Flashcards in headache Deck (19)
what are the sinister causes of headache?
- Vascular: subarachnoid haemorrhage, haematoma, cerebellar infarct
- Infection: meningitis, encephalitis
- Vision-threatening: tempora arteritis, acute glaucoma, pituitary apoplexy
- Intracranial pressure (raised) tumour/abscess/cyst, cerebral oedema, hydrocephalus, malignant HT
- Dissection: carotid dissection
what would you use to start characterising headache pain?
what are the "red flags" with a headache?
- dec level of consciousness
- sudden onset, worst headache ever
- seizures or focal neurological deficit
- reduced visual acuity
- persistent headache, worse when lying down, early morning sickness
- progressive and persistent
what basic obs would you carry out?
- altered consciousness
- BP and pulse
what are the different focal neurological signs?
- focal limb deficit (ICP)
- 3rd nerve palsy: ptosis, mydriasis, eye down and out (SAH)
- 6th nerve palsy: convergent squint (mass, raised ICP)
- 12th nerve palsy: tongue deviation (carotid artery dissection)
- Horner's syndrome (carotid artery dissection, cavernous sinus lesion)
what features should you look for in inspection of the eye?
- exophthalmos (cavernous sinus thrombosis)
- cloudy cornea (acute glaucoma)
- optic disc appearance on fundoscopy (papilloedema, raised ICP)
what final other things should you look for?
- dec. visual acuity (acute glaucoma, temporal arteritis)
- scalp tenderness (temporal arteritis)
- meningism (stiff neck, photophobia)
what are the causes of non-sinister headache?
- tension type headache
- medication overuse headache
- temporomandibular joint dysfunction syndrome
- trigeminal neuralgia
- cluster headache
describe tension-type headaches
- very common
- bifrontal pain
- pressure/tightness of the head
- last a few hours, not severely disabling
- no associated symptoms
- stress/fatigue are triggers
- 2x more in women
- aura in 1/3 of sufferers
- throbbing or pulsatile
- sensitivity to light, sound, smell
- 4-72 hours
- facial pain coming on over hours to days
- tight pain
- exacerbated by movement
- last several days, consistent with infection
- moderately severe
describe medication overuse headaches
- seen mostly with migraine medication and analgesics
- resemble migraine/tension types
- overtreatment can actually cause headache
- have to withdraw from treatment
- gets worse first
describe the headache in TMJ syndrome
- dull ache in muslces of mastication
- clicking sound when move jaw
describe the headache in trigeminal neuralgia
- unilateral facial pain
- pain lasts only seconds
- triggered by eating, laughing, talking, touching affected area
describe the pain in cluster headaches
- occurs in clusters for about 6-12 weeks every 1-2yrs
- same time every day/night
- focused over one eye
- red/watery eye
- Horner's syndrome
- disabling headaches
what are the main causes of SAH?
- rupture of arterial aneurysm
- arteriovenous malformations
what is your differential diagnosis for intracranial tumours?
- secondary brain tumours
- primary brain tumours (medulloblastomas, ependymonas)
- extra-axial (meningioma, vestibular schwannoma, pituitary adenomas, prolactinomas)
what are the main symptoms and signs of raised ICP?
- papilloedema (swollen optic disc)
- visual blurring
- Cushing's reflex
- Cushing's peptic ulcer