Secondary headaches Flashcards
What are the differential diagnoses of a thunderclap headache?
Primary (primary thunderclap, migraine etc) Subarachnoid hemorrhage Intracerebral haemorrhage Meningitis / encephalitis Intracranial hypotension Space occupying lesion / raised intracranial pressure Giant cell arteritis TIA/stroke Carotid/vertebral dissection Cerebral venous sinus thrombosis Pituitary apoplexy
What is the most common cause of subarachnoid hemorrhage?
Aneurysms
What percentage of patients with a thunderclap headache will be due to a subarachnoid haemorrhage?
80%
What investigations would you carry out if you suspected a subarachnoid haemorrhage?
CT head
LP
CT
(Beyond 2 weeks - angiography if required)
What symptoms are suggestive of meningitis?
Headache Nausea Photophobia Phonophobia Stiff neck Fever Rash
What symptoms are suggestive of encephalitis?
Headache Altered mental state / consciousness Focal symptoms / signs Seizures Rash
What are the main causes of raised intracranial pressure?
Glioblastoma multiforme Meningioma Cerebral abscess Hydrocephalus Venous infarct with focal area of haemorrhage Pappiloedema
What are the warning features of raised intracranial pressure?
Headache worse in the morning or wakes patient up
Worse when lying flat
Headache brought on or made worse by valsalva (coughing, stooping, staining)
Seizures
Visual obscurations and pulsatile tinnitus
What is the cause of intracranial hypotension?
Dural CSF leak
What are the characteristics of a headache due to low intracranial pressure?
Headache develops or worsens soon after standing up
Resolves when lying down
What investigations would you carry out if you suspected low intracranial pressure?
MRI head and spine
What type of patients should Giant cell arteritis always be considered in?
Patients over 50yrs presenting with new headache
What is the treatment for giant cell arteritis?
Prednisone and temporal artery biopsy
What is the presentation of a giant cell arteritis like?
Diffuse, persistent headache Usually systemically unwell Prominent, beaded, enlarged superficial temporal arteries Tender scalp Jae claudication Visual disturbance Loss of appetite Nausea
What is the treatment for intracranial hypotension?
Bed rest
Fluids
IV caffeine
Epidural blood patch
