Secondary Headache Flashcards
secondary headache
-caused by exogenous disorders
-can be mild secondary or life threatening
-SAH
-meningitis
-temporal arteritis
-posttraumatic headache
-glaucoma
-COVID-19 headache
-medication overuse headache (analgesic rebound)h
-increased intracranial mass lesion/pressure
-activity triggered headaches
-facial pain and headache
headache
-primary headache- trigeminal nerve that innervates: large intracranial vessels, dura mater (pia has no pain), pain processing pathways -> parasympathetic activation
-migraine and other primary headache types are not vascular headaches
-acute vs. recurrent, new, psychiatric hx
-neurological exam
-investigation- blood tests, dx imaging, lumbar puncture
-causes of headache is on a cellular level not really vasodilation
primary vs secondary headache
-primary diagnosed through history
-secondary diagnosed through investigation using blood test, imaging, LP
symptoms suggesting underling disorder for headaches
-sudden onset
-first severe headache or different type
-worst headache ever
-vomiting that precedes (can be tumor)
-subacute worsening over days or weeks
-pain induced by bending, lifting, coughing
-disturbs sleep or presents immediately upon awakening
-known systemic illness
-onset after age 55
-fever, systemic signs
-abnormal neurologic exam
-pain associated with local tenderness, e.g. temporal artery
SNNOOP10
- red flags for secondary causes of headache
-Systemic symptoms including fever- attributed to infection, nonvascular intracranial disorders, carcinoid, or pheochromocytoma
-Neoplasm Hx- neoplasms of the brain, metastasis
-Neurologic deficit- attributed to vascular, nonvascular intracranial disorders, brain abscess and other infections
-Onset is sudden- subarachnoid hemorrhage and other headache attributed to cranial or cervical vascular disorders
-Older age- giant cell arteritis (older women) and other headache attributed to cranial or cervical vascular disorders; neoplasms and other nonvascular intracranial disorders
-Pattern change- neoplasms, headache attributed to vascular, nonvascular intracranial disorders
-Positional headache- intracranial hypertension or hypotension
-Precipitated by sneezing, coughing, or exercise- posterior fossa malformations, chiari malformation
-Papilledema- neoplasms and other nonvascular intracranial disorders intracranial hypertension
-Progressive headache and atypical presentations- neoplasms and other nonvascular intracranial disorders
-Pregnancy or puerperium- headaches attributed to cranial or cervical vascular disorders, postdural puncture headache, hypertension related disorders (preeclampsia), cerebral sinus thrombosis, hypothyroidism, anemia, diabetes mellitus
-Painful eye with autonomic features- pathology in posterior fossa, pituitary region, cavernous sinus, tolosa hunt syndrome (severe, unilateral headaches with orbital pain and ophthalmoplegia due to extraocular palsies; other ophthalmic causes
-Posttraumatic onset of headache- acute and chronic posttraumatic headache; subdural hematoma and other headache attributed to vascular disorders
-Immune system pathology- opportunistic infections
-Painkiller overuse or new drug at onset of headache- medication overuse headache, drug incompatibility
SNNOOP10 condensed
-Systemic symptoms including fever
-Neoplasm hx
-Neurologic deficit
-Onset is sudden abrupt
-Older age
-Pattern change or recent onset of new headache
-Positional headache
-Precipitated by sneezing, coughing, or exercise
-Papilledema
-Progressive headache and atypical presentations
-Pregnancy or puerperium
-Painful eye with autonomic features
-Post traumatic onset of headache
-Pathology of the immune system such as HIV
-Painkiller (analgesic) overuse
subarachnoid hemorrhage
-sudden onset
-thunderclap headache
-sometimes followed by impaired consciousness
-often associated with meningismus- neck pain
-etiology- trauma, spontaneous (nontraumatic) SAH -> sentinel bleed (leak) - berry aneurysm or ateriovenous malformation
-dx confirmed by CT scan and/or LP
-cerebral arteriography usually needed to identify source of hemorrhage
-approx 50% have sentinel bleed
-50% with sentinel bleed will bleed again within 2-6 weeks
-re-bleed- 50% mortality, 50% of survivors have significant neurologic deficits
-head CT negative in 1-10% of cases- sensitivity decreases with time from onset of sx
-CT may not show bleed within the first 24 hours
-if head CT negative- repeat CT in 2 weeks or LP
-arteriography if + CT Or LP
prior to a lumbar puncture
-imaging required prior to LP if papillaedema
-check abnormal neurologic exam, mental status
-check abnormal funduscopic exam (papilledema, loss of venous pulsations)
-check meningeal sings
-do not do lumbar puncture- if infection, mass, or deformity in the area of puncture
emergent acute headache
-conduct imaging prior to leaving office/ED
-if abnormal neurologic exam/mental status
-thunderclap headache
urgent acute headache
-scheduled imaging prior to leaving office/ed
-HIV positive pt
-age > 50 years (normal neurologic exam)
subarachnoid hemorrhage: complications/concerns
-most immediate complications - cardiac arrhythmias and pulmonary edema
-concerns- re-bleed and development of hydrocephalus
subarachnoid hemorrhage: mortality and morbidity
-high morbidity and mortality
-10% of patients will die before they reach hospital
-40% will due in the hospital within one month of the hemorrhage
-a ruptured aneurysm needs to be secured (clipping/coiling) urgently to prevent re-bleeding
giant cell arteritis
-temporal arteritis
-rare before age 50
-temporal artery tenderness, swelling, redness, nodularity
-visual disturbance- visual loss in 7-60% if untreated - urgent
-jaw claudication (muscle pain)
-systemic symptoms- fever, wt loss, anorexia, malaise
-can be confused with meningitis- check for infection, age, ESR
-polymyalgia rheumatica (prox. muscle pain/tend/stiffness
-ESR (erythrocyte sedimentation rate) usually > 50(mm/hr)- nonspecific blood test -> shows inflammation does not dx specific things
-temporal artery biopsy- multinucleated giant cells/inflammation- can be skip lesions (not consistent along the artery) -> confirms dx
-therapy- high dose steroids (prednisone) -> decrease inflammation to prevent blindness
meningitis
-inflammatory response of the meninges and the CSF of the subarachnoid space to bacterial invasion (or viral)- can be various diff types of bacteria or virus
-often infectious (varies)
-1 of the most common CNS infections
-meningoencephalitis- meninges and brain parenchyma are infected
-acute- hours or days- often
-subacute/chronic
meningitis risk factors
-very young age
-asplenia- sickle cell disease and other chronic hemolytic anemias
-immunodeficiency’s (HIV infection, long term use of corticosteriods)
-malignancy
-diabetes mellitus
-homelessness/overcrowding
-being at risk for infective endocarditis
-recent visit to endemic areas
-refugee status (drought, famine, war)
-recent neurosurgery, head trauma, ear or sinus infection, invasive medical procedures, CSF Dural leaks, CSF rhinorrhea
