Evaluation of Patient with Headache Part 1 Flashcards
(29 cards)
What will bring the patient with a headache into the office?
- severity
2. Chronicity
Where is most of the headache diagnosis found?
- history
- physical examination
If the headache is throbbing, what component is present?
vascular component
If the headache is a steady pressure or ache what component is present?
muscular, tension
What must be done with all new onset headaches?
neurologic examination - including ophthalmoscopy of the retina
- if positive refer to a neurologist or neurosurgeon immediately
What local disease could be present if the headache is always in the same place?
- sinusitis
- brain tumor
- arteriovenous malformation
- circle of Willis aneurysm
- *physical diseases don’t move; migraines and tension headaches move
What should you think about with a patient with onset after age 50?
- temporal arteritis
- brain tumor
What tests should be done on patients with new onset headaches after age 50?
- neurologic exam
- ESR (M:age/2 F: (age+10)/2)
- MRI or CT of brain
Which neuroimaging exam is done first? second?
CT; if negative»_space;»MRI
What things will a CT miss?
- vascular disease
- neoplastic disease
- cervicomedullary lesions
- infections
What are the possibilities if the headache is sudden and abrupt?
- subarachnoid hemorrhage
- pituitary apoplexy
- posterior fossa brain tumor
- Bleed into a tumor
- arteriovenous malformations
What should be done if the headache is sudden and abrupt?
- MRI/MRA
- CT
- Lumbar puncture
Where are most aneurysms?
Anterior circulation
What are the symptoms for a ruptured congenital aneurysm?
- sudden explosive headache
- fever
- sweating
- vomiting
- Kernig Sign
- Brudzinski
Sudden massive degeneration with hemorrhagic necrosis of the pituitary gland.
Pituitary apoplexy
What is pituitary apoplexy headaches associated with?
pituitary tumor
What signals a pituitary apoplexy headache?
- abrupt headache
- loss of sight
- diplopia
- personality changes
- drowsiness
- confusion
- coma
If the headaches are chronic, what should the patient do?
keep a headache diary
What tests should be run if the frequency of headaches is increasing?
- MRI
- drug history and screen
What possible reasons are there for accelerating headaches?
- brain tumor
- subdural hematoma
- medication overuse (analgesics)
What should you think about with a cancer or HIV patient with new onset of headaches?
- meningitis
- brain abscess
- metastasis
What should you think about new headaches with fever, stiff neck and rash?
- meningitis
- encephalitis
- Lyme
- systemic infection
- connective tissue disease
What should you think about with focal neurologic symptoms or signs (other than aura)?
- tumor
- AVM
- Stroke
- Connective Tissue disease
How can blood pressure affect headaches?
High - hypertensive
Low - ischemic headache
