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Clinical Problem Solving > 11 - Headache > Flashcards

11 - Headache Flashcards

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1
Q

A 72-year-old patient presents with a headache. You palpate her scalp. What sign are you checking for?

A

Swollen temporal artery

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2
Q

What blood test should be arranged in any patient > 50 with a new headache, and why?

A

ESR (erythrocyte sedimentation rate) to check for temporal arteritis

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3
Q

A 72-year-old patient presents with a headache. You ask her to put her chin on her chest. What sign are you checking for?

A

Neck stiffness

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4
Q

Compare primary headaches and secondary headaches.

A

Primary: no underlying morbidity, benign
Secondary: underlying morbidity, benign or serious

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5
Q

What percentage of headaches are primary headaches?

A

90%

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6
Q

List 3 conditions leading to headaches with neck stiffness.

A
  1. Meningitis
  2. Raised intracranial pressure
  3. Subarachnoid haemorrhage
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7
Q

What type of headache worsens when lying down?

A

Raised intracranial pressure

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8
Q

How many types of headache are there?

A

Over 200

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9
Q

Presence of what would help you distinguish a benign headache from a serious one?

A

Red flag symptoms

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10
Q

List 6 possible examinations for a patient presenting with a headache.

A
  1. Blood pressure
  2. Optic fundi
  3. Temporal artery palpation
  4. Neurological examination
  5. Level of consciousness (Glasgow Coma Scale)
  6. Imaging
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11
Q

What scale would you use when examining a patient’s level of consciousness?

A

Glasgow Coma Scale

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12
Q

List 3 types of primary headache.

A
  1. Tension headache
  2. Migraine
  3. Cluster headache
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13
Q

Describe the pattern of attack for cluster headaches.

A
  • Last 15 minutes to 3 hours
  • Occur 1-8 times a day
  • Last 4-12 weeks
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14
Q

Describe cluster headaches.

A

Sharp, recurrent headaches on that occur on one side of the head, often accompanied by watery eyes and a runny nose

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15
Q

List 2 associated symptoms for a cluster headache.

A
  1. Watery eyes

2. Runny nose

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16
Q

List 3 risk factors for a cluster headache.

A
  1. Men
  2. Smoker
  3. Over 20
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17
Q

Describe trigeminal neuralgia.

A

Severe, episodic facial pain caused by compression of the trigeminal nerve

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18
Q

List 2 mental illnesses that can trigger tension headaches.

A
  1. Anxiety

2. Depression

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19
Q

Compare the site of a tension headache and a migraine.

A

Tension headache: both sides of the head

Migraine: one side

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20
Q

A patient presents with a mild band-like headache and no other symptoms. What is the likely diagnosis?

A

Tension headache

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21
Q

Describe the intensity of a tension headache.

A

Mild to moderate

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22
Q

List 2 ways to manage a tension headache.

A
  1. Painkillers

2. Stress management techniques

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23
Q

What is the typical duration of a tension headache?

A

30 minutes to a few hours

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24
Q

Migraines typically start ___ middle age.

