Neuro: Lecture 21- Headaches

Question 1

What are some common causes of headaches?

2

Answer 1

Subarachnoid haemorrhage
Meningitis
Opthalmic disorders
Sinusitis
Dental
Cervical

Question 2

Whats the different between a primary and secondary headache?
3

Answer 2

Primary vs. Secondary

Primary:
No organic cause / underlying pathology – “ idiopathic”
They are usually recurrent and non-progressive
Neurologic exam is unremarkable
Key to correct diagnosis is in a complete and thorough history, looking for the absence of red flags!

Secondary:
Underlying pathology
Often sudden onset, constant, progressive
Red Flags!

Question 3

What are the red flags for headaches?
SNOOP
4

Answer 3

SYSTEMIC SYMPTOMS or SECONDARY RISK FACTORS 
NEUROLOGIC SYMPTOMS 
OLDER
ONSET
PREVIOUS HEADACHE HISTORY

Question 4

What are the common presentations for a primary headache?

6 and 7

Answer 4

Primary Headache:

1. Migraine
2. Tension-type headache
3. Cluster headache

Cervicogenic headache – primary or secondary??

Question 5

Whats the different between a classic migraine and a common migraine?
8,9

Answer 5

Migraine:
-with aura (classic migraine)
-OR without aura (common migraine)
Classic Migraine (aura):
Characteristics as for common migraine PLUS
Prodromal phase is sometimes reported up to several hours before h/a : unusual symptoms such as mood changes, food cravings, excessive thirst
Aura:
(typical) one or more of the following*, fully reversible:
visual symptoms (eg, flickering lights, spots or lines) and/or loss of vision
sensory symptoms (eg. pins and needles) and/or numbness
speech disturbance
Symptoms last 5-60 mins; h/a occurs during aura or within 60 mins
Postdromal phase of fatigue

Common Migraine (no aura):

• Headaches typically last 4-72 hours
• General Characteristic features:
  
  • unilateral, pulsating, moderate – severe in intensity
• May be exacerbated by mild physical activity (walking)
• Commonly associated nausea / vomiting, photo- or phonophobia

Question 6

What is a tension type headache (TTH)

9

Answer 6

-most common form of H/A
-Pathophysiology of TTH generally poorly understood
-Range from infrequent (eg. once a month to chronic - >15 days month)
-Headaches can last 30 min – 7 days!
-General characteristic features:
-bilateral location, -pressing/tightening (non-pulsating) “band” quality, mild or moderate intensity
-not aggravated by routine physical activity such as
walking or climbing stairs
-No associated nausea* or vomiting, though may have photophobia or phonophobia

Question 7

What is a cervicogenic headache
Symptoms etc
11

Answer 7

• Cervico-genic!
• Diagnosis usually through demonstration of clinical signs that implicate a source of pain from the cervical spine:
  
  • Eg. disc lesion, myofascial referral
  • Trapezius and SCM are most common myofascial
• Symptoms exacerbated by neck movement and/or sustained, awkward head positioning
• Restricted ROM of the C/S
• H/A is moderate, non-throbbing, usually posterior head, most often unilateral that begins in the neck
• Mild dizziness, nausea or “aura” type symptoms are uncommon but may be present

Question 8

Making the diagnosis:
The patient history
Site
Onset

Answer 8

Location (Site) of the headache(s):

• Unilateral – migraine if ant; cervicogenic usually post
• Ocular or retroorbital – opthalmic cause or migraine
• Paranasal – sinusitis (often accompanied by local tenderness)
• “Band-like” – tension type (TTH)
• Occipital – TTH or meningeal, vascular or cervicogenic
• Onset: acute, subacute or chronic – any MOI? (mechanism of injury)
• Character of the pain:
  
  • Pulsating or throbbing most common – often migraine or TTH
  • SOL’s can cause headaches of virtually any description
    
    • Their typical pattern is constant and progressively worsening

Question 9

The vital role of Physical examination? What info should you find out

Answer 9

1. Cranial nerves
2. motosensory
3. cerebellar examination
4. VITALS- special tests

Question 10

In summary check out the table on slide 15 know it

Answer 10

y