Non-traumatic acute headaches Flashcards
what are some potential life-threatening conditions that can cause an acute non-traumatic headache?
Vascular events - ICH, malignant HTN, arterial dissection or aneurysm.
Infections - meningitis, encephalitis, brain abscess.
Intracranial masses/high ICP.
Carbon monoxide poisoning.
how are you concerned for if a pt has a sudden acute onset of a non-traumatic headache that reaches maximal and severe intensity within seconds/minutes?
this is a “thunderclap” headache. Subarachnoid hemorrhage.
what might you be concerned for if a pt’s acute non-traumatic headache begins after valsalva/cough, position change, exertion, or sexual activity?
concerned for increased intracranial pressure
what are 2 examples of pertinent PMHx that would increase your concern in a pt reporting an acute non-traumatic headache?
HTN (especially uncontrolled)
HIV+
in a pt reporting an acute non-traumatic headache, what are some symptoms they could report that would shift your differential towards a migraine? and which of those might also be associated with a mass or bleed?
Scintillating scotoma, photophobia, N/V - shift differential toward migraine.
Photophobia and N/V can occur with mass or bleed.
Elevated blood pressure and papilledema are sx that could be associated with what kind of finding?
increased intracranial pressure
what are the RED FLAGS to be on the lookout for when a pt presents with an acute non-traumatic headache?
Systemic sx/condition.
Neuro sx or abnormal signs.
Onset is new or sudden.
Other associated conditions or features.
Previous HA hx with HA progression or change in attack frequency, severity, or clinical feature.
what are some systemic RED FLAG sx when a pt presents with an acute non-traumatic HA?
fever, weight loss, CA, pregnancy, immunocompromised state (HIV)
what are some neurologic sx that are RED FLAGS when a pt presents with an acute non-traumatic HA?
confusion, impaired alertness or consciousness, papilledema, focal neuro sx, meningismus, or sz.
describe what type of onset is a RED FLAG in an acute non-traumatic HA
new onset (esp if over 50y/o) or sudden (thunderclap)
if a pt presents with an acute HA, what are some other associated conditions/features that would raise a RED FLAG?
Head trauma, illicit drug use, toxic exposure.
HA awakens from sleep, is worse w/ valsalva maneuvers, or is precipitated by cough, exertion, or sexual activity.
in a pt presenting with an acute HA, what with their prior medical history would raise a RED FLAG for you?
previous HA hx with HX progression or change in attack frequency, severity, or clinical feature
what are some signs of an acute HA that would require EMERGENT imaging?
abnormal neuro exam, abnormal mental status, “thunderclap” HA
what are some signs of an acute HA that would require URGENT (within 48hrs) imaging?
HIV+
>50 y/o (even if they have a normal neuro exam)
