Secondary Headache Flashcards
How do you identify a secondary headache from a primary headache
If the headache has an identifiable structural or biochemical cause
What is the common causes of secondary headaches
Tumor Meningits Vascular disorders Systemic infection head injury Drug-induces
Long standing episodic headaches usually indicates what
Its most likely not a serious intracranial pathology
What presentation indicating a more sinister cause to headache
Associated head trauma
First or worst
Sudden (thunderclap) onset
New daily persistent headache
Change in headache pattern or type
Returning patient
What is red flags suggesting a sister cause of a headache
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
What are signs of a high pressure headache
Headache worse when lying down
Headache wakening patient
Precipitated by physical exertion
What are signs of a low pressure headache
headache precipitated by sitting, standing up
What is giant cell arthritis
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
What arteries are specifically affected by giant cell arthritis
Temporal arteries
What disorder does giant cell arthritis often occur with
Polymyalgia rheumatica - a disorder of connective tissue causing stiffness and and pain of the muscles
What is the signs and symptoms of giant cell arthritis
Diffuse, persistent headache
systemically unwell
scalp tenderness
prominent or beaded temporal arteries
Jaw claudication
Visual disturbance
How do you diagnose Giant cell arthritis
Markers:
Raised ESR
Raised CPR
Raised platelet count
Temporal artery biopsy (if highly likely)
What is the treatment of giant cell arthritis if the diagnosis is highly likely
High dose prednisolone
What is the definition of a thunderclap headache
High intensity headache reaching maximum intensity in less than 1 minute, reaching major peak instantaneously
What is the potentially causes of a thunderclap headache
Primary
Subarachnoid haemorrhage
Intracerebral haemorrhage
TIA / stroke
Carotid / vertebral dissection
Cerebral venous sinus thrombosis
Meningitis / encephalitis
Pituitary apoplexy
Spontaneous intracranial hypotension
What is a risk factor for cerebral venous sinus thrombosis
High pressure in the brain
What is the most common assocation with thunder clap headache
Subarachnoid haemorrhage - caused by ruptured aneurysm
What is the preventative treatment and general treatment of subarachnoid haemorrhage
Coiling or clipping aneurysm
What is the typical presentation of subarachnoid haemorrhage
Sudden severe headache that peaks within few minutes and lasts for at east 1 hour
but on examination often appear normal
How is subarachnoid heamorrage diagnosed
CT brain (on presentation)
Lumbar puncture ( 12 hours after onset)
Angiography (beyond two weeks when CT& LP are unreliable)
What should be considered when patient presents with a headache and a fever
CNS infections especially meningitis and encephalitis
What is additioanl symptoms of meningitis
Nausea +/- vomitting
Photo/phono phobia
Stiff neck
rash
What is the additional symptoms of encephalitis
altered mental state/consciousness
Focal symptoms/signs
seizures
What are general causes of raised intracranial pressure
bleeding in the brain, a tumor, stroke, aneurysm, high blood pressure, brain infection
What are specific causes of increased intracranial pressure
Gilobastoma mutiforme
Cerebral abscess
Venous thrombosis
meningioma
Hydrocephalus - fluid accumulation in brain
What can increased Intra cranial pressure cause
Papilledema (bilateral optic disc swelling)
What is the warning features of raised intra cranial pressure
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
What is the cause of intracranial hypotension
Dural CSF leak
either spontaneous or iatrogenic (post lumbar puncture)
What is the main feature of a hypotension headache
Postural component:
Headache develops or worsens soon after assuming an upright posture and lessesn or resolves shortly after lying down
What is the sign that hypotension headache has become chronic
Looses its postural component
What is the investigation for intracranial hypotension
MRI of brain and spine
What is the treatment of intracranial hypotension
Bed rest, fluids, analgesia, caffeine (IV)
Epidural blood patch
How does visual disturbance occur in increased intracranial pressure
Due to papilledema
What is the presentation of raised intracranial pressure
Progressive headache with associated symptoms and signs
