Headache Flashcards
Concerns in hyperacute headaches
Intracranial haemorrhage
Meningitis
Recent onset not hyperacute headache - probable causes
In over 55s, giant cell arteritis (can cause blindness),
Raised intracranial pressure
Ear infection
Skull based lesions (infective/inflammatory, tumour)
Onset of benign headaches - age
Young or middle-aged adults
Timing of SAH
Hyperacute onset - like being hit in the back of the head.
Characteristics of SAH
Very severe global headache with neck stiffness
Associated symptoms of SAH
20% have neurological stroke like deficits.
Altered consciousness
Vomiting or collapse
Timing of intracerebral haemorrhage
Seconds to minutes.
Characteristics of intracerebral haemorrhage
Headache of variable severity.
Associated symptoms of intracerebral haemorrhage
Focal neurological deficit in most cases
Timing of meningitis headache
Depends on aetiology – viral/bacterial: hours Tuberculous: hours to days. Malignant or inflammatory: days to weeks
Characteristics of meningitis headache
Global headache often severe neck stiffness.
Associated symptoms of meningitis headache.
Fever in infective causes. Altered consciousness common.
Cranial nerve palsies and focal neurological deficits especially in more chronic forms. Purpuric rash, septicaemia and collapse in bacterial meningitis.
Timing of raised intracranial pressure headache
Onset usually over days but can be hours to weeks.
Characteristics of raised intracranial pressure headache.
Global headache typically worse after lying down, for example on waking in the morning, but this feature is often absent.
Associated symptoms of raised intracranial pressure headache.
Often with nausea and vomiting. As elevated pressure becomes more severe there is often ataxia and then drowsiness. Neurological deficits may occur from the causative lesion.
Timing of temporal arteritis headache.
Onset usually days to weeks.
Characteristics of temporal arteritis headache
Typically temporal tenderness, for example on combing the hair. Pain on chewing which causes the jaw to lock up (claudication). Some have predominantly nuchal pain.
Associated feature of temporal arteritis headache.
Often weight loss and malaise over a few weeks.
Transient or permanent neurological deficits due to ischaemia, especially visual loss in one or both eyes and cranial nerve palsies, especially III, IV and VI.
20% have had or will have polymyalgia rheumatica with limb girdle pain.
Timing of migraine headache
Onset usually over minutes to 1 hour.
Characteristics of migraine headache
Often unilateral but side may vary between different attacks. Typically throbbing.
Associated features of migraine headache.
Usually nausea, often photophobia. Sleep helps the headache which usually lasts 4-72 hours. Sometimes neurological symptoms in a migraine aura, such as flashing lights or tingling down one side of the body.
Papilloedema in GCA
Seen in ischaemia of the optic nerve head due to GCA and may be unilateral.
Usually more severe visual symptoms and signs with reduced acuity and visual fields than one sees in papilloedema due to raised intracranial pressure, where vision is often normal or near normal apart from an enlarged blindspot.
Causes of third nerve palsy + headache.
An aneurysm of the posterior communication artery and associated subarachnoid haemorrhage.
In comatose pt: tentorial herniation and compression due to raised ICP.
Multiple cranial nerve palsies with headache
Uncommon usually a subacute or chronic meningeal infiltrative process: chronic infection, malignant deposits in the CSF.
