week 22 - headaches and LOC Flashcards
What is the onset progression of a migraine usually like ?
gradually worsening in severity over minutes/hours
some patients get warning signs in the hours/days before like fatigue, ache, altered appetite…
What is the onset progression of headache due to cluster headache ?
- recurrent unilateral pain around the eye and temple
- rapid onset over minutes
- brief duration (15mins)
- occurs several times in a night
What is the onset progression of headache due to a subarachnoid haemorrhage ?
- sudden onset
- severe pain
- reaches maximal intensity in minutes
What is the onset progression of headache due to trigeminal neuralgia ?
- recurrent brief jabs of pain on one side of face
- may be triggered by touching affected area
What is the onset progression of headache due to raised inter cranial pressure ?
- progressively worsening headache over days/weeks
- worse when bending over and lying down
What is the headache pattern like when it’s caused by a migraine ?
- episodic headache
- last between 4hrs and 3 days
- intermittent with headache-free days between episodes
What is the headache pattern like when it’s caused by trigeminal neuralgia ?
- dozens of brief jabbing pains each day
- periods of spontaneous remission lasting weeks/months
What is the headache pattern like when it’s caused by raised intercranial pressure ?
- gradually worsening heachaes over weeks
- present daily
- pain wakes patient from sleep but eases once arisen
What is the headache pattern like when it’s caused by a cluster headache ?
- brief (15-30mins) headaches lasting weeks at a time
- headaches occur multiple times a day
- occur at night commonly
- periods of remission lasting weeks/months between episodes
What symptoms are common in migraines ?
- sensitivity to sound (phonophobia)
- sensitivity to light (photophobia)
- sensitivity to movement (mechanophobia)
- nausea and vomiting
- visual/sensory disturbance spreading across field/body prior to headache (aura)
how long does aura usually last ?
less than an hour
What are red flag symptoms of headache ?
- new onset of seizures
- no PMHx of headache in patients >50
- fever (suggests infective cause)
- episodes of transient vision loss when changing posture e.g standing (suggests raised inter cranial pressure)
- pain triggered by coughing/sneezing/valsalva (suggests raised inter cranial pressure)
what are some red flag signs UMN lesion as a cause for headache ?
- papilloedema = raised intracranial pressure (ICP)
- restricted visual fields = raised ICP
- oculoparesis + diplopia = 6th nerve palsy/raised ICP
- nystagmus = cerebellar lesion/raised ICP
- increased tone = contra lateral brain lesion
- brisk reflexes = contra lateral brain lesion
- pyramidal drift
- limb or gait ataxia = cerebellum lesion/raised ICP
What further investigations are required in a patient with migraine and no other neurological symptoms/findings ?
no further investigations !
What questions about ‘site’ are involved in a headache history ?
- unilateral/bilateral ?
- side locked ? always on same side?
- retro/peri-orbital ?
- head vs face ?
What are the main areas of questioning in a headache history ?
Site
Onset
Characteristics + intensity
Radiation
Aaggrevating/relieving factors
Timeline/duration
Episodes in the past
Symptoms associated with pain
What questions in a headache history would you ask about onset ?
sudden pain ?
gradual worsening ?
What questions in a headache history would you ask about timeline/duration ?
- episodic/chronic ?
- how long do they last? minutes/hours/days etc
- have they been worse at any point ?
What questions in a headache history would you ask about characteristics/intensity ?
- constant/variable?
- throbbing/pulsing ?
- aching/dull ?
- stabbing/sharp?
- tender ?
what type of headache is most likely to be described as aching/dull pain ?
tension headache
chronic migraine
what type of headache is most likely to be described as throbbing/pulsing pain ?
migraine
what type of headache is most likely to be described as stabbing/sharp pain ?
trigeminal neuralgia
What questions in a headache history would you ask about aggregating/relieving factors and other symptoms ?
- photophobia (light)
- phonophobia (sound)
- mechanophobia (movement)
- osmophobia (smell)
- positional changes
- nausea/vomiting ?
- visual changes ?
- runny nose/eyes?
- sensory/motor symptoms ?
- cognitive/behaviour changes ?
What conditions could a worsening headache with fever indicate ?
CNS infections
- meningitis
- encephalitis
- intracranial abscess
etc
