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Flashcards in Differentials for acute presentation - Headache Deck (14):
1

 

 

What are life-threatening causes of a headache?

 

  • Subarachnoid haemorrhage
  • Meningitis/encephalitis
  • SOL
  • Temporal arteritis
  • Pre-eclampsia

2

 

 

How would you explore the symptom of an acute headache?

 

  • SOCRATES
  • Meningeal symptoms - rash, fever, neck stiffness, photophobia
  • Temporal arteritis - temporal headache, jaw claudication
  • Glaucoma - visual problems, red eyes, halos around lights

3

 

 

What would you ask about on systems review in someone with an acute headache?

 

  • How patient feels
  • Fever
  • Fits/falls/LOC
  • Limb weakness
  • Altered sensations
  • Vision

4

 

 

What would you ask about in the drug history of someone with an acute headache?

 

  • Anticoagulants
  • Steroids
  • Analgesia

5

 

 

What would you ask about in family history for someone with an acute headache?

 

  • Previous headache problems
  • Berry aneurysms

6

 

 

What would you look for on examination in someone with an acute headache?

 

  • GCS
  • Signs of photophobia/rash/neck stiffness
  • Eyes - pupils, redness, vision
  • Sinuses + temporal artery
  • Kernigs / Brudzinski's sign
  • Full neuro exam
  • Cranial nerves
  • FUndoscopy - papilloedema/haemorrhages

7

 

 

What bloods would you consider doing in someone with  an acute headache?

 

  • FBC
  • CRP
  • U+E's
  • ESR
  • Blood cultures
  • Meningococcal PCR

8

 

 

What imaging would you consider doing in someone with a headache?

 

 

CT head

9

 

 

What specific tests would you consider doing in someone with an acute headache?

 

 

LP

10

 

 

What are primary causes of an acute headache?

 

  • Migraine
  • Cephalgias - Cluster headache, SUNCT, paroxysmal hemicrania
  • Tension headache
  • Trigeminal neuralgia

 

11

 

 

What are secondary intracranial causes of acute headache?

  • Meningitis
  • Temproal arteritis
  • Subarachnoid haemorrhage
  • Raised ICP
  • Venous sinus throbosis
  • Intracerebral haemorrhage
  • Encephalitis
  • Cerebral abscess
  • Tumour
  • Pituitary apoplexy
  • Subdural haematoma
  • Extradural haematoma

12

 

 

What are secondary extracranial causes of an acute headache?

 

  • Acute closed angle glaucoma
  • Sinusitis
  • Hypertensive encephalopathy
  • Pre-eclampsia
  • Carotid/vertebral artery dissection
  • Drugs/Withdrawal
  • Carbon monoxide poisoning
  • Post-trauma
  • Paget's disease
  • Hypoxia
  • Cervical spondylosis
  • Otitis media
  • Dental problems

13

 

 

What structured approach would you take to deciding what investigations to do in someone with an acute headache?

 

  • Bloods/Bedside
  • Orifices
  • X-ray/Imaging
  • ECG
  • Specific

14

 

 

What are red flag features of a headache?

 

  • Thunderclap/recent trauma - intracranial bleed
  • Postural/valsalva induced - Raised ICP
  • Onset > 50 years, other malignancy - SOL
  • Rash/fever/neck stiffness - meningitis
  • Visual problems/jaw claudication/scalp tenderness - temporal arteritis
  • Blurring/red eye/halos - Glaucoma