headache history Flashcards
(24 cards)
What are the cardinal symptoms of headaches?
headache syncope seizures falls dizziness / vertigo visual disturbances altered sensation aura
History of subdural haemorrhage
recent head injury
gradual onset headache, either constant or fluctuating
fluctuating levels of consciousness, may have loss of consciousness at time of injury followed by lucid interval followed by subsequent deterioration
more common in elderly and alcoholics
history of extradural haemorrhage
recent head injury
gradual onset headache, either constant or fluctuating
may have lucid interval
more common in young (dura mater less fixed to skull) and alcoholic
history if intracerebral haemorrhage
sudden onset, severe headache
symptoms of raised ICP
focal neurology
Subarachanoid history
sudden onset, severe headache
meningism
drowsiness / LOC
focal neurology
meningitis history
fever rash (non-blanching associated with meningococcal septicaemia) meningism nausea and vomiting drowsiness / LOC
What are the symptoms are meningism?
neck stiffness / photophobia
headache
site of headache
generalised, occipital or temporal
bilateral or unilateral
onset of headache
what doing?
recent head trauma or drug intake?
sudden or come on gradually?
how long to reach peak?
aggravating and relieving factors
what done to relieve the headache?
simple analgesia helped
t
What are common triggers for migraines?
cheese
chocolate
red wine
Associated symptoms and systematic enquiry
neurological history - loss of consciousness, motor or sensory deficit, gait, disturbances in vision, speech, hearing, incontinence meningism fever rashes scalp tenderness when brushing hair or on chewing nausea or vomiting infective symptoms aura before onset of headache watery eyes of nasal congestion use of glasses and last eye test
past medical history
general health hypertension kidney disease TIAs or strokes migraines or tension headaches similar episodes before?
Drug history
regular medications pain relief anticoagulants OCP over the counter allergies
Social history
smoking and alcohol history
occupation
recent stresses that contribute to symptoms
recent contact with meningitis
immediate management of headache
ABCDE
analgesia and anti-emetics
Investigations of suspected intracranial bleed
CT scan
negative does not rule out SAH
lumbar puncture at 12 hours to look for xanthochromia (yellow colour, indicative of Hb breakdown )
spectophotometry to detect bilirubin
investigation of suspected intracranial infection
FBC, U&Es, glucose, coagulation screen, blood cultures and CRP
Lumbar puncture and blood cultures
Only CT in focal neurological signs and raised ICP suspected
CT scan must not delay administration of antibiotics
Features of space occupying lesion
absence of clear diagnosis of headache older age focal neurological symptoms and signs headache on waking vomiting without nausea
Features of temporal arteritis
usually in patients over 60
frontal or occipital
jaw pain, scalp tenderness, visual disturbances
malaise and proximal muscle weakness
Features of cluster headahce
localised around one eye and associated with autonomic features such as lacrimation and nasal congestion
occurs 15mins - 2 hours daily for 6-8 weeks then subsides for months
Features of cervical spondylosis
headache associated with neck pain
worsens with neck movements
Features of migraine
chronic or recurrent headache may have prodrome or aura trigger OCP photophobia and visual disturbance nausea and vomiting family history
features of tension headache
band like dull headache, sometimes with sharp exacerbations
in scalp rather than cranium
last throughout day, worsening in the evening
may get tired or dizzy
