Headache Flashcards Preview

ACC > Headache > Flashcards

Flashcards in Headache Deck (12)
Loading flashcards...
1

Worry features of a headache

-↓ GCS
- Sudden onset
-severe
-recurrent vomiting
- photophobia
- rash/neck stiffness
- focal neurology
- seizure
- papilloedema
- ↑↓HR, ↑↓BP

2

Emergency causes of headache

intracranial haemorrhage (subarachnoid, subdural, extradural)
meningitis/encephalitis
↑ICP
Temporal arteriris
acute glaucoma
hypertensive crisis

3

Common

dehydration
tension
infection
migraine
extra cranial (sinuses, eyes, ears, teeth)
trauma
post-LP
post- nitrates

4

Any others

cluster
postcoital
hypoglcyaemic
hyponatraemia

5

Questions to ask in Pc Hx

SOCRATES
change with coughing, leaning forward
N&V
visual changes (before & currently)
trauma
seizures
rash, neck pain
sweating

6

Dhx

Nitrates, analgesia, antihypertensives

7

What to look out for in examination

Fluid status

Meningism: neck stiffness, photophobia, kernels, non-blanching rash (whole body)

red eye

visual disturbance, papilloedema

focal neurology

temporal artery tenderness & pulsatility

tenderness of sinuses

evidence of recent trauma

dental hygiene & ear dischage

8

What to do if: new onset focal neurology

reassess
-meningitis
- encephalitis
- ↑ ICP
consider Abx: call senior

9

Sudden onset severe constant headache

consider subarachnoid
15l/O2
Lie flat
Call senior

10

Unwell & deranged obs

consider meningitis or sepsis
15l/min O2
IV fluids
Discuss Abx
Senior

11

Red, painful eye, ↓Acuity

acute glaucoma
urgent ophthalmology referral

12

when to CT head

- GCS < 13 on presentation
- GCS < 15 after 2 hours of assessment
- Suspected open/depression skull fracture
- any sign of basal skull fracture
- post-traumatic seizure
- focal neurological deficit
- more than 1 episode of vomiting since head injury
- patient has ↑risk of bleeding: anticoagulants, dual anti platelets, coagulopathy
- Amnesia or LOC