Headache Flashcards
(78 cards)
Is a headache a symptom or a sign
A symptom
What are some reasons people get headaches?
Structural, pharmacological and psychological
What diagnosis could result after an acute single headache?
Febrile illness, sinusitis First attack of migraine Following a head injury Subarachnoid haemorrhage Meningitis, tumour, drugs, toxins, stroke Thunderclap (sudden onset), low pressure
What diagnosis could result after an dull headache that increases in severity?
Usually benign Overuse of medication (e.g. codeine) Contraceptive pill, hormone replacement therapy Neck disease Temporal arteritis Benign intracranial hypertension Cerebral tumour Cerebral venous sinus thrombosis
What diagnosis could result after an dull headache that is unchanged?
Chronic tension headache
Depressive
What diagnosis could result after recurrent headaches?
Migraine
Cluster headache
Episodic tension headache
Trigeminal or post-herpetic neuralgia
What diagnosis could result after triggered headaches?
Coughing, straining, exertion
Coitus
Food and drink
What are some red flags in headaches?
Acute onset Meningism Systemic symptoms (fever/rash) Neurological symptoms If its better lying down (orthostatic) Strictly unilateral
What are some red flag neurological syptoms?
Visual loss, confusion, seizures, hemiparesis, double vision, 3rd nerve palsy, Horner syndrome, papilloedema
When do patients get double vision?
If any eye muscle isnt working (or any associated nerve
What is 3rd nerve palsy? How does it present
When the patient has a droopy eyelid or a dilated pupil and eye points out
What is Horner syndrome? How does it present
When the sympathetic supply to the eye is affected. Eye is slightly droppy, inopthalmos
How does headache occur with subarachnoid haemorrhage?
Sudden and generalised
They have meningism (stiff neck and dont like light)
How are subarachnoid haemorrhages caused?
Aneurysm ruptre
How fatal are subarachnoid haemorrhages?
50% are fatal
How are subarachnoid haemorrhages treated?
Nimodipine and BP control.
Early neurosurgical assessment to confirm the bleed and establish the cause.
CT brain, lumbar puncture and MRA, angiogram.
How are aneurysms treated?
They used to be clipped or coiled, now they are filled with platinum coils
What is an acute intracerebral bleed? Why does it happen?
A fatal haemorrhage due to coning
What is herniation and coning?
When vol in the brain increases and starts to increase intracranial pressure so that the brain starts to be squeezed out of the skull and starts weeping
What is papilloedema?
When pressure in the brain rises and you can see the retina being pushed outwards
What is a carotid or vertebral artery dissection? How can it cause a stroke?
When the blood vessel tears and the false lumen becomes large causing turbulent flow in the actual lumen. This can cause clotting and stroke so aspirin or anticoag is given
What is temporal arteritis? How does it present?
Constant unilateral headache, scalp tenderness and jaw claudication
How is temporal arteritis diagnosed?
Elevated ESR and CRP
Temporal artery are inflamed and tortuous visible on ultrasound
How is temporal arteritis treated?
High dose steroids and aspirin
