Headache Flashcards
Headache history
Onset
Location
Pulsatile or constant
Frequency, intensity and duration
Change over time
Impact on activities
Red flag symptoms
Associated symptoms
-Aura
-Photophobia, phonophobia
-Nausea
-Jaw clarification
-Autonomic features
-Fullness or tinnitus in ear
Personal and family history
Response to treatment so far
Sleep, exercise, weight, diet
Contraception
Association with menses
Headache red flags
S2N2O2P9
Systemic signs or symptoms
-Fever
-Myalgias
-Weight loss
Systemic illness
-GCA
-Autoimmune
-HIV
Neurological signs or symptoms
-Vision change
-Numbness, weakness, ataxia
-Behavioural change
-Confusion
-Decreased level of consciousness
Neoplasia
Onset sudden
Older onset (>50 years)
Progressive with loss of headache free periods
Precipitated by valsava (sneeze, cough, exercise)
Postural aggrevation
Post traumatic
Pregancy
Painkiller overuse
Painful eye
Papilledema
Migraine criteria
At least five attacks
Lasts 4-72hrs (untreated or unsuccessfully treated)
Headache with at least two of
-unilateral
-pulsatile
-moderate to severe pain
-worse with or avoiding activity
During headache at least one of
-nausea or vomiting
-photophobia or phonophobia
Migraine aura criteria
At least two episodes
Fully reversible aura symptoms
-visual
-sensory
-speech
-motor
-brainstem
-retinal
At least three of the following
-aura spreads over >5 mins
-two or more symptoms in succession
-each aura symptoms lasts 5-60 mins
-at least one aura symptoms is unilateral
-at least one aura symptoms is positive
-aura accompanied or following within 60 mins by headache
Migraine non headache features
Prodrome
-2-48hrs prior to headache
-yawning
-euphoria, depression, irritability
-food craving
-neck stiffness
Aura
-Precedes or accompanied by head he
-Occurs in 25%
-Gradual development
-Slow spread
-Lasts no more than an hour
-Positive followed by negative
-Complete reversibility
Postrome
-After resolution of headache
-Sudden head movements cause pain at site of previous headache
-Exhaustion or euphoria
Cutaneous allodynia
-Pain from innocuous stimuli
-Typically around face and scalp
Tension headache features
Lasts 30 mins to one week
Bilateral
Pressing or tightening
Mild or moderate intensity
Not aggravated by physical activity
No nausea or vomiting
May have photophobia or phonophobia, but not both
Cluster headache features
Unilateral
Orbital, supraorbital or temporal pain
Severe
Restlessness
Lasts 15 mins to 3 hours
Nocturnal onset
Ipsilateral autonomic symptoms
-ptosis
-miosis
-conjunctival injection
-lacrimation
-rhinorrhea, nasal congestion
-sweating
