S9.1 - Headache

Question 1

headaches - give the primary and secondary casues (not all)

Answer 1

primary - not life or sight threat
Tension headache, Cluster Headache, Migrane

secondary 
meningitis, encephalitis
sub arachnoid hemmorage - thunderclap
intracranial hemmorage/burst aneurysm 
hypertension an dpre eclampsia
medication overuse and med releated
SoL (tumour or abscess)
acute glaucoma
Temporal Giant cell atreritis
hangover
any reason for a raised ICP

Question 2

when doing a diff diagnosis how to help between 1 and 2 cause

Answer 2

1 - clincal exam is typically normal

2 - clinical exam abnormal

Question 3

red flags for sight or life threat headache

mnemonic

Answer 3

SNOOP

Systemic signs - menigitis - fever, prego (pre-eclampsia)
Neurological symptoms - SoL,Glaucoma
Onset new or changed - Malignancy, Giant cell arteris
Onest of thunderclap - vascular hemmoraghe
Papillodema, positional provocation, precipitated by exercise - ICP issues

Question 4

outline tension headache

Answer 4

generalised
tight band
mild
stress, no sleep, poor posture
simple analgesics work well
normal examination
short - 30mins

Question 5

outline a migrane

Answer 5

unilateral
moderate-severe
throbbing/pulsaltile
prolonged time -hours to days
simple analgesics okay

Question 6

outline medicaiton over use headache

Answer 6

use meds to help w/ chronic headaches for too long

headache not responding to pain killers

stop the meds - headache will worsen initially
take 2 months-ish

Question 7

outline cluster headache

Answer 7

REALLY REALLY FUCKING HURTS

see unilateral autonomic issues - Ptosis, sweating, pupils

comes in clusters for days every 30 mins - short
periods of remission up to years
some triggers ie alchol or smoke/smells
simple analgesics no good

Question 8

2’ headaches to look out for

sight or life threat

Answer 8

SoL- raised ICP
Trigeminal neuraligia
Temporal giant cell arteritis

Question 9

outline SoL

Answer 9

gradual and progressive
Dull and progressive
worse in mornings, lean forward, cough, exercise
simple analgesics good at start - danger to ignore for patient
nausea and emis

will see papilodema due to raised ICP - REFER ASAP

Question 10

outline trigeminal neuralgia

Answer 10

95 % Compression of CNV due to a looping blood vessel

unilateral
sharp, electric stabbing pain w/w.o headache
severe sudden

Question 11

outline tempral (GC) arteritis

Answer 11

vasculitis of small and medium arteries of head

older age (over 50)
+
abrupt headache and visual disturbance with jaw claudication

refer asap

can see a large popping superficial temporal artery

risk permanent loss of vision due to CN1 ischaemia