A

Before

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25
Are migraines more common in women or men?
Women
26
What percentage of females are affected by migraines?
20%
27
What percentage of males are affected by migraines?
6%
28
What type of primary headache may have a family history component?
Migraine
29
What medication might aggravate migraines?
Oral contraceptive pills
30
How long would an untreated migraine typically last?
4 to 72 hours
31
Describe the quality of migraine pain.
Throbbing
32
What type of primary headache is worsened by movement?
Migraine
33
A patient presents with a migraine. What would be the result of examination?
Normal
34
Describe the intensity of migraine pain.
Moderate to severe
35
80% of migraine sufferers experience prodrome. What is prodrome?
General malaise and irritability indicating that a migraine will occur
36
What percentage of migraine patients experience aura?
20%
37
What is aura (re: migraines)?
VISUAL or SENSORY disturbances signalling a migraine
38
List 3 types of sensory aura precipitating a migraine.
1. Tingling 2. Numbness 3. Speech impairment
39
List 4 types of visual aura precipitating a migraine.
1. Scintillating scotoma 2. Shimmering 3. Temporal visual field loss 4. Zigzag lines
40
List 5 potential symptoms of a migraine (in addition to a severe, throbbing headache).
1. Sensitivity to stimuli (i.e., light/sound/smell/motion) 2. Nausea 3. Vomiting 4. Dizziness 5. Fatigue
41
Migraines increase sensitivity to which 4 stimuli?
1. Light 2. Sound 3. Smell 4. Motion
42
What is an antiemetic?
Drug that relieves nausea and vomiting
43
What is an analgesic?
Drug that relieves pain
44
A patient presents with a migraine. What antiemetic would you prescribe?
Metoclopramide
45
Drugs belonging to the triptan class (e.g., sumatriptan) would be prescribed for which ailment?
Migraines
46
List 2 drugs that could prevent migraines.
1. Propranolol | 2. Amitriptyline
47
Compare a hemorrhage and a hematoma.
Hemorrhage: bleeding Hematoma: collection of blood outside the vessels
48
The acronym VINDICATE is a mnemonic for the differential diagnosis of secondary headache. What does it stand for?
``` Vascular Infection Neoplasia Drugs Inflammatory Congenital Autoimmune Trauma Endocrine ```
49
Define aneurysm.
A balloon-like bulge in a weak blood vessel
50
What is the most common cause of a subarachnoid hemorrhage?
Ruptured brain aneurysm
51
What is the most common site for a subarachnoid hemorrhage?
Back of the head
52
Name an infection that could induce a secondary headache.
Meningitis
53
Name a neoplasm that could induce a secondary headache.
Brain tumour
54
Name a drug that could induce a secondary headache.
Codeine
55
A patient presents with a headache. You suspect meningitis. List 5 additional symptoms you might have encountered.
1. Fever 2. Neck stiffness 3. Rash 4. Vomiting 5. Seizure
56
Compare the underlying pathology of aseptic meningitis and meningococcal meningitis.
Aseptic: VIRAL Meningococcal: BACTERIAL
57
You suspect meningitis. What investigation do you carry out?
Lumbar puncture
58
What is a lumbar puncture?
Collection of CSF with a needle for diagnostic testing
59
What is an abscess?
Buildup of puss
60
List 3 causes of raised intracranial pressure.
1. Hemorrhage 2. Abscess 3. Tumour
61
What is focal weakness?
Impaired CNS function in a specific region of the body
62
A patient presents with a headache, vomiting, and seizures. You suspect raised intracranial pressure. List 5 additional symptoms you may have encountered.
1. Focal weakness 2. Neck stiffness 3. Papilledema 4. Drowsiness 5. Behavioural changes
63
What is papilledema?
Swelling of the optic nerve caused by raised intracranial pressure
64
What percentage of malignant tumours are brain tumours?
1%
65
What is the most common benign brain tumour?
Meningioma
66
What is the most common cause of malignant brain tumours?
Metastases
67
What is the immediate mortality rate for a patient presenting with a subarachnoid hemorrhage?
10-15%
68
Patients with a subarachnoid hemorrhage would present with a thunderclap headache. What is a thunderclap headache?
Headache with a sudden, severe onset
69
What percentage of strokes in the UK comprise of a subarachnoid hemorrhage?
5%
70
How might a subarachnoid hemorrhage lead to neck stiffness?
Bleeding irritates the meninges, which cover the CNS (including the neck)
71
List 2 investigations that could confirm a subarachnoid hemorrhage.
1. Lumbar puncture | 2. CT scan
72
How would you treat a subarachnoid hemorrhage?
Neurosurgery
73
What is subdural hematoma?
Blood in the subdural space following rupture of a vein
74
What is the most common cause of subdural hematoma?
Trauma
75
A patient fell two weeks ago. Over the past few days, they have complained of a headache. You suspect subdural hematoma. List 5 other symptoms you may have encountered.
1. Disorientation 2. Confusion 3. Memory loss 4. Drowsiness 5. Seizures
76
Compare the onset of a subarachnoid hemorrhage and subdural hematoma.
Subarachnoid hemorrhage: sudden | Subdural hematoma: days of weeks after trauma
77
Compare the treatment for a subarachnoid hemorrhage and a subdural hematoma.
Subarachnoid hemorrhage: surgical | Subdural hematoma: surgical OR conservative
78
Which age group is most susceptible to temporal arteritis?
50+
79
The acronym SNOOPTHAT can be used to identify headache red flags. Briefly describe what each letter stands for.
Systemic – fever, weight loss, fatigue, rash Neurological – confusion, unconsciousness, personality changes, seizure Onset – thunderclap (i.e., sudden, severe) Older – 50+ Pattern – first headache, different from previous headaches Timing – early morning Hurling – vomiting WITHOUT nausea Aggravating – worsened by coughing, exercise, or lying down Trauma – within past 90 days

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