Secondary Headache

Question 1

How do you identify a secondary headache from a primary headache

Answer 1

If the headache has an identifiable structural or biochemical cause

Question 2

What is the common causes of secondary headaches

Answer 2

Tumor 
Meningits 
Vascular disorders
Systemic infection 
head injury 
Drug-induces

Question 3

Long standing episodic headaches usually indicates what

Answer 3

Its most likely not a serious intracranial pathology

Question 4

What presentation indicating a more sinister cause to headache

Answer 4

Associated head trauma

First or worst
Sudden (thunderclap) onset

New daily persistent headache

Change in headache pattern or type

Returning patient

Question 5

What is red flags suggesting a sister cause of a headache

Answer 5

New onset headache

Change in headaches (frequency, characteristics, or associated symptoms)

Neurological symptoms (focal, nonfocal, on examination)

Neck stiffness with fever

High pressure or low pressure signs

Giant cell arthritis

Question 6

What are signs of a high pressure headache

Answer 6

Headache worse when lying down

Headache wakening patient

Precipitated by physical exertion

Question 7

What are signs of a low pressure headache

Answer 7

headache precipitated by sitting, standing up

Question 8

What is giant cell arthritis

Answer 8

Disorder that causes inflammation of your arteries, usually in the scalp, neck, and arms,
narrowing the arteries, which keeps blood from flowing well to your head

Question 9

What arteries are specifically affected by giant cell arthritis

Answer 9

Temporal arteries

Question 10

What disorder does giant cell arthritis often occur with

Answer 10

Polymyalgia rheumatica - a disorder of connective tissue causing stiffness and and pain of the muscles

Question 11

What is the signs and symptoms of giant cell arthritis

Answer 11

Diffuse, persistent headache

systemically unwell

scalp tenderness

prominent or beaded temporal arteries

Jaw claudication

Visual disturbance

Question 12

How do you diagnose Giant cell arthritis

Answer 12

Markers:
Raised ESR
Raised CPR
Raised platelet count

Temporal artery biopsy (if highly likely)

Question 13

What is the treatment of giant cell arthritis if the diagnosis is highly likely

Answer 13

High dose prednisolone

Question 14

What is the definition of a thunderclap headache

Answer 14

High intensity headache reaching maximum intensity in less than 1 minute, reaching major peak instantaneously

Question 15

What is the potentially causes of a thunderclap headache

Answer 15

Primary

Subarachnoid haemorrhage

Intracerebral haemorrhage

TIA / stroke

Carotid / vertebral dissection

Cerebral venous sinus thrombosis

Meningitis / encephalitis

Pituitary apoplexy

Spontaneous intracranial hypotension

Question 16

What is a risk factor for cerebral venous sinus thrombosis

Answer 16

High pressure in the brain

Question 17

What is the most common assocation with thunder clap headache

Answer 17

Subarachnoid haemorrhage - caused by ruptured aneurysm

Question 18

What is the preventative treatment and general treatment of subarachnoid haemorrhage

Answer 18

Coiling or clipping aneurysm

Question 19

What is the typical presentation of subarachnoid haemorrhage

Answer 19

Sudden severe headache that peaks within few minutes and lasts for at east 1 hour

but on examination often appear normal

Question 20

How is subarachnoid heamorrage diagnosed

Answer 20

CT brain (on presentation)

Lumbar puncture ( 12 hours after onset)

Angiography (beyond two weeks when CT& LP are unreliable)

Question 21

What should be considered when patient presents with a headache and a fever

Answer 21

CNS infections especially meningitis and encephalitis

Question 22

What is additioanl symptoms of meningitis

Answer 22

Nausea +/- vomitting
Photo/phono phobia
Stiff neck
rash

Question 23

What is the additional symptoms of encephalitis

Answer 23

altered mental state/consciousness

Focal symptoms/signs

seizures

Question 24

What are general causes of raised intracranial pressure

Answer 24

bleeding in the brain, a tumor, stroke, aneurysm, high blood pressure, brain infection

Question 25

What are specific causes of increased intracranial pressure

Answer 25

Gilobastoma mutiforme Cerebral abscess Venous thrombosis meningioma Hydrocephalus - fluid accumulation in brain

Question 26

What can increased Intra cranial pressure cause

Answer 26

Papilledema (bilateral optic disc swelling)

Question 27

What is the warning features of raised intra cranial pressure

Answer 27

Headache worse in morning or wakes patient from sleep Headache worse lying flat or brought on by valsalva (cough, stooping, straining) Focal symptoms or signs Non-focal symptoms e.g. cognitive or Seizures Visual obscurations pulsatile tinnitus

Question 28

What is the cause of intracranial hypotension

Answer 28

Dural CSF leak either spontaneous or iatrogenic (post lumbar puncture)

Question 29

What is the main feature of a hypotension headache

Answer 29

Postural component: Headache develops or worsens soon after assuming an upright posture and lessesn or resolves shortly after lying down

Question 30

What is the sign that hypotension headache has become chronic

Answer 30

Looses its postural component

Question 31

What is the investigation for intracranial hypotension

Answer 31

MRI of brain and spine

Question 32

What is the treatment of intracranial hypotension

Answer 32

Bed rest, fluids, analgesia, caffeine (IV) | Epidural blood patch

Question 33

How does visual disturbance occur in increased intracranial pressure

Answer 33

Due to papilledema

Question 34

What is the presentation of raised intracranial pressure

Answer 34

Progressive headache with associated symptoms and signs