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Oxford Clinical Cases > Headache > Flashcards

Flashcards in Headache Deck (32)
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1

Sinister causes of a headache

V - vascular
I - infectious
V - vision-threatening
I - intracranial pressure
D - dissection

2

Vascular diagnoses?

SAH
Sub/extradural haematoma
cerebral venous sinus thrombosis
cerebellar infarct

3

Infectious diagnoses?

Meningitis
Encephalitis

4

Vision-threatening diagnoses?

temporal arteritis
acute glaucoma
cavernous sinus thrombosis
pituitary apoplexy
posterior leucoencephalopathy

5

Intracranial pressure diagnoses?

SOL
idiopathic intracranial HTN
hydrocephalus
malignant HTN
cerebral oedema

6

Dissection diagnoses?

carotid dissection

7

Red flag symptoms

decreased consciousness
sudden onset
worst headache ever
seizure (or focal neurological deficit)
lack of previous episodes
reduced visual acuity
persistent
worse when lying down/in the morning
FLAWSV symptoms
history of malignancy

8

Why would you check temperature?

check for fever to indicate intracranial infection

9

Why would you check BP

malignant HTN

10

Focal neurological signs

limb deficit
third nerve palsy
sixth nerve palsy
twelfth nerve palsy
Horners sydrome

11

What is the horners syndrome triad?

partial ptosis
anhydrosis
miosis

12

what does exophthalmos suggest?

cavernous sinus thrombosis

13

what does a cloudy cornea or fixed dilated or oval pupil?

acute glaucoma

14

what does optic disc appearance on a fundoscopy suggest?

raised ICP

15

what does scalp tenderness suggest?

temporal arteritis

16

symptoms of temporal arteritis

jaw claudication
headache
scalp tenderness
visual disturbances

17

pathophysiology of temporal arteritis

formation of immune inflammatory granulomas in the tunica media of medium/large arteries

18

management of temporal arteritis

blood test for raised ESR and CRP
high dose corticosteroids
temporal artery biopsy

19

diagnosis criteria of temporal arteritis

3 of the following:
onset of symptoms above 50 years old
new headache
ESR elevated >55mm/hr
clinically abnormal temporal artery - tender or non-pulsatile
biopsy reveals mononuclear cell infiltration or granuloma

20

differentials of non-sinister headaches

tension-type
migraine
sinusitis
medication-overuse
temporomandibular joint dysfunction
trigeminal neuralgia
cluster

21

tension-type

often bi-frontal
no other symptoms
usually lasts no more than a few hours

22

migraine

usually unilateral
associated with aura - sensitivity to sound/light/smell
can last between 4-72 hours
differential for epilepsy and TIAs

23

treatment for migraines

Triptans - sumatriptan
5HT receptor agonists - cerebral vasoconstriction and inhibition of trigeminal nerve transmission

24

sinusitis

facial pain that comes on over hours/days
in conjunction with coryzal symptoms (acute inflammation of the nasal mucus membranes)
headaches last several days - associated with time course of infection

25

medication overuse

very common
resemble cluster or tension-type
seen with migraine medications and analgesic overuse
remove medication for a while to treat

26

TMJ syndrome

most common in 20-40 year olds
dull ache in the muscles of mastication

27

trigeminal neuralgia

very rare
mainly in women ages 60-70
unilateral stabbing, sharp facial pain
attacks only last seconds but have many triggers
attacks rarely occur during sleep

28

cluster

mainly affects men
onset of symptoms occurring in clusters of 6-12 weeks every 1-2 years at exactly the same time every day
pain is focused over one eye
very intense pain
red watery eye, rhinorrhea, horners syndrome

29

Sub-arachnoid haemorrhage

sudden onset, worst headache ever - possibly due to ruptured aneurysm
order CT scan to look for blood in CSF
nimodipine - CCB for management
cerebral angioplasty

30

Brain tumour

persistent headache in the occipital area
fundoscopy reveals optic disc cupping
MRI scan to locate
dexamethasone to reduce inflammation
surgery