Headache in General Practise Flashcards
(36 cards)
How do you diagnose headaches in primary care?
- Good history taking
- Exam the pt well - esp neurologically
- Check for red flags
- Avoid over investigation
What are the 4 C’s of socrates in history taking?
Circumstances
Character
Causes
Co symptoms
What are the questions would you ask in circumstances ?
How long you suffered?
How long it lasted ?
How often ?
How constant ?
Episodic ? When ?
Any pattern ?
Have they changed ?
What are the questions would you ask in character ?
The nature
Site & severity
Pain ? throbbing, stabbing, global, one-sided, neck , back/front of head, band like, facial ?
What are the questions would you ask in causes ?
is there anything that trigger ?
Aggravate or relieving factors ?
Periods
What are the co-symptoms ?
Nausea
Vomiting
Visual
Photophobia
Neurological ?
Is there any different types of headaches between headache
also make sure to ask for ICE
Classify the headaches accordingly to chronically ?
Acute new headache
Acute recurrent headache
Subacute headache
Chronic headache
What are the causes of acute new headache ?
Meningitis
Subarachnoid haemorrhage
Viral UTI
Sinusitis
Dental problems
Tropical illness e.g malaria
What are the causes of acute recurrent headache ?
Migrane
Cluster headache
Exertional headache
Trigeminal headache
glaucoma
What causes subacute headache ?
Temporal artheritis
What causes chronic headache ?
Tension type
Cervicogenic
Medication overuse
Raised intracranial pressure
What would you ask in PMH/Surgical history?
Sinus problems
Dental problem
Migrane
Hypertention / Intracranial bleeding
Recent head injury
Malignancy
HIV
Depression /Mental illness
What would you ask in Social history?
Job
Recent travel
drugs
alcohol
Home situation
Stress with work, bills, relationship
Family problems, children, parents , illness
How would you keep a headache diary?
If the cause is not known yet then keep a headache diary
What would you record on Headache diary ?
Frequency, duration, severity
associated symptoms
Medication used
possible precipitations
Relationship to periods
What are the red flags in headache?
Fever , purpuric rash, meningism ?
- Meningitis
Thunderclap headache
- Subarachnoid headache
Worsening over few weeks or change in chronic headache - SOL
Headache with change in posture, coughing, sneezing, exercise - vomiting ? Increased Intracranial Pressure
Furthermore red flags ?
Are they new onset + h/o , cancer, HIV, immunosuppressant - infection /met
Recent head injury (<3cm ) - Bleed
Any changes in personality, cognition, new neurological defecit - SOL
What are the Atypical aura in migraine?
Motor weakness
double vision
unilateral vision symptoms
Poor balance
Reduced consciousness
What do you look during Inspection of the examination ?
Neuro signs
Rash ? purpura , the glass test
In eyes - look for red, pupils PERLA, Cornea and photophobia
injury
Mood
What do you look during palpation of the examination ?
The temporal area
Tender Scalp
Sinuses for tenderness
Examine the neck to exclude neck pain as a factor
What would you look for in Neuro examination ?
Include Fundi ( papilledema )
Visual acuity
Gait
cranial nerves/ full neuro exam
What would be your investigation ?
Not needed in GP
-If the cause is acute- they’re admitted
-if the cause is serious - they’re referred
-Temporal arteritis - ESR raised
What more investigations would you consider for pts with lethargic, pallor and jaundice?
FBC
U & E
TFT
LFT
What is tension type of headache ?
- 2 % prevelance
- 2 F : 1M
- Pts that present with stress/anxiety
- FH of 40%
- often comes during the day
and gets worse at the end of the day - It lasts few hrs
-it does not disturb sleep
-it also doesn’t affect physical activity
