1. Headache

Question 1

What are the sinister causes of a headache?

Answer 1

VIVID

Vascular, infection, vision threatening, raised intracranial pressure, dissection

When asking questions about their headache, think SOCRATES!

Question 2

What are the vascular causes of a headache?

Answer 2

Subarachnoid haemorrhage, haematoma (extradural or subdural), cerebral venous sinus thrombosis, cerebellar infarct

Question 3

What are the infective causes of a headache?

Answer 3

Meningitis and encephalitis

Question 4

What are vision threatening causes of a headache?

Answer 4

Temporal arteritis, acute glaucoma, cavernous sinus thrombosis, pituitary apoplexy, posterior leucoencephalopathy

Question 5

What are the causes of a raised intracranial pressure?

Answer 5

Space occupying lesion, cerebral oedema, hydrocephalus, malignant hypertension, idiopathic intracranial hypertension

Question 6

What are the red flags to look out for in someone with a headache?

Answer 6

Decreased level of consciousness, sudden onset worst headache, seizure, no previous episodes, reduced visual acuity, headaches worse when lying down, progressive persistent headache, constitutional symptoms

Question 7

What might a decreased level of consciousness suggest in someone with a headache?

Answer 7

subdural haematoma- fluctuating consciousness
extradural haematoma- altered consciousness following a lucid interval
subarachnoid haemorrhage

Question 8

What does a persistent headache, worse when lying down with early morning nausea suggest?

Answer 8

Raised intracranial pressure

Question 9

What might a progressive persistent headache suggest?

Answer 9

Expanding space occupying lesion

Question 10

What are constitutional symptoms?

Answer 10

weight loss, night sweats, fever

Question 11

What might a focal limb deficit suggest with a headache?

Answer 11

Intracranial pathology is more likely

Question 12

What signs are seen in a third nerve palsy?

Answer 12

Ptosis, mydriasis, eye deviated down and out

Question 13

What signs are seen in a sixth nerve palsy?

Answer 13

Convergent squint and/ or failure to abduct the eye laterally

Question 14

What are signs of horner’s syndrome?

Answer 14

Partial ptosis, anydrosis, miosis

Question 15

What does scalp tenderness suggest?

Answer 15

Classically seen in temporal arteritis

Question 16

What are the causes of non sinister headache?

Answer 16

tension type headache
migraine
sinusitis
medication overuse headache
TMJ dysfunction syndrome
trigeminal neuralgia
cluster headache

Question 17

What are characteristics of a tension type headache?

Answer 17

It is bifrontal and more common in women

Question 18

What are characteristics of trigeminal neuralgia?

Answer 18

More common over 60s, unilateral sharp facial pain, lasts seconds

Question 19

What are the characteristics of a migraine?

Answer 19

Unilateral, aura, more common in women, sensitive to light

Question 20

What are the features of sinusitis?

Answer 20

Constitutional symptoms and facial pain

Question 21

What are the features of a cluster headache?

Answer 21

Unilateral pain over one eye, more common in men, causes patients to wake up at night, occurs in clusters every few weeks