Headache Flashcards
Headache DDx?
” My Brain’s Tension Makes Terrible Triggers. I Suffer Bad Clusters, TMJ, Eye, and Neck Pain also.”
Migraine
Brain tumors
Tension headache
Meningitis
Temporal arteritis
Trigeminal neuralgia
Infections
Subarachnoid hemorrhage
Benign intracranial hypertension
Cluster headache
TMJ dysfunction
Eye
Cervicogenic headache
Migraine key points?
Throbbing, pulsating U/L headache, Not responding to simple analgesics
Red flags of headache?
Characteristics of Tension Headache?
S: Diffuse B/L headache
I : mild to moderate intensity,
Q : dull, aching sensation, rather than throbbing or pulsating like migraines.
Many people with tension headaches describe a feeling of tightness or pressure around their head, as if a band is being tightened around it.
O: few hours to several days
Lack of associated symptoms like migraine
Common triggers for tension headaches include stress, anxiety, muscle tension, poor posture, and fatigue.
Temporal Arteritis key points?
Meningitis Key points?
Key features of BIH?
In young obese women ( acne+) - 13yrs
- Headache: a dull, throbbing, or pulsating sensation that is often worse in the morning or when lying down. The headache may be localized to the back of the head or behind the eyes.
- Vision prob: blurring of vision, double vision, Vision impairment
- Tinnitus
-Red flag signs +/-
- Menstrual Hx: menarche + ? on OCP
- PMHx: Acne - on retinoids. Rx recently with Ab ( Tetracycline)
- Psychosocial prob (+)
PEFE:
High BMI ( 25). Neuro - NL.
Papilledema (+)
Immediate Mx of BIH?
Due to increased ICP
Aim - reduced ICP to relieve symptoms & prevent visual loss
Mx:
- Stop medication - Will R/W
- Acetazolamide - reduce CSF production (1st line)
Also: frusemide
- Therapeutic lumbar puncture - Removing a small amount of cerebrospinal fluid (CSF) through a needle inserted into the lower back. It can provide immediate relief by lowering intracranial pressure and alleviating symptoms.
- Wt loss
- Visual field testing: Visual field testing, such as perimetry, is performed to assess any changes in peripheral vision. This helps detect and monitor any potential vision loss
- Referral to specialists: neurologists, ophthalmologists, or neurosurgeons
- MRI - to rule out SOL
- Psychotherapy
Facial Pain DDx?
“Never Try Getting Punched, Cause It’s Bad For Teeth, jaw & Sinuses.”
- Neuralgia - Trigeminal, Glossopharyngeal, Post herpetic, Optical
- Sinusitis
- Dental problems
- TMJ dysfunction
- Cluster headache
- Brain tumors + oropharyngeal CA
- Facial migraine
- ## Facial trauma
A patient comes with a Headache + multiple somatic complaints. Ix done on somatic C/O - NL. DDx
Δ : Tension headache + somatic symptoms disorder/ Depression
Depend on ans to psychosocial Hx
- Mood
- Sleep
- Anhedonia
- Appetite
- Suicide Qs
Explain HEADDS mnemonic
H - Home: Inquires about the patient’s living situation, family dynamics, and any significant stressors at home.
E - Education and Employment: Explores the patient’s educational background, current or past employment, and any difficulties or successes in these areas.
A - Activities: Covers the patient’s hobbies, interests, and recreational activities. It helps to assess the patient’s level of engagement and enjoyment in their daily activities.
D - Drugs, Alcohol, and Smoking: Evaluates the patient’s history of substance use, including alcohol, tobacco, and illicit drugs. It also considers the impact of substance use on their mental health and overall well-being.
D - Depression, Anxiety, and Mood: Assesses the patient’s mental health, specifically looking for symptoms of depression, anxiety, or mood disorders. It explores their emotional well-being and any related challenges.
S - Suicidality and Self-Harm: Explores the presence of suicidal thoughts or tendencies, as well as any history of self-harm or suicidal attempts. This domain is crucial for assessing the patient’s safety and risk factors.