Secondary headaches

Question 1

Red-flags

Answer 1

New onset
Change in type of headache
Change in frequency, associated symptoms
Focal neurological symptoms
Non-focal neurological symptoms
Abnormal neurological examination
Neck stiffness/fever
High pressure
-Headache worse when lying down/ wakes patient up
-Headache precipitated by the valsalva manoeuvre
-Headache precipitated by physical exercise
Low pressure: headache precipitated by standing up

For Giant cell arthritis:

• Jaw claudication/ visual disturbance
• Prominent/beaded temporal arteries

Question 2

what are thunder clamp headaches?

Answer 2

High intensity headache reaching full intensity in less than 1 minute
Can be primary or secondary

Question 3

Differential diagnosis for a thunderclamp headache

Answer 3

• Primary
• SAH
• Intercerebral hemmorage
• TIA/Stroke
• Carotid/vertebral disseaction
• Meningitis/encephalitis
• Pituitary apoplexy
• Spontaneous intracranial hypotension
• raised ICP/ space occupying lesion

Question 4

Properties of GCA

Answer 4

Artheritis of cells in the Brain
Diffuse, persistent headache
Must be considered especially in over 50s
Systemically unwell patient: scalp tenderness, Jaw claudication and visual disturbance
Beaded or prominent temporal arteries
Diagnosis is made on enlarged ESR
Also have elevated CRP and platelet count
If diagnosis is supported: start predinosole- temporal artery biopsy arranged

Question 5

Properties of an elevated INCREASED spontaneous hypotension

Answer 5

During a CSF leak
Can be either spontaneous or iatrogenic e.g. LP
Visible postural component
When headache becomes chronic it looses its postural component
Treatment: bed rest, analgesics, fluid, epidural blood patch

Question 6

Properties of increased ICP

Answer 6

Worsening headache with associating symptoms
non-focal neurological symptoms
Gets worse in evening/wakes up patient from sleep
Seizures
Visual obstruction
Pulsatile tinnitus