Approach - headache Flashcards Preview

► Med Misc 43 > Approach - headache > Flashcards

Flashcards in Approach - headache Deck (14):
1

(8) Things to ask in a neurological Hx

–Weakness
–Numbness
–Dizziness
–Clumsiness
–Pain
–Speech problems
–Disturbance of hearing or vision
–Altered mentation or consciousness

2

How can you classify neurological patterns (5)?

•Peripheral nerve (e.g. femoral, median)
•Spinal nerve
•Peripheral neuropathy
•Hemisyndrome
•Spinal cord (e.g. paraplegia)

3

How do you classify timeline of a headache?

•Onset
–Acute: Instantaneous (ictal), Seconds, Minutes, Hours
–Sub-acute
–Chronic
•Sequence of symptoms
•Constant vs. episodic
•Progressive vs. stable
•Gradual vs. step-wise

4

What (3) interacting illnesses & risk factors should you ask in a headache?

–Diabetes
–Rheumatological conditions
–Vascular risk

5

5 types of important headaches

•Migraine: Headache+Aura
•Tension-type headache
•Chronic daily headache
•Sub-arachnoid haemorrhage
•Raised intracranial pressure

6

Describe migraine
- epidemiology
- risk factors
- Px
- associated features

•Common: 20% women, 5-10% of men
•Idiopathic headache syndrome: Genetic
•May be preceded by aura but
Over 2/3 have migraine without aura

Px:
• a few hours to 3 days
•Recurrent, episodic headache
•Really bad pain
–Moderate to severe
–Building over minutes
•UNILATERAL
•Pulsating
•Aggravated by exercise

Associated with:
–Nausea and vomiting
–Photo- or phonophobia
- paraesthesia, weakness, dysphasia, basilar migraine
- visual phenomena

7

Describe tension-type headache
- Px
- associated features

•Mild to moderate
•Band-like
–BILATERAL
–Pressing

•NOT associated with
–Exercise induction
–Nausea
–Photo/phonophobia

8

Describe chronic daily headache
- Px
- associated features

•Most days, most of the day

•Chronic migraine
–Evolves from migraine without aura
–Just as miserable as it sounds

•Chronic tension-type headache
–Individually mild headaches
–Persistence distressing

9

Describe subarachnoid haemorrhage
- timeline
- Px
- associated features
- Ix

•Thunderclap headache: SUDDEN ONSET IS THE KEY

•May have neurological symptoms/signs
–Weakness/sensory loss
–Impairment of consciousness often occurs. Depth of coma marks prognosis

Headache is meningeal
•Moderate to severe
•Photo/phonophobia
•Nausea
•May be unilateral

Ix: plain CT. If negative, do lumbar puncture

10

Other (3) thunderclap headaches than SAH

•Sexual and exertional headaches
•Vasospastic headache
•Primary thunderclap headache

11

Describe raised ICP headache
- Px
- associated features

•Diffuse headache
•Variable severity: Often progressive
•Nausea prominent

•Worse with increases in ICP
–Valsalva (cough, straining)
–Morning headache
–Better standing

•Papiloedema
–Peripheral visual loss
–Transient blindness

•Diplopia
–Sixth nerve palsy

12

26yo woman with transient, objective left sided weakness and sensory disturbance.

Acute presentation to ED.
Sensory and motor symptoms fully resolved.

DDx?

•Migraine aura: High prior probability
•Transient ischaemic attack
•Focal seizure
•Hypoglycaemia
•Vasospastic headache
•Functional neurological disorder

13

Compare Px of migraine, TIA & focal seizures

All have cortical involvement, acute onset

Migraine:
- gradual offset & often stepwise
- nausea, headache
- photo/phonophobia
- more likely in young

TIA:
- gradual offset
- CV history. MI/Stroke/PVD
- common in >65yo

Focal seizure:
- distinct offset; Todd's paresis
- clonus/dystonia prior to weakness
- dyscognitive phase
- previous, stereotyped events

14

Does EEG diagnose seizure?

NO.

But it predicts recurrence sometimes

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