer positional and he developed a stiff neck with photophobia.
What should you think?
low pressure headache
What are clinical signs of low pressure headache?
due to intracranial hypotension, often following lumbar puncture, thin female
positional in the beginning, begins upon arising, relived by reclining
dull pain, bilaterally, stiff neck, nausea
symptoms resolve a few days after lumbar puncture
in post-LP: CT guided epidural blood patch
How do you treat post-LP headache?
IV Na caffeine benzoate
epidural blood patch
18 year old female with the complaint of headaches with standing for 2 months. Some non-postural headache as well. Pain is generalized and pressure like. She had been experiencing significant fatigue. No autonomic symptoms. Her general neurological examination is normal.
What should you think?
POTS = postural orthostatic tachycardia syndrome
What is clinical presentation of POTS?
in young post pubertal female, orthostatic and non-orthostatic headache
fatigue, decreased concentration, exercise intolerance, syncope
often follows infectious disease
diagnostic = tachycardia with increase of at least 30 BPM after prolonged standing
What is treatment for POTS?
hydration and NaCl
elastic stockings
beta blockers
72 year old male, developed sharp pains in his right cheek and lip. These increased with light touch and he was nearly unable to shave or eat. His neurological examination was entirely normal.
What should you think?
trigeminal neuralgia
What is clinical presentation of trigeminal neuralgia?
clinically characterized by brief paraoxysms of electric-like lancinating pains
usually affects V2 and V3; V1 is rare
stimulation of trigger points induces attacks
exam usually normal
